A randomized clinical trial of the impact of local estrogen on postoperative tissue quality after vaginal reconstructive surgery

Female Pelvic Med Reconstr Surg. 2012 Jul-Aug;18(4):211-5. doi: 10.1097/SPV.0b013e31825e6401.


Objective: To evaluate the use and effect of early administration of vaginal estrogen via a continuous low-dose estradiol vaginal ring placed immediately after pelvic reconstructive surgery.

Methods: This was a randomized controlled trial of 65 postmenopausal women undergoing vaginal reconstructive surgery. The subjects were randomly assigned to receive an estradiol-releasing vaginal ring, placebo vaginal ring, or control without vaginal ring for 12 weeks immediately after vaginal reconstructive surgery. The primary outcome was tissue quality based on vaginal maturation 3 months postoperatively. Secondary outcome measures were subjective and objective signs of atrophy; vaginal pH; the presence of granulation tissue, microscopic inflammation, and major healing abnormalities; and the ability to tolerate an intravaginal ring.

Results: At 12 weeks, the estradiol ring group had a significantly improved maturation value (P<0.01) and objective atrophy assessment (P<0.01) compared with the placebo ring and control arms. Granulation tissue was increased in the placebo ring arm (P<0.01). Subjective atrophy scores did not differ among the groups (P=0.39).

Conclusions: Early administration of vaginal estrogen after vaginal surgery via an estradiol-releasing ring is feasible and results in improved markers of tissue quality postoperatively compared to placebo and controls.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Intravaginal
  • Aged
  • Atrophy / etiology
  • Atrophy / pathology
  • Atrophy / prevention & control
  • Cohort Studies
  • Contraceptive Devices, Female
  • Estradiol / administration & dosage*
  • Estrogens / administration & dosage*
  • Feasibility Studies
  • Female
  • Granulation Tissue / drug effects
  • Humans
  • Middle Aged
  • Pelvic Organ Prolapse / pathology
  • Pelvic Organ Prolapse / surgery*
  • Postoperative Care*
  • Treatment Outcome
  • Vagina / drug effects*
  • Vagina / pathology*
  • Vagina / surgery
  • Wound Healing / drug effects


  • Estrogens
  • Estradiol