Efficacy of Vaginal 17β-Estradiol on the Urinary Storage Symptoms in Postmenopausal Women
Summary
The goal of this clinical trial is to evaluate whether vaginal 17β-estradiol effectively treats storage symptoms of lower urinary tract symptoms (LUTS) and enhances quality of life. The main questions it aims to answer are: * What is the efficacy of vaginal 17β-estradiol treatment compared to placebo in alleviating storage symptoms of LUTS? * How does vaginal 17β-estradiol treatment affect the urethral maturation index and vaginal pH compared to placebo? * What impact does vaginal 17β-estradiol treatment have on overall quality of life and patients' perception of global improvement (PGI)? Participants in the trial will undergo the following procedures: * Screening procedures at the first visit to exclude correctable causes of LUTS and to complete a bladder diary. * Visit the clinic at 1-2 weeks for a review of the bladder diary and a check-up. Participants will receive the assigned dosage of vaginal 17β-estradiol or placebo: one vaginal tablet daily for two weeks, followed by one vaginal tablet twice a week for 10 weeks. * The third and fourth visits (at 4 and 12 weeks after treatment) will involve: completion of bladder diaries, questionnaires, vaginal pH testing, collection of urethral maturation index (UMI), observation of intervention's side effects and monitoring of LUTS symptoms.
Timeline
- Start
- 2024-04-08
- Primary completion
- 2024-10-22
- Completion
- 2024-10-31
Publications
- Background Tomaszewski J. Postmenopausal overactive bladder. Prz Menopauzalny. 2014 Dec;13(6):313-29. doi: 10.5114/pm.2014.47984. Epub 2014 Dec 30.
- Background Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A; Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003 Jan;61(1):37-49. doi: 10.1016/s0090-4295(02)02243-4. No abstract available.
- Background Weber MA, Kleijn MH, Langendam M, Limpens J, Heineman MJ, Roovers JP. Local Oestrogen for Pelvic Floor Disorders: A Systematic Review. PLoS One. 2015 Sep 18;10(9):e0136265. doi: 10.1371/journal.pone.0136265. eCollection 2015.
- Background Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May;20(6):327-36. doi: 10.1007/s00345-002-0301-4. Epub 2002 Nov 15.
- Background Iosif CS, Batra S, Ek A, Astedt B. Estrogen receptors in the human female lower uninary tract. Am J Obstet Gynecol. 1981 Dec 1;141(7):817-20. doi: 10.1016/0002-9378(81)90710-9.
- Background Chung da J, Bai SW. Roles of sex steroid receptors and cell cycle regulation in pathogenesis of pelvic organ prolapse. Curr Opin Obstet Gynecol. 2006 Oct;18(5):551-4. doi: 10.1097/01.gco.0000242959.63362.1e.
- Background Rud T, Andersson KE, Asmussen M, Hunting A, Ulmsten U. Factors maintaining the intraurethral pressure in women. Invest Urol. 1980 Jan;17(4):343-7.
- Background Matsubara S, Okada H, Shirakawa T, Gotoh A, Kuno T, Kamidono S. Estrogen levels influence beta-3-adrenoceptor-mediated relaxation of the female rat detrusor muscle. Urology. 2002 Apr;59(4):621-5. doi: 10.1016/s0090-4295(01)01583-7.
- Background Shenfeld OZ, McCammon KA, Blackmore PF, Ratz PH. Rapid effects of estrogen and progesterone on tone and spontaneous rhythmic contractions of the rabbit bladder. Urol Res. 1999 Oct;27(5):386-92. doi: 10.1007/s002400050168.
- Background Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, Amarenco G, Game X, Kirby R, Van Der Aa F, Cornu JN. A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. Eur Urol. 2019 Jun;75(6):988-1000. doi: 10.1016/j.eururo.2019.02.038. Epub 2019 Mar 26.
- Background Chen HY, Lin YN, Chen WC, Wang SJ, Chen CJ, Chen YH. Urethral proteomic analysis in ovariectomized mice administered 17beta-oestradiol replacement therapy. J Obstet Gynaecol. 2017 Aug;37(6):757-765. doi: 10.1080/01443615.2017.1292225. Epub 2017 Mar 28.
- Background Johnston SL. Pelvic floor dysfunction in midlife women. Climacteric. 2019 Jun;22(3):270-276. doi: 10.1080/13697137.2019.1568402. Epub 2019 Mar 11.
- Background Benness C, Wise BG, Cutner A, et al. Does low dose vaginal oestradiol improve frequency and urgency in postmenopausal women. Int Urogynaecol J. 1992;3:281.
- Background Eriksen PS, Rasmussen H. Low-dose 17 beta-estradiol vaginal tablets in the treatment of atrophic vaginitis: a double-blind placebo controlled study. Eur J Obstet Gynecol Reprod Biol. 1992 Apr 21;44(2):137-44. doi: 10.1016/0028-2243(92)90059-8.
- Background Pratt TS, Suskind AM. Management of Overactive Bladder in Older Women. Curr Urol Rep. 2018 Sep 10;19(11):92. doi: 10.1007/s11934-018-0845-5.
- Background Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001 Jun;87(9):760-6. doi: 10.1046/j.1464-410x.2001.02228.x.
- Background Titapant V, Ek-anankul W, Chawanpaiboon S. Prevalence of Overactive Bladder Among Nurses at Siriraj Hospital. Siriraj Med J. 2002 Nov. 1;54(11):710-5.
- Background Gormley EA, Lightner DJ, Faraday M, Vasavada SP; American Urological Association; Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015 May;193(5):1572-80. doi: 10.1016/j.juro.2015.01.087. Epub 2015 Jan 23.
