Effect of Local Estrogen Cream on Vaginal Health after Pessary Use for Prolapsed Pelvic Organ: A Randomized Controlled Trial
Paponrad Tontivuthikul MD*, Usanee Sanmee MD*, Supreeya Wongtra-Ngan MD*, Chailert Pongnarisorn MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background : Currently, there is no evidence whether local estrogen cream should always be used in conjunction with a
pessary as atrophic prevention. There is still no consensus about the long-term safety of local estrogen cream. Therefore,
it is recommended to use hormone for the shortest duration as possible.
Objective : Evaluate the effect of local estrogen cream on vaginal health in pessary use for pelvic organ prolapse.
Material and Method: Forty postmenopausal women with pelvic organ prolapse who had used a pessary in conjunction
with local estrogen cream for six weeks were randomly selected to use vaginal conjugated equine estrogen (CEE) cream
0.5 g once a week (treatment group) or no treatment (control group) for 24 weeks. The primary outcome was vaginal health
assessment composed of vaginal symptom score, vaginal pH, and vaginal maturation index. The secondary outcome measures
were the difficulty to use pessary and the endometrial thickness.
Results : No statistical differences were found for all vaginal health assessment at baseline, 12, and 24 weeks among the
treatment and the control groups. There was also no significant difference between the groups about the difficulty to insert
and remove the pessary or the endometrial thickness.
Conclusion : Vaginal CEE cream 0.5 g once a week did not show any additional positive effect on vaginal health in pessary
use.
Keywords : Pelvic organ prolapse, Pessary, Local estrogen cream, Vaginal health
