Benefit and safety of 28-day transdermal estrogen regimen during vaginal hysterectomy (a controlled trial)

Abstract

Objectives: Assessment of benefit and safety of 28-day transdermal 17-beta estradiol regimen during vaginal hysterectomy.

Methods: Two-hundred and sixty-nine postmenopausal women, undergoing vaginal hysterectomy were divided into: transdermal estrogen hormone replacement therapy (TEHRT) group (n=119) with 28-day transdermal 17-beta estradiol 50 mg/day, 14 days before and after operation; and vaginal estrogen hormone replacement therapy (VEHRT) group (n=150) with 14-day preoperative vaginal conjugated estrogen 0.625 mg/day. The effect on: endometrium, wound healing, infection, recurrent organ prolapse were evaluated.

Results: Pain symptoms, vaginal fetid discharge, swelling, crusting (p<0.001); visible wound opening on the 4 week control (p<0.01); patient assessment of outcome (p<0.001) were in favor of TEHRT. On the fifth postoperative day, VEHRT group showed: higher leukocytes increase (p<0.01); more patients with leukocytes count higher than 15x10(9) L(-1) (p<0.001) and afternoon body temperature higher than 38 degrees C (p<0.01). On the last follow-up control (VEHRT--28.3 months and TEHRT--24.5 months) TEHRT group had more patients with stage 0 of the apical segment (p<0.05). Point C was higher and total vaginal length longer in TEHRT group (p<0.01; p<0.05). Frequency, constipation, painful coitus, incontinence during intercourse were more frequent in VEHRT (p<0.001; p<0.05; p<0.05; p<0.05). Endometrium with a thickness between 2 and 4 mm, was more frequent in the TEHRT group (p<0.05). There were no significant differences in occurrence of more thickened endometrium and more significant morphological changes (endometrial polyp, simplex hyperplasia) between the groups. In none of the patients from the both study groups complex hyperplasia, atypical hyperplasia or endometrial carcinoma were observed.

Conclusions: The 28-day transdermal 17-beta estradiol regimen seems to be safe and effective procedure.