Effect of vaginal estrogen in postmenopausal women using vaginal pessary for pelvic organ prolapse treatment: a randomized controlled trial

Chiengthong, Keerati; Ruanphoo, Purim; Chatsuwan, Tanittha; Bunyavejchevin, Suvit

doi:10.1007/s00192-021-04821-y

Cited by 11 publications

(20 citation statements)

References 20 publications

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“…We also found that lack of use of vaginal estrogen in conjunction with pessary use was associated with complications. Some studies have not shown that adjunctive vaginal estrogen is beneficial for pessary use, whereas others reflect findings that are similar to ours 11 . Dessie et al 12 looked at 199 patients and found that women who used vaginal estrogen had a higher incidence of continued pessary use and a lower incidence of increased vaginal discharge than women who did not.…”

Section: Discussionsupporting

confidence: 54%

“…Some studies have not shown that adjunctive vaginal estrogen is beneficial for pessary use, whereas others reflect findings that are similar to ours. 11 Dessie et al 12 looked at 199 patients and found that women who used vaginal estrogen had a higher incidence of continued pessary use and a lower incidence of increased vaginal discharge than women who did not. Similar findings were reported in a study comparing the outcomes of different types of pessaries and longevity of use.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes in Women With Pelvic Organ Prolapse Presenting With Pessary-Related Complications

Omosigho

Propst

Ferrando

2023

UROGC

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Importance There is currently a paucity of data describing the outcomes of women with pelvic organ prolapse (POP) and/or urinary incontinence (UI) who present with pessary-related complications. Objective This study aimed to describe outcomes in women with POP and UI managed with a pessary who present with pessary-related complications. Study Design This was a retrospective cohort study of women with POP and/or UI who elected for management with a pessary from January 1, 2016, to December 31, 2020. Patients were included if they had used a pessary for at least 1 year and had a documented pessary-related complication. Complications were defined a priori, and patient charts were abstracted using International Classification of Diseases, Ninth and Tenth Revisions codes associated with pessary use. Results Of 2,088 of women receiving pessary care, 444 (21%) experienced a complication. Of 154 of women, 34.6% experienced 2 pessary-related complications during the study period, whereas 12.6% (56) experienced 3, 4.5% (20) experienced 4, and 1.8% (8) experienced 5. One hundred fifty-two patients (34.2%) underwent surgery during the study period to manage their POP and/or UI. Patients who were older were less likely to have surgery (adjusted odds ratio, 0.70 [95% confidence interval, 0.20–0.90]; P = 0.002), and patients who had an indication of pessary use for both POP and UI were more likely to undergo surgery during the study period (adjusted odds ratio, 2.12 [95% confidence interval, 1.29–3.48]; P = 0.003). Conclusions Our results suggest that 1 in 5 patients has a documented complication associated with pessary use of greater than 1 year. Of these patients, one third will eventually undergo surgery for management of their POP and/or UI.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Outcomes in Women With Pelvic Organ Prolapse Presenting With Pessary-Related Complications

Omosigho

Propst

Ferrando

2023

UROGC

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“…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.…”

mentioning

confidence: 99%

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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“…Participants' rating of global improvement were collected using a question from the Thai version of Patient Global Impression of Improvement (PGI-I). The Thai version was developed by Orawee Chinthakanan (52) and it has a satisfactory validity. The PGI-I use a descriptive scale where participants will self-report whether they are: very much better, much better, a little better, no change, a little worse, much worse and very much worse.…”

Section: Qol and Global Improvementmentioning

confidence: 99%

Treatment effects of amitriptyline on pain symptoms, quality of life and heart rate variability in burning mouth syndrome patients

Chaiworn¹

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The objectives of this research project were 1) To evaluate the effectiveness of amitriptyline therapy on improving pain and the oral health-related quality of life (OHRQoL) in BMS patients when compared to palliative topical therapies (sodium bicarbonate mouthwash). 2) To determine the association between therapy of amitriptyline and heart rate variability (HRV) parameters. 3) To assess the association between pain outcomes and fluctuations in HRV parameters. This project was composed of a retrospective and a prospective study, and subjects were primary BMS patients recruited at the Oral Medicine Clinic, Faculty of Dentistry, Chulalongkorn University. In the retrospective study, 20 female participants were phone interviewed with 3 validated questionnaires and specific data was retrieved from the subject's clinical charts. Four females already taking amitriptyline or sodium bicarbonate mouthwash were then recruited into a pilot prospective study to evaluate changes on pain, OHRQoL and HRV between baseline, 3-month and 6-month follow-up visits. No significant differences on patient global impression of change (PGI-C) and OHRQoL between different age groups, working status, treatment options or psychological profile were found in the retrospective study (p<0.05). Regarding the prospective study, pain intensity in the sodium bicarbonate group was decreased from baseline to 3 months, while in amitriptyline group it increased and PGI-C was not changed. OHRQoL in sodium bicarbonate group and amitriptyline group were comparable at baseline and 6 months. HRV parameters in the amitriptyline group was higher than subjects in sodium bicarbonate group. These findings emphasize the value of PGI-C and OHRQoL assessments when it comes to adjust strategies during pain management in each individual with primary BMS. However, this is a pilot prospective study and must be interpreted with caution because of the limited sample size. Future investigations should be performed to confirm our findings with a randomized controlled clinical trial and also to determine the number of primary BMS patients that need to be treated (NNT) to have a clinical impact.

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Effect of vaginal estrogen in postmenopausal women using vaginal pessary for pelvic organ prolapse treatment: a randomized controlled trial

Cited by 11 publications

References 20 publications

Outcomes in Women With Pelvic Organ Prolapse Presenting With Pessary-Related Complications

Outcomes in Women With Pelvic Organ Prolapse Presenting With Pessary-Related Complications

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

Treatment effects of amitriptyline on pain symptoms, quality of life and heart rate variability in burning mouth syndrome patients

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