Vaginal Estrogen for Improvement of Outcomes Following Pelvic Organ Prolapse Surgery

NCT ID: NCT07030426

Last Updated: 2025-06-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

180 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-01

Study Completion Date

2029-09-30

Brief Summary

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This open-label randomized control trial will study the use of vaginal estrogen in the first six weeks after pelvic organ prolapse (POP) repair surgery. This is a pilot trial that will examine the feasibility of the study, focussing on recruitment rates. Participants will be randomized to one of three groups; (1) no vaginal estrogen for 6 weeks, (2) vaginal estrogen twice weekly for 6 weeks, or (3) vaginal estrogen daily for 6 weeks. Participants will be seen at 6 weeks post surgery, 6 months post surgery, 1 year and 2 years post surgery. Additional outcomes will include patient satisfaction, Genitourinary Syndrome of Menopause (GSM) symptoms, post-operative complications, adherence and safety.

Detailed Description

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Multi-center, randomized, open-label, parallel-group, feasibility-controlled trial

The intervention is the use of vaginal estrogen for 6 weeks after pelvic organ prolapse surgery. Participants will be randomized into 3 groups:

1. No vaginal estrogen
2. Vaginal estrogen 2 times per week
3. Vaginal estrogen daily

Participants may be enrolled after diagnosis of pelvic organ prolapse and decision to proceed with surgery. Participants will be seen for a randomization visit within 6 weeks of their scheduled surgery. The intervention lasts from the day of surgery until 6 weeks after surgery. Participants will be seen for a post-operative follow-up visit at 6 weeks, and study follow-up visits at 6 months, 1 year and 2 years.

Sample Size: N=60 in each group, for a total of N=180 participants. For this pilot trial, we will recruit approximately 15% of the sample size required for the full-scale trial. Data from this pilot trial will be used to adjust the event rate in the sample size calculation for the full trial, if needed. Our sample size accounts for a non-compliance rate of 5% and a loss to follow-up rate of 5%.

After enrollment, participants will complete a baseline questionnaire that collects information on demographics and health history. This may be completed online via an email link sent through REDCap, in person on a hard copy questionnaire, or the questions can be administered verbally by study staff.

After enrollment, a study investigator or delegate will complete a case report for that collects additional information on the participant's pregnancy and pelvic health history.

At each study visit, a study investigator or delegate will complete a case report form that captures any changes in the participant's health history since the previous visit.

At all post-surgical visits, a study investigator or delegate will collect information in these same case report forms on complications and treatment failure. The questions in these case report forms will be administered verbally, with verification through chart review as appropriate or as needed.

At each study visit a Pelvic Organ Prolapse Quantification (POP-Q) and Visual Analog Scale (VAS) on GSM symptoms assessment will be completed by a study investigator or medical learner under direct supervision of a study investigator. As well, height, weight and blood pressure will be measured. If any of these are collected/done for clinical reasons at the same visit, the clinically collected data will be used for study purposes. The measurements and assessments will not be repeated for study purposes.

At each study visit the Prolapse Quality of Life Questionnaire (P-QOL) and incontinence questionnaires including the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Incontinence Impact Questionnaire Short Form (IIQ-7), and the Urogenital Distress Inventory Short Form (UDI-6) will be administered. These may be completed online via an email link sent through REDCap, in person on a hard copy questionnaire, or the questions can be administered verbally by study staff.

At the 6 week and 6 month post-surgical visit the Surgical Satisfaction Questionnaire (SSQ-8) will be administered. These may be completed online via an email link sent through REDCap, in person on a hard copy questionnaire, or the questions can be administered verbally by study staff.

At the 6 week post-surgical visit adherence to the study intervention will be assessed through collection of study product diaries and by querying participants on vaginal estrogen usage in the intervention period.

Conditions

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Pelvic Organ Prolapse (POP)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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No Vaginal Estrogen Group

No vaginal estrogen

Group Type NO_INTERVENTION

No interventions assigned to this group

Twice Weekly Vaginal Estrogen Group

Twice Weekly Vaginal Estrogen

Group Type ACTIVE_COMPARATOR

Vaginal Estrogen - Twice Weekly

Intervention Type DRUG

Twice weekly for six weeks following pelvic organ prolapse repair surgery. 0.5 grams of cream per vagina at bedtime .

