Oestradiol-releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms

Objectives To assess the efficacy of an oestradiol-releasing vaginal ring and oestriol pessaries in the alleviation of Lower urinary tract symptoms occurring after the menopause. Design Randomised, parallel group, controlled trial. Setting Twenty-six clinics of practising gynaecologists and one outpatient clinic at a department of obstetrics and gynaecology. Population Two hundred and fifty-one postmenopausal women; with a mean age of 66 years, reporting at least one bothersome lower urinary tract symptom. Methods One hundred and thirty-four women were treated with the oestradiol-releasing ring for 24 weeks; 117 women were treated with oestriol pessaries 0.5 mg every second day for 24 weeks. Main outcome measures Subjective scores of urgency, frequency, nocturia, dysuria, stress incontinence and urge incontinence. Results The two treatments were equally efficacious in alleviating urinary urgency (51% vs 56%), urge incontinence (58% vs 58%), stress incontinence (53% vs 59%) and nocturia (51% vs 54%). Dysuria was alleviated in 76% vs 67%, equivalence was not demonstrated. No statistically significant difference was found for any primary efficacy endpoint. Sixty percent of the participants rated the form of administration via the vaginal ring as excellent, compared with 14% for the pessaries (P < 0.0001). Conclusions Low dose vaginally administered oestradiol and oestriol are equally efficacious in alleviating lower urinary tract symptoms which appear after the menopause. The form of administration of the vaginal ring, seems to be more acceptable than oestriol pessaries.