Introduction and hypothesis Many providers recommend concurrent estrogen therapy with pessary use to limit complications; however, limited data exist to support this practice. We hypothesized that vaginal estrogen supplementation decreases incidence of pessary-related complications and discontinuation. Methods We performed a retrospective cohort study of women who underwent a pessary fitting from 1 January 2007 through 1 September 2013 at one institution; participants were identified by billing code and were eligible if they were post-menopausal and had at least 3 months of pessary use and 6 months of follow-up. All tests were two sided, and P values < 0.05 were considered statistically significant. Results Data from 199 women were included; 134 used vaginal estrogen and 65 did not. Women who used vaginal estrogen had a longer median follow-up time (29.5 months) compared with women who did not (15.4 months) and were more likely to have at least one pessary check (98.5 % vs 86.2 %, P < 0.001). Those in the estrogen group were less likely to discontinue using their pessary (30.6 % vs 58.5 %, P < 0.001) and less likely to develop increased vaginal discharge than women who did not [hazard ratio (HR) 0.31, 95 % confidence interval (CI) 0.17–0.58]. Vaginal estrogen was not protective against erosions (HR 0.93, 95 % CI 0.54–1.6) or vaginal bleeding (HR 0.78, 95 % CI 0.36–1.7). Conclusions Women who used vaginal estrogen exhibited a higher incidence of continued pessary use and lower incidence of increased vaginal discharge than women who did not.

Introduction/Hypothesis Opioid use, addiction, and overdose are a growing epidemic in the United States. Our objective was to determine if the amount of opioids prescribed following gynecologic and pelvic reconstructive surgery was insufficient, adequate, or in excess. We hypothesized that we were overprescribing postoperative opioids. Methods Participants who were at least 18 years old and underwent gynecologic and/or pelvic reconstructive surgery from April through August 2016 were eligible to participate. Routine practice for pain management is to prescribe 30 tablets of opioids for major procedures and 10-15 tablets for minor procedures. At the two-week postoperative visit, participants completed a questionnaire that asked about the number of tablets prescribed and used, postoperative pain control experience, and relevant medical history. Fisher’s exact test was used to compare data. Results Sixty-five participants completed questionnaires. Half (49.1%) reported being prescribed more opioids than needed, while 2 (3.5%) felt the amount was less than needed. Though not significant, participants who underwent major surgeries were more likely to report being prescribed more than needed (53.5%) compared with participants who underwent minor surgeries (35.7%; p=0.47). Though not significant, participants with anxiety were less likely to report being prescribed more tablets than needed compared to participants without anxiety (44.4% vs. 57.1%; p=0.38). This was also true of participants with depression compared to those without depression (37.5% vs. 58.3%); p=0.17), and those with chronic pain compared to those without chronic pain (33.3% vs. 60.0%; p=0.10). Conclusions Our current opioid prescription practice for postoperative pain management may exceed what patients need.