***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effect of oral oestriol ( 3 mg/day for 4 weeks followed by 2 mg/day for a further 6 weeks ) on the vaginal bacterial flora , vaginal cytology and urogenital symptoms was assessed in a double-blind , placebo-controlled study in 35 women with symptoms of the urogenital oestrogen deficiency syndrome . No significant differences were observed with regard to the occurrence or severity of urogenital symptoms , vaginal pH , karyopyknotic index ( KPI ) or the baseline results of vaginal bacterial cultures in the 18 patients ( mean age 71.6 + /- 1.0 years ) treated with oestriol and the 17 women ( mean age 72.6 + /- 1.4 years ) who received placebo tablets . A decrease in both vaginal pH ( P less than 0.001 ) and the proportion of faecal-type bacteria ( P less than 0.05 ) , and an increase in the KPI ( P less than 0.01 ) and the proportion of lactobacilli ( P less than 0.001 ) were recorded after 10 weeks of treatment with oral oestriol . At the end of the following 10 medication-free weeks all of these parameters except vaginal pH had returned to values that were not significantly altered from the corresponding baseline levels . In the patients treated with placebo no significant changes occurred in vaginal pH , KPI or the proportion of lactobacilli in vaginal cultures during the course of this study . Urogenital symptoms improved in both groups after medication ( and even after the medication-free period ) in relation to the baseline assessment , which reflects the latter 's subjective nature BACKGROUND In postmenopausal women , raloxifene hydrochloride has favorable effects on bone and lipid metabolism and does not stimulate reproductive tissues . The studies reported herein evaluated the long-term ( 3-year ) effects of raloxifene treatment on bone mineral density ( BMD ) , serum lipid levels , and drug tolerability in healthy postmenopausal women . METHODS A total of 1145 healthy European and North American postmenopausal women aged 45 through 60 years were enrolled in 2 parallel , double-blind , r and omized , placebo-controlled trials of identical design and r and omly assigned to receive raloxifene hydrochloride , 30 , 60 , or 150 mg , or placebo daily ; all groups received 400 to 600 mg of elemental calcium . Assessment s included measurements for BMD by dual-energy x-ray absorptiometry , markers of bone turnover , and serum lipid levels . RESULTS Lumbar spine BMD changed from baseline to 36 months as follows : placebo ( mean percentage change + SE ) , -1 . 32 % + 0.22 % ; raloxifene , 30 mg , 0.71 % + 0.23 % ; raloxifene , 60 mg , 1 . 28 % + 0.23 % ; and raloxifene , 150 mg , 1.20 % + 0.24 % . Comparable BMD changes were observed in the hip and total body . Biochemical markers of bone turnover were suppressed by raloxifene to normal premenopausal ranges through 3 years . Serum low-density lipoprotein cholesterol was reduced 7 % to 12 % below baseline through 3 years . Study withdrawals due to any reason ( 37 % ) and withdrawals due to adverse events ( 14 % ) were not different among groups . The only significant adverse effect of therapy was hot flashes ( 25 % in the 60-mg raloxifene group vs 18 % in the placebo group ) ; hot flashes were typically reported as mild and were not associated with study withdrawal ( 1.7 % for 60-mg raloxifene vs 2.4 % for placebo ) . CONCLUSIONS Raloxifene preserves BMD at important skeletal sites , lowers serum low-density lipoprotein cholesterol levels , and has a tolerability profile comparable to placebo . These results indicate a favorable benefit-risk profile of raloxifene for long-term use in healthy postmenopausal women . Arch Intern Med . 2000;160:3444 - 3450 Twenty-nine postmenopausal women with slight to severe stress urinary incontinence and estrogen deficiency symptoms in the urogenital tract were treated with estriol , p.o . 4 mg once daily , and either phenylpropanolamine ( PPA ) , p.o . 