Estrogen for Treatment of Recurrent UTIs

Why do I need vaginal estrogen before surgery?

Vaginal estrogen in cream or pill form is often prescribed to post-menopausal women before vaginal surgeries. Estrogen is a hormone made predominantly by the ovaries. Under the influence of estrogen, the vaginal lining has a thicker cellular wall. When estrogen production decreases around the time of menopause, this results in a thinning (atrophy) of the vaginal lining. Pelvic organ prolapse, including cystocele, rectocele, enterocele and uterine prolapse, can also stretch out the vaginal lining as the organs sag, further thinning out the vaginal tissue. Supplemental estrogen applied intravaginally (inside the vagina) works locally to enhance the health of the tissue and to thicken the previously thinned out vagina. The result is healthier vaginal tissue, similar to its premenopausal state. Why is this important? For optimal post-surgical results, we want a thick, healthy vaginal tissue that will successfully heal over the surgical site. We utilize estrogen before surgery in post-menopausal women who are planning to undergo vaginal prolapse repair, da Vinci robotic prolapse repair or a mid-urethral sling. With vaginal application, there is minimal systemic absorption resulting in a lower side effect profile and associated risks. Patients are advised to use the estrogen until surgery and then resume the medication after surgery. Post operatively, we usually advise patients to continue the medication for at least 6 weeks, to improve healing. The vaginal estrogen also works to decrease the risk of urinary tract infections and to enhance lubrication for intercourse. Women who have a history of recurrent urinary tract infections will often be advised to continue the medication long term, to reduce the risk of developing an infection. Women who experience pain with intercourse due to vaginal dryness with intercourse will often choose to stay on vaginal estrogen supplementation long term to alleviate these symptoms.