- Background Robinson D, Cardozo L. Estrogens and the lower urinary tract. Neurourol Urodyn. 2011 Jun;30(5):754-7. doi: 10.1002/nau.21106.
- Background Artibani W. Complications of surgery for stress incontinence. In: Cardozo L, Staskin L, editors. Textbook of female urology and urogynecology. 2nd ed. Taylor & Francis Ltd; 2007;1345-62.
- Background Cardozo L., Staskin, D. (Eds.). Textbook of Female Urology and Urogynecology: Clinical Perspectives (5th ed.). Boca Raton: CRC Press; 2023
- Background Simunic V, Banovic I, Ciglar S, Jeren L, Pavicic Baldani D, Sprem M. Local estrogen treatment in patients with urogenital symptoms. Int J Gynaecol Obstet. 2003 Aug;82(2):187-97. doi: 10.1016/s0020-7292(03)00200-5.
- Background Cardozo LD, Wise BG, Benness CJ. Vaginal oestradiol for the treatment of lower urinary tract symptoms in postmenopausal women--a double-blind placebo-controlled study. J Obstet Gynaecol. 2001 Jul;21(4):383-5. doi: 10.1080/01443610120059941.
- Background Mostafaei H, Janisch F, Mori K, Quhal F, Pradere B, Hajebrahimi S, Roehrborn CG, Shariat SF. Placebo Response in Patients with Oral Therapy for Overactive Bladder: A Systematic Review and Meta-analysis. Eur Urol Focus. 2022 Jan;8(1):239-252. doi: 10.1016/j.euf.2021.02.005. Epub 2021 Mar 3.
- Background Cardozo L, Rovner E, Wagg A, Wein A, Abrams P. (Eds) Incontinence 7th Edition. Bristol UK: ICI-ICS. International Continence Society. 2023.
- Background Mostafaei H, Mori K, Quhal F, Miura N, Motlagh RS, Pradere B, Laukhtina E, Lysenko I, Ghaffari S, Hajebrahimi S, Shariat SF. Nocebo Response in the Pharmacological Management of Overactive Bladder: A Systematic Review and Meta-analysis. Eur Urol Focus. 2021 Sep;7(5):1143-1156. doi: 10.1016/j.euf.2020.10.010. Epub 2020 Nov 3.
- Background Chattrakulchai K, Manonai J, Silpakit C, Wattanayingcharoenchai R. Validation of the Thai version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Int Urogynecol J. 2020 Dec;31(12):2603-2610. doi: 10.1007/s00192-020-04422-1. Epub 2020 Jul 4.
- Background Kochakarn W, Pummangura N, Kijvikai K, Viseshsindh W, Sukying C, Lertsithichai P. Reliability of a Thai version of King's Health Questionnaire in Thai females with overactive bladder symptoms. J Med Assoc Thai. 2005 Nov;88(11):1526-34.
- Background Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010 May;21(5):523-8. doi: 10.1007/s00192-009-1069-5. Epub 2009 Dec 15.
- Background Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010 Jan;21(1):5-26. doi: 10.1007/s00192-009-0976-9. Epub 2009 Nov 25.
- Background Mension E, Alonso I, Tortajada M, Matas I, Gomez S, Ribera L, Ros C, Angles-Acedo S, Castelo-Branco C. Genitourinary Syndrome of Menopause Assessment Tools. J Midlife Health. 2021 Apr-Jun;12(2):99-102. doi: 10.4103/jmh.jmh_93_21. Epub 2021 Jul 27.
- Background Notelovitz M. Estrogen therapy in the management of problems associated with urogenital ageing: a simple diagnostic test and the effect of the route of hormone administration. Maturitas. 1995 Dec;22 Suppl:S31-3. doi: 10.1016/0378-5122(95)00960-4.
- Background Manonai J. Management of Female Urogenital Atrophy. 1st ed. Bangkok: Ramathibodi Press; 2014:52-3.
- Background Manonai J, Seif C, Bohler G, Junemann KP. The effect of Pueraria mirifica on cytologic and urodynamic findings in ovariectomized rats. Menopause. 2009 Mar-Apr;16(2):350-6. doi: 10.1097/gme.0b013e318188b279.
- Background Bergman A, Karram MM, Bhatia NN. Changes in urethral cytology following estrogen administration. Gynecol Obstet Invest. 1990;29(3):211-3. doi: 10.1159/000293384.
- Background Simon JA, Reape KZ, Wininger S, Hait H. Randomized, multicenter, double-blind, placebo-controlled trial to evaluate the efficacy and safety of synthetic conjugated estrogens B for the treatment of vulvovaginal atrophy in healthy postmenopausal women. Fertil Steril. 2008 Oct;90(4):1132-8. doi: 10.1016/j.fertnstert.2007.07.1359. Epub 2007 Dec 3.
- Background Meisels A. The maturation value. Acta Cytol. 1967 Jul-Aug;11(4):249. No abstract available.
- Background Brunzel NA. Fundamentals of Urine and Body Fluid Analysis. 4 th ed. St.Loius: Elsevier; 2018.
- Background Simon J, Nachtigall L, Gut R, Lang E, Archer DF, Utian W. Effective treatment of vaginal atrophy with an ultra-low-dose estradiol vaginal tablet. Obstet Gynecol. 2008 Nov;112(5):1053-60. doi: 10.1097/AOG.0b013e31818aa7c3.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | 17-beta estradiol | Unknown | 10 ug | Other |