50 mg twice daily , or placebo for periods of 6 weeks according to a r and omized double-blind crossover schedule . At urodynamic recordings the maximum urethral closure pressure increased by 22 % with combined treatment ( p less than 0.001 ) and an additional effect of PPA to estriol was shown ( p = 0.022 ) . The pressure transmission ratio increased , by about 15 % , with both treatments ( p less than 0.07 ) . The number of leakage episodes was reduced by 28 % with combined treatment ( p = 0.007 ) , but not with estriol alone ( p = 0.08 ) . Both combined treatment and estriol alone reduced significantly ( p less than 0.01 ) the urinary incontinence complaints . Twelve women ( 43 % ) preferred combined treatment , while 7 ( 25 % ) preferred estriol alone . In women with initially slight to very severe urine loss , combined treatment reduced also ( p = 0.02 ) the amount of urine loss , measured at a st and ardized physical stress test . Signs of estrogen deficiency in vulva , vagina and urethra were reduced , 75 % ( p less than 0.001 ) or 65 % ( p = 0.001 ) with estriol given in combination with PPA or alone . Maturation index of both urethral and vaginal epithelium displayed significant changes . It is concluded that the combined treatment , PPA + estriol , by affecting both the muscular and mucosal factor of the urethra , is more effective than estriol alone for treatment of female stress urinary incontinence in the postmenopausal ages A r and omized open comparative cross-over trial was carried out in 20 postmenopausal women , mean age 69 years , suffering from urinary incontinence due to urethral sphincteric insufficiency . They were treated with phenylpropanolamine ( PPA ) 50 mg p.o . twice daily or estriol vaginal suppositories 1 mg daily separately and in combination for periods of 4 weeks . Urodynamic investigations were carried out before and after each period of treatment . Both PPA and estriol increased the maximal urethral closure pressure and the continence area significantly compared to the initial values , but combined treatment was substantially more effective . The functional urethral length increased significantly while on estriol . No significant change was registered in the bladder pressure or in the pressure transmission ratio . PPA was clinical ly more effective than estriol , but not sufficient to obtain complete continence . With combined treatment 8 patients became completely continent , 9 were considerably improved and only 1 patient remained unchanged . 2 patients dropped out of the study because of side effects . Combined treatment with PPA and estriol represents a recommendable treatment to postmenopausal women with urinary incontinence due to urethral sphincteric insufficiency The objective of the study was to assess the effects of low-dose vaginal treatment with oestradiol before vaginal operation . In a double-blind r and omized study including 43 postmenopausal women scheduled for vaginal repair operation for genital descensus , it was found that 7 patients suffered from concomitant urinary stress incontinence .  Vagifem ( 25 micrograms oestradiol ) or placebo was administered as vaginal pessaries daily , 3 weeks prior to surgery and the clinical effects evaluated . One month postoperatively the prevalence of bacteriuria ( > 100,000 CFU/ml urine ) was significantly lower when using oestradiol than in the placebo group . At follow-up 3 years later 40 women ( 93 % ) answered the question naires . None received hormone replacement therapy . Nineteen percent in the preoperative oestradiol group and 11 % in the preoperative placebo group had had more than two episodes of cystitis treated with antibiotics . This difference is not statistically significant ( p > 0.05 ) . Recurrent cystitis was not correlated to bacteriuria postoperatively . Seventy-nine percent of the women with genital prolapse but only 29 % of the women with concomitant urinary stress incontinence were cured ( p < 0.05 ) . Neither preoperative  oestradiol  treatment nor body weight had any influence on relapse . Preoperative low-dose vaginal oestradiol treatment may reduce the incidence of bacteriuria in the immediate postoperative period but no long-lasting effects on recurrent cystitis or relapse were seen . Longer-lasting hormone replacement therapy may be necessary to achieve lasting effects CONTEXT AND OBJECTIVE Estriol is an estrogen with considerably weaker stimulatory effects on endometrial proliferation than estradiol . A study was conducted to determine the level of estrogen receptors ( ERs ) and progesterone receptors ( PRs ) in women who received 14-day vaginal estriol therapy , compared with those who did not receive this therapy . ER and PR gene expression was analyzed in the endometrium , myometrium and vagina of postmenopausal women treated with estriol .  