Pelvic organ prolapse (POP) is the herniation of pelvic organs into or beyond the vaginal
walls and is a common health problem that affects daily activities and sexual function.
Its negative impact on women's quality of life has been the subject of clinical research
all over the world due to the economic burden it brings to the healthcare system.
The use of different classification systems for diagnosis and the fact that many women
with mild prolapse are asymptomatic make it difficult to determine the exact prevalence
of pelvic organ prolapse. Among women aged 50-79, the prevalence is 41% and the lifetime
risk of prolapse surgery is 11%. This risk is expected to increase in the future.
Advancing age and postmenopausal status are known risk factors for pelvic organ prolapse.
Since estradiol receptors alpha and beta (ESR1/2) are found in the squamous epithelium of
the bladder, urethra, vagina, and pelvic floor muscles, it is evident that the pelvic
organs and their surrounding muscle and connective tissue are sensitive to estrogen and
that menopause is an important risk factor for the development of pelvic organ prolapse.
The decline in estrogen during the postmenopausal period contributes not only to symptoms
of pelvic organ prolapse but also to other pelvic floor disorders, including vulvovaginal
atrophy, stress urinary incontinence (SUI), urge urinary incontinence (UUI), sexual
dysfunction, and dyspareunia.
Studies show that estrogen levels have a significant impact on the function of the
genital and lower urinary tract. Estrogen regulates the function of the vascular smooth
muscles in the vaginal wall, affecting vaginal wall perfusion and smooth muscle tone. It
also regulates bladder smooth muscle contractility, cellular and extracellular
composition, and nerve density.
Local estrogen therapy (LET) works by increasing vaginal tissue blood flow, epithelial
thickening, increased epithelial secretion and decrease in vaginal pH. From a
physiological and psychosocial perspective, women using estrogen therapy describe
positive effects such as normalization of sexual function, increased quality of life,
improvement in relationships with their spouses, feeling 'less old', higher self-esteem
and having a better social life.
In recent years, local estrogen therapy has become the focus of treatment of pelvic floor
disorders. Various conservative and surgical methods have been described in the treatment
of pelvic organ prolapse. Conservative treatment methods include topical estrogen. Among
the surgical approaches, many vaginal and abdominal methods with or without graft
material have been described. Surgical methods are mostly preferred in treatment.
The primary goal of POP surgery is to reduce symptoms and improve health-related quality
of life. However, despite the continuous evolution in current surgical techniques,
recurrence of symptoms is common. It is important to find ways to improve pelvic organ
prolapse surgery outcomes. It is unclear whether preoperative LET is beneficial. Ismail
and colleagues concluded in a Cochrane systematic review that further studies with
long-term follow-up are needed to evaluate the effects of estrogen preparations before
prolapse surgery.
The aim of this study is to evaluate the effects of preoperative local estriol
application on the vaginal tissues and the effects of preoperative local estriol
application on early postoperative period pelvic floor functions, satisfaction with the
surgery and vaginal health in postmenopausal women planned for vaginal repair surgery.
As a result, steroid receptors (ER, PR, AR), immune cell types and distribution, CD34 and
vascular endothelial density, collagen fiber density, S100 in the anterior and/or
posterior vaginal wall in patients with and without local estriol treatment before
colporrhaphy anterior and/or posterior. The difference in nerve fiber density and
epithelial maturation index levels will be investigated. In addition, the Pelvic Floor
Distress Inventory (PFDI-20), which is valid in Turkish, Pelvic Floor Impact
Questionnaire (PFIQ-7), Patient General Impression of Improvement (PGI-I) and VAS scoring
and early postoperative pelvic floor functions were evaluated in the study and control
groups before and after surgery. and patient satisfaction regarding the surgery will be
compared. There will also be comparisons between the pre-surgical study and control group
through the vaginal health index (VHI), which is a quantitative assessment of vaginal
health. Follow-ups are planned to be carried out with the patients' routine check-up
visits to the hospital.