ESTROgen use for complications in women treating pelvic organ prolapse with vaginal PESSaries (ESTRO-PESS)—a randomized clinical trial

Coêlho, Suelene Costa de Albuquerque; Giraldo, Paulo César; Brito, Luiz Gustavo Oliveira; Juliato, Cássia Raquel Teatin

doi:10.1007/s00192-020-04654-1

Cited by 7 publications

(13 citation statements)

References 25 publications

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“…Vaginal estrogen therapy, despite being used routinely, may have an impact on the vaginal microenvironment, yet has not been shown to change pessary-related symptoms. 7,10 Our study offers important information about the use of vaginal probiotics and pessary care. The popularity of probiotic products is growing worldwide, 23 and this affects the urogynecology population.…”

Section: Discussionmentioning

confidence: 99%

“…A secondary analysis performed by Fregosi et al 6 demonstrated no difference in pessary-related adverse effects based on frequency of pessary removal. Vaginal estrogen therapy, despite being used routinely, may have an impact on the vaginal microenvironment, yet has not been shown to change pessary-related symptoms 7,10 …”

Section: Discussionmentioning

confidence: 99%

“…7 However, VET use has not been consistently shown to make a difference in the amount of vaginal discharge or patient satisfaction with pessary use. [7][8][9][10] More treatment options for these adverse effects are needed.…”

Section: Why This Mattersmentioning

confidence: 99%

“…Vaginal estrogen therapy (VET) is commonly recommended during pessary use and is thought to decrease the rate of vaginal erosions 7 . However, VET use has not been consistently shown to make a difference in the amount of vaginal discharge or patient satisfaction with pessary use 7–10 . More treatment options for these adverse effects are needed.…”

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confidence: 99%

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The Impact of Vaginal Probiotics on Pessary Use: A Randomized Controlled Trial

Sappenfield

Mellen

Wilcox

et al. 2023

UROGC

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Importance Pessary-related adverse effects are common, and treatment options are limited. Probiotics may improve pessary-related adverse effects by altering the vaginal microenvironment. Objective This study aimed to evaluate the effect of a vaginal probiotic suppository on the vaginal microenvironment among pessary users. Study Design Women who used pessaries were randomized to vaginal probiotic suppository use versus without use. The intervention was a vaginal probiotic suppository and moisturizing vaginal gel. The vaginal microenvironment was assessed using Gram stain and Nugent's criteria at baseline and 3 months by a microbiologist blinded to group allocation. Symptoms and experience with use of the probiotic were assessed using questionnaires. The primary outcome was change in lactobacilli count on Nugent subscore at 3 months. Results A total of 147 postmenopausal women were randomized (86 to the intervention arm and 61 to the control arm), and 124 (87.9%) presented for a 3-month follow-up. There was no difference between the arms in age, race, body mass index, and Charlson Comorbidity Index. A majority of participants had the pessary managed by the health care professional (intervention arm vs control arm, 46 [76.7%] vs 55 [68.8%]; P = 0.30). Composition of the vaginal microenvironment did not differ with or without probiotic treatment at 3 months. Bother from vaginal symptoms, including discharge, itching, and discomfort, did not differ between arms. Adverse effects from the intervention were minor, resolved with discontinuation, and occurred at 39.1%. Conclusion Vaginal probiotic suppository use did not affect the composition of the vaginal microenvironment, patient satisfaction, or vaginal symptoms after 3 months of use in pessary users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Why This Mattersmentioning

confidence: 99%

mentioning

confidence: 99%

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The Impact of Vaginal Probiotics on Pessary Use: A Randomized Controlled Trial

Sappenfield

Mellen

Wilcox

et al. 2023

UROGC

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“…Vaginal estrogen may be helpful to manage this and can decrease the risk of vaginal discharge and pessary discontinuation, although it may not prevent erosions. 63,64 In the past, TrimoSan (hydroxyguinoline) gel was commonly prescribed to decrease bacterial vaginosis in pessary use, but a multicenter randomized trial including 184 participants found that it did not decrease the prevalence of bacterial vaginosis or vaginal symptoms and did not change the likelihood of a patient continuing pessary use at 3 months compared with no gel. 65 Vaginal bleeding may also occur around the time of insertion and removal because of atrophy and trauma and later also from vaginal erosion or granulation tissue.…”

Section: Pessary Side Effects and Complicationsmentioning

confidence: 99%

Nonoperative Management of Pelvic Organ Prolapse

Sung

Jeppson

Madsen

2023

Obstetrics &Amp; Gynecology

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Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior, posterior, or apical vagina. It is a common condition, with up to 50% of women having prolapse on examination in their lifetimes. This article provides an overview of the evaluation and discussion of nonoperative management of POP for the obstetrician-gynecologist (ob-gyn), with consideration of recommendations from the American College of Obstetricians and Gynecologists, the American Urogynecologic Society, and the International Urogynecological Association. The initial evaluation of POP requires a history documenting whether the patient is experiencing symptoms and what they are, and discovery of which symptoms they believe are attributable to prolapse. Examination determines the vaginal compartment(s) and to what degree prolapse exists. In general, only patients who have symptomatic prolapse or medical indication should be offered treatment. Although surgical options exist, all patients who are symptomatic and desire treatment should be offered nonsurgical treatment first, including pelvic floor physical therapy or a pessary trial. Appropriateness, expectations, complications, and counseling points are reviewed. Educational opportunities between the patient and the ob-gyn include disentangling common beliefs that the bladder is dropping or that concomitant urinary or bowel symptoms are necessarily caused by prolapse. Improving patient education can lead to a better understanding of their condition and better alignment of treatment goals and expectations.

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