Investigation to Minimize Prolapse Recurrence of the Vagina Using Estrogen

Inclusion Criteria: * Postmenopausal: no menses for \>1 year * Minimum age: 48 years * Symptomatic apical and/or anterior vaginal wall prolapse, stage 2 or greater * No estrogen replacement within the last month (may come off current treatment, i.e. wash out, to join the study) * Medically fit for elective surgery * Physically able to apply/insert the study drug * Available for clinic follow-up for minimum 1yr Exclusion Criteria: * Concurrent use of steroid creams for other indications (e.g. lichen sclerosis) * BMI \>35 kg/m2 * Recent history (within last month) of vaginal infection or vaginitis * Contraindications to estrogen therapy (e.g. spontaneous DVT, stroke, breast or endometrial/ hormone-responsive cancer, genital bleeding of unknown cause) * History of connective tissue disease * Any oral or transdermal estrogen, SERM, or other medication impacting vaginal milieu * History of vaginal irradiation * Allergy to Premarin or its constituents * Prior apical repair or use of mesh for prolapse repair * Current tobacco use