DESIGN AND SETTING Analytical cross-sectional study , at the Research Institute of the Polish Mothers ' Memorial Hospital , Lodz , Pol and . METHODS Twenty-seven postmenopausal women ( 57 - 74 years of age ) were included in the study . All of them were waiting for per vaginam hysterectomy or plastic surgery on the vagina and perineum because of uterine prolapse .  ER and PR gene expression was determined by means of the technique of reverse transcription polymerase chain reaction ( RT-PCR ) . RESULTS In the estriol-treated patients , in comparison with the control group , a significant increase in ER gene expression was observed in the endometrium and vagina , while enhanced PR gene expression was found in the endometrium . However , under histological examination of the endometrium , estrogen stimulation of low and medium degree was diagnosed for 21.4 % and 14.3 % of the estriol-treated women , respectively . CONCLUSION The results obtained suggest that the women who received 14 days of treatment with vaginal estriol had higher ER and PR mRNA levels . No difference between these groups regarding endometrial proliferation was observed BACKGROUND No authors have investigated whether the administration of local oestrogens in addition to antimuscarinics could have a synergistic effect in the therapy of overactive bladder ( OAB ) . OBJECTIVES To compare the efficacy of antimuscarinics alone versus antimuscarinics in combination with local oestrogens for OAB ; to verify whether risk factors for lower antimuscarinic efficacy can be overcome by the concomitant use of local oestrogens . DESIGN , SETTING , AND PARTICIPANTS Some 229 postmenopausal women with symptomatic urodynamically proven detrusor overactivity were prospect ively enrolled at a tertiary level urogynaecology centre and divided into two groups . INTERVENTION Women in group 1 ( n=129 ) were prescribed tolterodine extended release ( ER ) 4 mg once daily ; women in group 2 ( n=100 ) were prescribed both tolterodine ER 4 mg and concomitant oestriol cream application once daily . MEASUREMENTS All women underwent clinical evaluation and urodynamics in accordance with the Good Urodynamic Practice s Guidelines . After 12 wk of treatment the two groups were compared in terms of subjective efficacy for OAB symptom improvement using a three-point scale . Nonresponders were compared to the patients who improved or were cured in order to identify risk factors for resistance to therapy . RESULTS AND LIMITATIONS There was no significant difference between the two groups in terms of efficacy of therapy : 80.6 % in group 1 versus 82 % in group 2 ( p=0.86 ) . Patients with urodynamically proven detrusor overactivity ( DO ) occurring during provocative manoeuvres and patients with coital incontinence during orgasm reported a higher failure rate both in the overall study population and in group 2 . A possible limitation of the study is the nonr and omised design . CONCLUSIONS No synergistic effect of local oestrogens and antimuscarinics in the treatment of OAB was found . Antimuscarinic treatment has lower cure rates in women with symptomatic DO complaining of incontinence at orgasm or in patients with DO following provocative manoeuvres . The association of local oestrogens does not influence the role of the two mentioned risk factors Objective To assess the efficacy and safety of intravaginal estriol administration on  urinary incontinence , urogenital atrophy , and recurrent urinary tract infections in postmenopausal women . Design Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve , r and omized , placebo-controlled study . Participants were r and omly divided into two groups , with each group consisting of 44 women . Women in the treatment group received intravaginal estriol ovules : 1 ovule ( 1 mg ) once daily for 2 weeks and then 
    Output:
    
Urinary incontinence may be improved with the use of local oestrogen treatment .
Conversely , systemic hormone replacement therapy using conjugated equine oestrogen may worsen incontinence .
There were too few data to reliably address other aspects of oestrogen therapy , such as oestrogen type and dose , and no direct evidence comparing routes of administration .
The risk of endometrial and breast cancer after long-term use of systemic oestrogen suggests that treatment should be for limited periods , especially in those women with an intact uterus