Vaginal pessaries are a noninvasive therapeutic option in the management of pelvic organ prolapse. Vaginal pessaries are, however, a stopgap measure, until surgery is performed. While they provide symptomatic relief, their use is often associated with adverse effects such as increased vaginal discharge. A systematic review and meta-analysis of five randomized controlled trials (RCTs) and cohort studies published in the journal Climacteric has examined the effect of using local estrogen along with a vaginal pessary on adverse effects in postmenopausal women with pelvic organ prolapse.¹

Analysis revealed that women who used estrogen together with vaginal pessary showed a marked lower incidence of bacterial vaginosis compared to controls with odds ratio of 0.29. The OR for vaginal ulceration was 0.98, for vaginal bleeding it was 0.80 and for vaginal discharge it was 0.74.

This study has demonstrated the beneficial effect of the use of local estrogen together with a vaginal pessary in reducing the rate of bacterial vaginosis among postmenopausal women with pelvic organ prolapse. At the same time, the authors note the lack of consensus regarding the concurrent use of estrogen for lessening the other complications of pessaries and advocate larger studies to analyse the effect of estrogen use on reducing pessary-related complications.

Reference

1. F Ai, et al. Effect of estrogen on vaginal complications of pessary use: a systematic review and meta-analysis. Climacteric. 2022 Dec;25(6):533-542. doi: 10.1080/13697137.2022.2079973.