Estrogen Replacement Therapy Improves Pulmonary Function in Postmenopausal Women with Genital Prolapse Ivica Stipic, 1,2 Ozren Polasek, 2 Marko Vulic, 1,2 Hrvoje Punda, 2 Leo Grandic, 2,3 and Tomislav Strinic 1,2 Abstract Objective: This study examined the impact of estrogen replacement therapy with spirometry on pulmonary function in surgically castrated (salpingo-oophorectomy) postmenopausal women with genital prolapse. Methods: The study included 60 postmenopausal women with pelvic organ prolapse. The study received institutional Ethics Committee approval, and all subjects signed an informed consent. Women were randomly divided into two groups of 30 subjects: Group 1 (n = 30) was administered estrogen replacement with 1 mg of stradiol hemihydrate (1 mg/day) orally for 6 months, and group 2 (n = 30) was not taking estrogen. Both groups were matched by age, height, body mass index, parity, and duration of postmenopause. All subjects were evaluated with spirometry initially and after 6 months. For statistical analysis, descriptive and analytical methods were used, based on data type and distribution. The mean and standard deviations were used as measures of central tendency and variability. Categorical data were expressed as absolute and relative numbers (percentage). The t-test for independent samples (for comparison of groups) and t-test for dependent samples (for comparison of serial measurements in the same patients) were used. The analysis was performed using R software (www.r-project.org), with the level of significance set at p < 0.05. Results: Analysis of spirometry parameters showed statistically significant differences between the estrogen users and the nonusers groups. Conclusion: The most important study result was the significantly improved lung respiratory function in postmenopausal women with genital prolapse after 6 months of taking estrogen, confirming that hormone replacement therapy should be recommended to postmenopausal women. The findings of our study suggest the need for further research into the effect of estrogen on pulmonary function. Introduction I n the postmenopausal years, all women experience physical effects of aging. The most important changes occurring in postmenopausal women are due to the weak- ening of ovarian function. These changes can include seri- ous health conditions such as osteoporosis, heart disease, urogenital prolapse with urinary incontinence, and oth- ers. 1–4 Furthermore, other conditions such as lung function are associated primarily with aging but certainly are im- pacted by ovarian hormones. All sex steroid hormone re- ceptors have been shown to be expressed in lung tissue. 5 The respiratory system undergoes various structural, physiological, and immune changes with age. There is an increase in airspace size with aging, resulting from the loss of supporting tissue. Loss of lung function occurs quickly in postmenopausal women, and respiratory muscle strength decreases with age. 6,7 Spirometry is an interesting biomarker of aging and a physiological test that measures how an individual inhales or exhales volumes of air as a function of time. The primary signal measured in spirometry may be volume or flow. Spirometry performed by dozens of thousands of individuals has resulted in large databases that can be used to determine lung age. 8–10 It is known that estrogen can affect women’s pulmonary functions. 11–15 One such study showed that postmenopausal women who used estrogen replacement therapy (ERT) had higher levels of forced expiratory volume in first second (FEV1) and less airway obstruction. 13 Most postmenopausal women who are treated with hormone 1 Department of Gynecology and Obstetrics, University Hospital, 21000 Split, Croatia. 2 School of Medicine, University of Split, 21000 Split, Croatia. 3 Department of Surgery, University Hospital, 21000 Split, Croatia. REJUVENATION RESEARCH Volume 15, Number 6, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/rej.2012.1337 1