Several posters seemed concerned about the assertion that estrogen is associated with wound healing. When I replied to the initial post I did not have access to my references.

Estrogen has been demonstrated to increase vascularity of the vaginal tissues in postmenopausal women.

Am J Obstet Gynecol. 1982 Jun 15;143(4):375-8.
Effect of conjugated estrogens on vaginal blood flow in surgically menopausal women.
Abrams RM, Stanley H, Carter R, Notelovitz M.

There are studies that have demonstrated that estrogen is associated with improved wound healing.

Cornea. 2012 Oct;31(10):1158-64. doi: 10.1097/ICO.0b013e31823d03ca.
Effects of 17β-estradiol on human corneal wound healing in vitro.
Oh TH, Chang DJ, Choi JS, Joo CK.
Source
Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Korea

Int Urogynecol J. 2012 Dec;23(12):1763-9. doi: 10.1007/s00192-012-1793-0. Epub 2012 May 12.
Vaginal incisional wound healing in a rabbit menopause model: a histologic analysis.
Abramov Y, Golden B, Sullivan M, Goldberg RP, Sand PK.
Source
Division of Urogynecology and Reconstructive Pelvic Surgery, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel. [log in to unmask]

Prevalence, pathophysiology and current management of dehisced perineal wounds following childbirth (784kb)
Lynn Dudley, Christine Kettle, Khaled Ismail 
British Journal of Midwifery, Vol. 21, Iss. 3, 07 Mar 2013, pp 160 - 171
(this article references a midwifery textbook that cites vaginal blood flow as a primary effector of perineal wound healing, re:Abrams above)


Cuff dehiscence is not a common occurrence, but the rate can approach 5% if the woman has a total laparoscopic hysterectomy. 

J Minim Invasive Gynecol. 2007 May-Jun;14(3):311-7.
Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies.
Hur HC, Guido RS, Mansuria SM, Hacker MR, Sanfilippo JS, Lee TT.


And a relatively recent study looked specifically at postoperative tissue and estrogen therapy.

Female Pelvic Med Reconstr Surg. 2012 Jul-Aug;18(4):211-5. doi: 10.1097/SPV.0b013e31825e6401.
A randomized clinical trial of the impact of local estrogen on postoperative tissue quality after vaginal reconstructive surgery.
Karp DR, Jean-Michel M, Johnston Y, Suciu G, Aguilar VC, Davila GW.
Source
Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA. [log in to unmask]


I want to be clear that I am not advocating that the original poster's patient stop breastfeeding; I am only seeking to answer her question about why a pelvic floor surgeon would want estrogen levels to be normal. Personally, I endorse Joanne's approach of an open discussion with her surgeon.



Elizabeth Boggs, MD
Women Physician Associates
Columbia SC





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