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Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications?
Post Reprod Health. 2015 Dec; 21(4):141-5.PR

Abstract

OBJECTIVE

Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use.

STUDY DESIGN

We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz).

RESULTS

Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge.

CONCLUSION

Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse.

Authors+Show Affiliations

Birmingham Women's NHS Foundation Trust, Birmingham, UK drsupriya73@yahoo.co.uk.Birmingham Women's NHS Foundation Trust, Birmingham, UK.School of Clinical and Experimental Medicine, University of Birmingham, Birmingham UK.Birmingham Women's NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, Birmingham UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26537626

Citation

Bulchandani, Supriya, et al. "Does Vaginal Estrogen Treatment With Support Pessaries in Vaginal Prolapse Reduce Complications?" Post Reproductive Health, vol. 21, no. 4, 2015, pp. 141-5.
Bulchandani S, Toozs-Hobson P, Verghese T, et al. Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications? Post Reprod Health. 2015;21(4):141-5.
Bulchandani, S., Toozs-Hobson, P., Verghese, T., & Latthe, P. (2015). Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications? Post Reproductive Health, 21(4), 141-5. https://doi.org/10.1177/2053369115614704
Bulchandani S, et al. Does Vaginal Estrogen Treatment With Support Pessaries in Vaginal Prolapse Reduce Complications. Post Reprod Health. 2015;21(4):141-5. PubMed PMID: 26537626.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications? AU - Bulchandani,Supriya, AU - Toozs-Hobson,Philip, AU - Verghese,Tina, AU - Latthe,Pallavi, Y1 - 2015/11/03/ PY - 2015/11/6/entrez PY - 2015/11/6/pubmed PY - 2016/9/17/medline KW - Postmenopausal women KW - prolapse KW - vaginal estrogen KW - vaginal pessary SP - 141 EP - 5 JF - Post reproductive health JO - Post Reprod Health VL - 21 IS - 4 N2 - OBJECTIVE: Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use. STUDY DESIGN: We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz). RESULTS: Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge. CONCLUSION: Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse. SN - 2053-3705 UR - https://www.unboundmedicine.com/medline/citation/26537626/Does_vaginal_estrogen_treatment_with_support_pessaries_in_vaginal_prolapse_reduce_complications DB - PRIME DP - Unbound Medicine ER -