eTable 1. Current randomized controlled trials (RCTs) and meta-analyses on local estrogenization, pessary therapy, and pelvic floor conditioning.

n	Comparison	Study design	Primary endpoint	Results [95% confidence interval]	Adverse events
Study: Verghese et al. (2020) (e7)
325	pre- and postoperative administration of local estradiol vs. no application	randomized pilot study	Compliance > 75 % Applikation secondary urinary tract infections symptom questionnaires	preoperatively 79 % (34/43), 83 % (35/42) 6 weeks postoperatively 8/42 (19 %) vs. 4/42 (10 %)* no differences	no serious complications related to estrogeni‧zation
Study: Chiengthong et al. (2022) (e8)
78	postmenopausal pessary therapy with estriol 0.03 mg intravaginally + Lactobacillus vs. without	randomized controlled trial (RCT)	bacterial vaginosis normal flora index ICIQ-VS questionnaire	2/35 (6%) vs. 2/32 (6%) after 14 weeks 8/37 (6%) vs. 5/35 (6%)* 4.5 vs. 7.0	vaginal bleeding in a single patient in the control group
Study: Lillemon et al. (2022) (e9)
39	vaginaler Estrogenring vs. Placebo-Vaginalring	RCT	changes in the microbiome and urogenital symptoms	no significant changes in Lactobacilli or the microbiome	unclear
Study: Probst et al. (2020) (e10)
130	continuous pessary therapy for 24 vs. 12 weeks (= standard)	RCT	frequency of occurrence of vaginal epithelial lesions/erosionsnon-inferiority margin 7.5 percentage points	group differences –5.7 percentage points [-7, 4; 4.0] = longer duration of use non-inferior	none
Study: Boyd et al. (2021) (e11)
132	effect of pessary therapy on size of genital hiatus and degree of prolapse	Cohort study	mean change of genital hiatus (GH) and POPQ stage	−0.47 ± 1.02 cm* anterior compartment –0.47 ± 0.76* posterior compartment –0.47 ± 1.02* middle compartment –0.32 ± 1.33*	not reported
Study: Nekkanti et al. (2022) (e12)
50	urethral pessary vs. disposable continence tampon	RCT	improvement of stress incontinence (Patient Global Impression of Improvement-[PGI]-I)	80 % (8/10) vs. 75 % (9/12)study underpowered because of low patient recruitment	none
Study: Stafne et al. (2022) (e13)
855	targeted vs. no pelvic floor exercises during pregnancy	RCT	rate of urinary incontinence 7 years postpartum	78 (51 %) vs. 63 (57 %)	none
Study: Luginbuehl (2022) (e14)
96	pelvic floor training with vs. without reflex contraction exercises	RCT	changes in the ICIQ short-form questionnaire	2.9 vs. 3.0	none
Study: De Marco et al. (2022) (e15)
52	pelvic floor exercises with or without manual therapy	RCT	changes in the ICIQ short-form questionnaire	10,6 (± 4,9) vs. 11,2 (± 5,7)	none
Study: Leonardo et al. (2022) (e16)
562	pelvic floor exercises with or without biofeedback, and pelvic floor exercises vs. electrostimulation	systematic review and meta-analysis of RCTs	changes (mean differences) in two symptom questionnaires: King´s Health (KHQ) + Incontinence Impact Questionnaire (IIQ)	KHQ: –2.8 [-17.1; 11.5] IIQ: –2.5 [-0.5; 5.5] KHQ: 16.5 [6.1; 26.9]* IIQ: 5.3 [1.6; 9.1]* for electrostimulation	none
Study: Wang (2022) (e17)
	pelvic floor exercises vs. no intervention in women with prolapse	meta-analysis	changes of the mean Prolapse Symptom Score POP-SS and POPQ stage	changes –1.7 [-2.4; 0.9]*RR 1.5 [1.1; 2.0]* long-term data without significant change	none

*p ≤ 0.05

ICIQ, International Consultation on Incontinence Questionnaire; POPQ, pelvic organ prolapse quantification; RR, risk ratio