Uterine prolapse: evaluation of glycosaminoglycans in postmenopausal women after estrogen therapy

Abstract

Objective: To evaluate glycosaminoglycans (GAGs) in the parametrium, paraurethral tissue and vaginal apex in postmenopausal women with uterine prolapse and to evaluate the effect of 30-day estrogen therapy in these patients.

Material and methods: Double-blind trial of estrogen and placebo in 40 women with a control group of 20 premenopausal women without uterine prolapse. Twenty postmenopausal women with prolapse formed a second group and were treated with placebo for 30 days before vaginal hysterectomy. The third group included 20 postmenopausal women with prolapse who received 0.625 mg oral conjugated estrogens for 30 days before vaginal hysterectomy. Samples of the parametrium, vaginal apex and paraurethral tissue were obtained during surgery.

Results: Hyaluronic acid was the predominant GAG detected, followed by dermatan sulfate, chondroitin sulfate and heparan sulfate. In postmenopausal women with prolapse, we did not observe significant differences in total GAGs compared to the control group. However, hyaluronic acid was increased in the parametrium of women receiving estrogen compared to those treated with the placebo (2033.39 ± 3037.90 mg/g vs. 587.87 ± 697.89 mg/g, respectively; p = 0.041).

Conclusions: There are differences in GAGs in the parametrium, paraurethral tissue and vaginal apex between women in premenopause and those in the postmenopause period. Therefore, 30-day estrogen therapy produces significant differences in levels of hyaluronic acid, dermatan sulfate and chondroitin sulfate.