SANTA FE, N.M. — Vaginal estrogen should always be prescribed to menopausal women undergoing pelvic or urogynecologic surgery, Marvin H. Terry Grody, M.D., advised at a conference on gynecologic surgery sponsored by Omnia Education.
Estrogen therapy is essential to preserve the strength and elasticity of connective tissue and, ultimately, to extend the success of reconstructive surgery, according to Dr. Grody of Robert Wood Johnson Medical School in Camden, NJ.
“The pelvis is full of estrogen receptors going all the way from the urethra to the anus and extending unquestionably into the ligament supports of the pelvis that suspend the vault [and] suspend the uterus and the cervix, and the anterior and posterior upper reaches of the vagina,” he said. “Why are estrogen receptors there? They have a purpose, and to make our operations work, they ought to be fulfilled.”
Endometrial cancer is not usually a concern when preoperative estrogen is prescribed, according to Dr. Grody, given that in these surgeries, the uterus has often been or will be removed. Possible cardiovascular and breast cancer effects are a worry to women as well as to physicians, however, and he warned that oral estrogen might elicit medical and/or legal concerns.
“The only way I see that we can handle this and play it safe for both the patient and ourselves is to use vaginal estrogen in one form or another in an appropriate dosage,” Dr. Grody noted.
Vaginal cream, pulvules, and tablets are each an option, he said, citing a Duke University study that found half a gram of Premarin cream three times a week produced adequate effects in the pelvis without systemic distribution (Obstet. Gynecol. 1994;84:215–8).
Dr. Grody recommended starting vaginal estrogen at least 6 weeks before surgery and urging the patient to stay on vaginal estrogen for the rest of her life.”