Weber M A, Kleijn M H, Langendam M, Limpens J, Heineman M J, Roovers J P
Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands.
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands.
PLoS One. 2015 Sep 18;10(9):e0136265. doi: 10.1371/journal.pone.0136265. eCollection 2015.
The decline in available oestrogen after menopause is a possible etiological factor in pelvic floor disorders like vaginal atrophy (VA), urinary incontinence (UI), overactive bladder (OAB) and pelvic organ prolapse (POP). This systematic review will examine the evidence for local oestrogen therapy in the treatment of these pelvic floor disorders.
We performed a systematic search in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the non-MEDLINE subset of PubMed from inception to May 2014. We searched for local oestrogens and VA (I), UI/OAB (II) and POP (III). Part I was combined with broad methodological filters for randomized controlled trials (RCTs) and secondary evidence. For part I and II two reviewers independently selected RCTs evaluating the effect of topical oestrogens on symptoms and signs of VA and UI/OAB. In part III all studies of topical oestrogen therapy in the treatment of POP were selected. Data extraction and the assessment of risk of bias using the Cochrane Risk of Bias Tool was undertaken independently by two reviewers.
The included studies varied in ways of topical application, types of oestrogen, dosage and treatment durations. Objective and subjective outcomes were assessed by a variety of measures. Overall, subjective and urodynamic outcomes, vaginal maturation and vaginal pH changed in favor of vaginal oestrogens compared to placebo. No obvious differences between different application methods were revealed. Low doses already seemed to have a beneficial effect. Studies evaluating the effect of topical oestrogen in women with POP are scarce and mainly assessed symptoms and signs associated with VA instead of POP symptoms.
Topical oestrogen administration is effective for the treatment of VA and seems to decrease complaints of OAB and UI. The potential for local oestrogens in the prevention as well as treatment of POP needs further research.
绝经后可用雌激素的减少是盆底功能障碍（如阴道萎缩（VA）、尿失禁（UI）、膀胱过度活动症（OAB）和盆腔器官脱垂（POP））的一个可能病因。本系统评价将审视局部雌激素治疗这些盆底功能障碍的证据。
我们在MEDLINE、EMBASE、Cochrane对照试验中央注册库以及PubMed的非MEDLINE子集中进行了从建库至2014年5月的系统检索。我们检索了局部雌激素与VA（I）、UI/OAB（II）和POP（III）。第一部分结合了针对随机对照试验（RCT）和二级证据的广泛方法学筛选标准。对于第一部分和第二部分，两名评价员独立选择评估局部雌激素对VA和UI/OAB症状及体征影响的RCT。在第三部分，选取了所有局部雌激素治疗POP的研究。两名评价员独立进行数据提取并使用Cochrane偏倚风险工具评估偏倚风险。
纳入研究在局部应用方式、雌激素类型、剂量和治疗持续时间方面存在差异。客观和主观结局通过多种测量方法进行评估。总体而言，与安慰剂相比，主观和尿动力学结局、阴道成熟度及阴道pH值的变化有利于阴道雌激素。未发现不同应用方法之间存在明显差异。低剂量似乎已产生有益效果。评估局部雌激素对POP女性影响的研究较少，且主要评估与VA相关的症状和体征而非POP症状。
局部应用雌激素对VA治疗有效，似乎还能减少OAB和UI的主诉。局部雌激素在预防和治疗POP方面的潜力需要进一步研究。
Zotero 插件
