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

Abstract

Women with prolapse who are managed with a pessary often are prescribed vaginal estrogen to prevent vaginal irritation and erosion. However, the data behind the rationale are lacking. This single-blinded randomized trial evaluated the effect of topical vaginal estrogen use on pessary complications including erosion, vaginal discharge and urinary symptoms among post-menopausal women. Women with stage 3 and stage 4 pelvic organ prolapse (POP) and conservatively managed with a pessary (ring) were randomized to either concomitant use of topical promestriene three times a week or no estrogen use. Interview, pelvic examination and microbiological analysis were performed at the time of the recruitment, 3 months and 6 months. The pessary was removed and cleaned in the office every 3 months. Despite no significant difference in erosion rate (p = 0.175), topical estrogen users had lower rates of bacterial vaginosis (BV) and had significant improvement of urinary frequency. This study adds valuable information to the common practice of concomitant use of vaginal estrogen and pessaries. Estrogen decreases the rates of BV and urinary symptoms among pessary users, while erosion rates were not significantly affected by routine estrogen use in a short-term follow-up period.