To evaluate the benefit of adjunctive vaginal estriol in female patients with relapsing-remitting multiple sclerosis and urogenital dysfunction.

Urinary tract dysfunction is seen in 80% of the MS patients. Symptoms include urinary frequency, urgency, incontinence, retention and frequent urinary tract infections. Bladder dysfunction interferes with daily activities and has a major impact in the patient’s quality of life.

Oral estriol is associated with entero- hepatic recirculation which prolongs exposure due to recycling. Vaginal estrogen delivery has a regional benefit to the lower urogenital tract. This study showed a statistically significant benefit in urogenital symptoms and quality of life of MS patients treated with vaginal estriol.

Vaginal estriol (1mg) was prescribe as adjunctive therapy in female patients with RRMS who wished to participate in the trial and had history of hysterectomy or menopause. Urogenital (BLCS) questionnaire was done at baseline 6 and 9 months. Quality of life questionnaire (MSQoL) was performed at baseline and 9 months. Patients with progressive MS, personal history of breast uterine or ovarian cancer were excluded. Levels of estriol, FSH, LH were done at baseline and 9 months. Pilot study included 12 patients.

Improvement of bladder disfunction symptoms were observed among all participants at 6 and 9 months. Statistically significant improvements were observed for BCLS Questionnaire (p =0.001*) as well as in quality of life questionnaire MSQoL 54 Physical (p = 0.009*), and MSQoL 54 Mental (p = 0.042*). Statistically significant improvements were observed for Urinary urgency (p = 0.008*), Urinary frequency (p = 0.002*), and Frequent UTI (p = 0.016*).

Adjunctive vaginal estriol (1mg) significantly improved bladder disfunction symptoms and quality of life in RRMS patients.