Can Premarin Cream prevent an erosion?
No. Premarin Cream can treat small erosions. Larger erosions must be excised surgically.
In the Linda Dunfee case, Elia Robertson argued that Linda Dunfee got an erosion, she took vaginal estrogen cream, and the first erosion healed.
When she got a second erosion, she restarted using vaginal estrogen cream, but was told by her doctor that her erosion was too large and would not heal without revision surgery to remove the eroded mesh that was in her vagina.
Ms. Robertson argued that Ms. Dunfee still had erosions while taking systemic estrogen pills, but the defense argued that only the vaginal estrogen cream was effective in preventing erosions.
The Defense argued Linda Dunfee was responsible for the mesh erosions because she failed to use the vaginal estrogen cream as prescribed by her doctors. The Plaintiff's expert, Dr. Richard Bercik, and Linda Dunfee, herself, both denied that she was ever prescribed vaginal estrogen cream for life by her treating doctor, Dr. Della Badia.
Plaintiff took systemic estrogen tablets/pills for a time, and later took a natural organic estrogen therapy that would not pose a risk of breast cancer.
Initially, at least 1 month of conservative treatment including topical estrogen cream, pain relief with analgesic agents, and enhanced local hygiene was advised. If the conservative treatment failed or the erosion did not improve, revision surgery was considered.
Accumulating evidence has suggested a potential role for vaginal estrogen in managing small mesh erosions following pelvic organ prolapse surgery. Despite the lack of evidence, clinicians often offer a trial of vaginal estrogen for several vaginal pathologies given the minimal adverse effects of the drug. http://www.discoverymedicine.com/Ariana-L-Smith/2010/12/08/estrogen-replacement-therapy-for-the-treatment-of-postmenopausal-genitourinary-tract-dysfunction/
Pessaries may be used in conjunction with a topical, low-dose estrogen cream to improve skin tone and elasticity and, therefore, reduce skin erosion. https://www.ourbodiesourselves.org/book-excerpts/health-article/pelvic-organ-prolapse/
Premarin Vaginal Cream (conjugated estrogens) is a mixture of estrogen hormones, a female sex hormone produced by the ovaries, used to treat the vaginal symptoms of menopause such as dryness, burning, irritation, and painful sexual intercourse.
Common side effects of Premarin Vaginal Cream include:
• stomach cramps,
• breast pain/tenderness/swelling,
• weight changes,
• changes in appetite,
• freckles or darkening of facial skin,
• increased hair growth,
• loss of scalp hair,
• problems with contact lenses,
• vaginal itching or discharge,
• changes in your menstrual periods,
• decreased sex drive,
• dizziness, or
• tired feeling.
Local application of estrogen cream might allow a layer of vaginal mucosa to grow and cover the sling. Based on patient selection, this may be helpful in 0–100% cases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424888/#ref114
With this long list of adverse side effects, prescribing premarin cream for life does not make sense, and it does not cure large erosions, where only surgical intervention can help.
Patients with suture erosion were treated conservatively with estrogen cream. All five patients with mesh erosion required transvaginal removal of the mesh. https://worldwidescience.org/topicpages/v/vaginal+mesh+erosion.html
In some cases, conservative management of erosion may be possible. For example, some surgeons may prescribe topical estrogen cream to help vaginal tissues heal. https://www.drugwatch.com/transvaginal-mesh/bladder-sling/
It is rarely if ever prescribed for life as a preventative measure to prevent erosions, particularly where the patient does not have vaginal atropy or thinning of the vaginal tissues due to menopause.
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