Can estrogen help a prolapse?
Why would a doctor recommend estrogen for a prolapse?
I don’t feel comfortable taking estrogen…is there an alternative?
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The Research on Estrogen for Pelvic Organ Prolapse:
First and foremost, let’s be clear on the research. Much of the research on prolapse and estrogen focuses on menopausal prolapse and not postpartum. I have my fingers crossed this changes in the next 5-10 years but right now we have to look at the information available.
So…how are menopause and postpartum prolapse similar? It’s all about estrogen. During menopause estrogen levels naturally decrease. During the postpartum period, if a person is breastfeeding they also have low levels of estrogen. This is a NORMAL change in response to postpartum breastfeeding. If a person is menstruating, they have two phases when estrogen is the lowest - during menstruation and again immediately after ovulation.
Effects of Estrogen on vagina, vulva and pelvic floor
You might be thinking, what exactly does estrogen have to do with my vulva and vagina? Here are the signs/symptoms of decreased estrogen in relation to the vulva and vagina:
*Vagial dryness
*Vaginal itching
*Vaginal burning (with or without urination)
*Urinary urgency (you have to go NOW)
*Frequent urination
*Recurrent urinary tract infections
*Thinning of vaginal tissue
*Discomfort during sex
*Need for more lubrication (through increased foreplay or lubrication)
Along with the effects estrogen has on the pelvic floor tissues, estrogen also affects the pelvic floor muscles and ligaments including:
*Decreased risk of osteoporosis including all pelvic bones
*Increased muscle mass and strength - ability to increase pelvic floor muscle strength
*Increases collagen production of Type I and Type III connective tissue (Type III connective tissue surrounds the urethra allowing you to control the flow of urine
*Increases wound healing
*Improves skin elasticity
Benefits of Estrogen on prolapse, vagina and vulva
When we look at the effects estrogen has locally to the pelvic floor, it is no wonder why estrogen is frequently recommended. In addition to the effects above, benefits of estrogen include:
*Improves symptoms of decreased estrogen
*Decreases sensation of overactive bladder and urinary incontinence
*Decreases risk of osteoporosis
*Decrease in risk of heart attack
Types of Estrogen for Prolapse
To say that estrogen is strong is an understatement and it is equally important to look at the different types of estrogen as each of them are uniquely beneficial on their own.
*Vaginal estrogen cream: This is a cream you can apply directly to your vulva and vagina. The benefit of vaginal estrogen cream is that it is an effective way to increase estrogen levels in a local area. The benefit of estrogen cream is that you can control how much estrogen you get and you can change the frequency of how often you use it. Some people benefit from daily cream for 2-4 weeks while others do well with application every 1-3 days for months…the key is to find what works for you.
*Vaginal estrogen ring: This is a convenient option that is similar to cream but your provider will insert a flexible ring in the upper portion of your vagina and it will slowly release estrogen over a 3 month time period. The main downside to the ring is that you can’t control the amount of estrogen you receive from day-to-day.
Risks of Estrogen Supplemention for Prolapse
If you’re anything like me, you’ve heard all about the risks of hormone therapy. I have to admit, when I first heard about the risks I thought there was no possibility I would ever recommend it to a patient or loved one. So I’m going to call out the elephant in the room. All estrogen, whether it is produced by the body or given topically, can cause breast and endometrial cancer. With that being said, the risk is about 1/1000 women per year for those taking estrogen + progestin and that increase doesn’t start until after three years of use. This is the same increase in breast cancer rate as someone who drinks one glass of wine per day. To date, no research supports that short term topical estrogen use increases the risk of cancer in people who have not previously had cancer. The (very big) catch to this is if you have hormone receptor positive cancer as the risk of recurrence is higher with estrogen use and unfortunately the research isn’t clear for those who had hormone receptor negative cancer as to whether the risk is the same or slightly higher.
Now that the elephant has been called out, let’s discuss the other risks of estrogen therapy which includes:
*Weight gain
*Fluid retention
*Nausea
*Headaches
*Breast tenderness
*Increased risk of blood clots - there is an increase, although rare and this risk decreases with topical estrogen as opposed to oral hormone replacement therapy
BRAIN for Estrogen and Prolapse
One beautiful thing about medicine is that there is NEVER a one-size fits all approach. We always have to weigh individual benefits, risks, alternatives as well as intuition and what would happen if we do nothing. This changes based on your history, your fears, your concerns and your body. If you decide that estrogen is not something you feel comfortable utilizing, there are alternatives.
Alternatives to Topical Vaginal Estrogen for Prolapse:
*Vaginal moisturizers: Replens
*Vitamin E suppository (little risk reported with Vitamin E use)
*Hyaluronic Acid (little risk reported with use)
*Sea Buckthorn oil (additional risk includes joint pain and stomach issues)
Natural Alternatives to Estrogen for Prolapse
If you decide estrogen isn’t something you feel comfortable supplementing, there are other ways to increase estrogen. The key here is to work with a functional medicine provider to help optimize your entire body and not just your pelvic floor. Diets with increased plant estrogens (phytoestrogens) can improve pelvic floor dryness but it’s important to make sure all nutrients are optimized. While it’s easy to guess what supplements might benefit your pelvic floor (Vitamin A, E, beta carotene, B-vitamins and omega-3 fatty acids have all been shown to improve estrogen levels), the key is to finding someone who can help you find out exactly what supplements and diet changes will help your body.
Now, one of the most important things I want to let you know is that there are things you can do to increase your estrogen levels, even if you’re on a budget and can’t afford topical estrogen or one of its substitutes or a functional medicine provider and supplements.
*30 minutes of exercise daily can increase your levels of estrogen
*Sex (and orgasm) can increase blood flow and estrogen levels in the pelvic floor (yes, I am recommending sex to improve pelvic floor pain)
*Sleep: This can be a vicious little cycle but it is important to get sleep as not sleeping well can cause cortisol levels to increase and decreases estrogen levels. In return, estrogen affects our sleep-wake cycle and helps us sleep better at night...and low estrogen can cause insomnia. It is important to try and not disrupt your sleep in order to get a more peaceful and restful sleep.
So you decided to take estrogen….now what?
Some providers recommend estrogen and that is that. I believe it is important to look at you as a whole during this time. Estrogen PLUS a pessary, muscle training, strength training, nutrition, sleep and exercise will have a far better outcome than any topical cream alone.