Impact of Vaginal Estrogen in the Treatment of Symptomatic Mild Pelvic Organ Prolapse With Pelvic Floor Physical Therapy
Overview
- Phase
- Not Applicable
- Intervention
- Vaginal estrogen
- Conditions
- Pelvic Organ Prolapse
- Sponsor
- Pamela Moalli
- Enrollment
- 53
- Locations
- 1
- Primary Endpoint
- Patient Global Impression of Improvement
- Status
- Recruiting
- Last Updated
- 3 years ago
Overview
Brief Summary
This is a randomized controlled trial in which women with symptomatic mild pelvic organ prolapse undergoing Pelvic Floor Physical Therapy (PFPT) receive vaginal estrogen versus placebo to see if a combined approach to treatment leads to improvement in clinical outcomes. The investigators predict that PFPT in combination with vaginal estrogen will lead to decreased pelvic floor symptoms and improved anatomical support corroborated by biomarker data.
Detailed Description
The pathogenesis of pelvic organ prolapse (POP) is unknown. Few studies have correlated patient symptoms and amount of prolapse with biomarkers. POP has traditionally been managed with a pessary or surgery. Recent studies suggest a reduction in POP symptoms following Pelvic Floor Physical Therapy (PFPT). Vaginally delivered hormones are also commonly used to treat prolapse symptoms, with little evidence supporting a clinical benefit. The investigators hypothesize that the optimal approach to improving prolapse symptoms in the patient with mild prolapse requires re-alignment and strengthening of levator muscles via PFPT, and optimization of tissue integrity via local estrogen therapy. The investigators propose to test this hypothesis in a randomized controlled trial in which women with symptomatic mild prolapse opting for PFPT, receive treatment with PFPT in combination with vaginal estrogen versus placebo. The investigators predict that the combined approach will lead to decreased symptoms and improved anatomical support corroborated by biomarker data.
Investigators
Pamela Moalli
Associate Professor
University of Pittsburgh
Eligibility Criteria
Inclusion Criteria
- •Women in good health aged 40-80
- •Has symptoms of pelvic organ prolapse; answers yes to at least 1 of the following questions:
- •Do you feel or see a vaginal bulge? Do you feel pressure in the vagina?
- •Meets POP-Q criteria on exam for stage I, II, or III prolapse
- •Interested in PFPT for management of POP
- •Normal mammogram within 1 year of enrollment
Exclusion Criteria
- •Prior surgery for prolapse or incontinence
- •Other prior interventions for prolapse (e.g. pessary, PFPT)
- •Previous bilateral salpingo-oophorectomy (women with 1 ovary will be eligible)
- •Known liver dysfunction
- •Connective tissue diseases known to affect collagen or elastin remodeling (including: Lupus, Rheumatoid Arthritis, Scleroderma, Sjogrens syndrome, Marfan syndrome, and Ehlers-Danlos syndrome)
- •Unevaluated abnormal vaginal bleeding or abnormal pap smear in the previous year
- •BMI \> 35 kg/m2
- •Estrogen therapy (including birth control) in the previous year
- •Current or prior breast or pelvic malignancy (ovarian, tubal, uterine, cervical or vaginal)
- •Contraindication to hormone use (i.e. thromboembolic disorder, use of anti-coagulants, coronary artery disease, history of stroke)
Arms & Interventions
Vaginal estrogen
Patients in the experimental group will receive vaginal estrogen cream
Intervention: Vaginal estrogen
Placebo cream
Patients in the comparison group will receive placebo vaginal cream
Intervention: Placebo
Outcomes
Primary Outcomes
Patient Global Impression of Improvement
Time Frame: 6 months after starting vaginal cream
The Patient Global Impression of Improvement (PGI-I) is a global index that may be used to rate the response of a condition to a therapy (transition scale). It is a simple, direct, easy to use scale that is intuitively understandable to clinicians. Potential Responses: 1. Very Much Better 2. Much Better 3. A Little Better 4. No Change 5, A Little Worse 6. Much Worse 7. Very Much Worse Lower scores indicate more imiprovment / better outcome.
Secondary Outcomes
- Pelvic Floor Symptoms(6 months)
- General Quality of Life(6 months)
- Pelvic Organ Prolapse Stage(6 months)
- Collagenase Activity(6 months)
- Sexual Function(6 months)