Effect of vaginal estrogen on pessary use

Abstract

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.

Optimal Pessary Care: A Modified Delphi Consensus Study

“…However, recent small, nonrandomized studies have reported no clear benefit in reduction of discomfort with pessary removal or ulceration and bleeding when women elect to use vaginal estrogen, thus reinforcing the need for further study . One self‐selected group of women who chose to use vaginal estrogen did exhibit a higher incidence of continued pessary use and lower incidence of increased vaginal discharge than women who did not …”

The mysteries of menopause and urogynecologic health: clinical and scientific gaps

“…72 A retrospective cohort study of 134 women treated with pessaries for at least 3 months demonstrated that women using vaginal estrogen were more likely to continue pessary use. 73 While topical estrogen did not impact the rate of vaginal ulcerations and related vaginal bleeding, women who used vaginal estrogen were less likely to experience bothersome vaginal discharge compared with those who did not. 73…”

“…73 While topical estrogen did not impact the rate of vaginal ulcerations and related vaginal bleeding, women who used vaginal estrogen were less likely to experience bothersome vaginal discharge compared with those who did not. 73…”

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

“…Seven studies provided data on risk of adverse events with long-term pessary use (without removal or cleaning) [17][18][19][20][21][22][23]. Nine additional articles were reviewed that provided information of interest during the pandemic [24][25][26][27][28][29][30][31][32]. Our analysis included three randomized controlled trials, three prospective cohorts, and one retrospective cohort.…”

“…Use of a specific telemedicine encounter is preferred for tracking and reimbursement purposes over a telephone encounter (typically used for sharing of discrete information) & Patients can safely extend the time interval between pessary cleanings to 6 months (and, in some cases, up to 24 months) with minimal risk of adverse events [17][18][19][20][21][22][23]. & Patients capable of pessary removal and reinsertion should be encouraged to self-clean their pessary [27,[31][32][33][34][35]. & Providers should consider empiric vaginal estrogen to minimize adverse events for patients not already using vaginal estrogen [17,18,28,31,33].…”