Daily Vaginal Estrogen Group

Daily Vaginal Estrogen

Group Type ACTIVE_COMPARATOR

Vaginal Estrogen - Daily

Intervention Type DRUG

Daily for six weeks following pelvic organ prolapse repair surgery. 0.5 grams of cream per vagina at bedtime.

Interventions

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Vaginal Estrogen - Twice Weekly

Twice weekly for six weeks following pelvic organ prolapse repair surgery. 0.5 grams of cream per vagina at bedtime .

Intervention Type DRUG

Vaginal Estrogen - Daily

Daily for six weeks following pelvic organ prolapse repair surgery. 0.5 grams of cream per vagina at bedtime.

Intervention Type DRUG

Other Intervention Names

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Conjugated Estrogens CSD, 0.625 mg/g, Vaginal Cream Conjugated Estrogens CSD, 0.625 mg/g, Vaginal Cream

Eligibility Criteria

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Inclusion Criteria

1. Participant who, in the opinion of the investigator, can and will comply with the requirements of the protocol.
2. The participant has given written consent after the study has been explained according to local regulatory requirements and before any study specific procedures.
3. Age ≥18 years at the time of consent.
4. Undergoing an apical suspension (vaginal or abdominal, mesh or native tissue) for pelvic organ prolapse at one of the participating centers.
5. Primary or recurrent prolapse surgery without a history of mesh surgery.
6. Willing to complete surveys related to demographics, pelvic health and function, and sexual health and function.
7. Plans to reside in the study area for at least 2 years after their surgery.

Exclusion Criteria

Any individual meeting any of the following criteria is not eligible for participation in this study:

1. Participant undergoing anterior and/or posterior repair only (no apical prolapse repair).
2. Participant undergoing obliterative procedures.
3. Participant with a history of mesh surgery for prolapse.
4. Participant undergoing uterine sparing surgery.
5. Participant with a contraindication to vaginal estrogen use, including but not limited to the following list, at the discretion of the study investigator:

* Patients who are hypersensitive to the drug or to any ingredient in the formulation or component of the container.
* Liver dysfunction or disease as long as liver function tests have failed to return to normal.
* Known or suspected estrogen-dependent malignant neoplasia (e.g. endometrial cancer).
* Endometrial hyperplasia.
* Known, suspected, or past history of breast cancer.
* Undiagnosed abnormal genital bleeding.
* Known or suspected pregnancy
* Active or past history of arterial thromboembolic disease (e.g. stroke, myocardial infarction, coronary heart disease).
* Partial or complete loss of vision due to ophthalmic vascular disease.
* Known thrombophilic disorders (e.g., protein C, protein S OR antithrombin deficiency); prothrombin mutation or anticardiolipin antibodies).
6. Any conditions that, in the Investigator's judgement, may interfere with participant's ability to comply with study procedures or receipt of care, such as behavioral or cognitive impairment or neuropsychiatric illness.
7. Concurrently participating in another clinical study, at any time during the study period, in which the participant has been or will be exposed to an investigational or a non-investigational vaccine/product.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Queen's University

OTHER

Sponsor Role lead

Responsible Party

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Sarah Wozney

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sarah Wozney, MD, MScHQ

Role: PRINCIPAL_INVESTIGATOR

Queen's University

Locations

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Health Sciences Centre

St. John's, Newfoundland and Labrador, Canada

Site Status

Kingston Health Sciences Centre

Kingston, Ontario, Canada

Site Status

Countries

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Canada

Central Contacts

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Jessca Pudwell, MPH, MSc

Role: CONTACT

613-549-6666 ext. 3937

Kira King

Role: CONTACT

613-549-6666 ext. 2740

Facility Contacts

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Jessica Pudwell, MPH, MSc

Role: primary

613-549-6666 ext. 3937

Kira King

Role: backup

613-549-6666 ext. 2740

Other Identifiers

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Ref: No 70577

Identifier Type: -

Identifier Source: org_study_id

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