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

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Abstract

Introduction and hypothesis

Evidence and recommendations for the use of intravaginal estrogen for prevention of bacterial vaginosis and pessary-related complications are limited and controversial. We hypothesized that adding intravaginal estrogen to pessary use would decrease the incidence of bacterial vaginosis and other pessary-related complications.

Methods

A single-center, open-label, randomized, parallel study was conducted between April 2018 and August 2020. Participants were randomized to either receive intravaginal estriol 0.03 mg plus Lactobacillus acidophilus 100 million viable cell vaginal tablets or have no treatment. The Amsel criteria, normal flora index, visual analog scale, Thai version of the ICIQ-VS (International Consultation on Incontinence Questionnaire-Vaginal symptoms) questionnaire, vaginal abrasions and vaginal bleeding were evaluated at entry and at 2- and 14-week follow-up.

Results

Seventy-eight women were included and randomized to two groups (39 women per group). At 2-week follow-up, one participant in the intervention group and two participants in the control group were diagnosed with bacterial vaginosis (2.7% vs. 5.7%, p = 0.609). At 14-week follow-up, two participants in the intervention group and two participants in the control group were diagnosed with bacterial vaginosis (5.7% vs. 6.2%, p = 0.926). Normal flora index was significantly different at 2-week follow-up [8 (6.3) vs. 5 (6.0), p = 0.032]. There was no significant difference in the visual analog scale, Thai version of the ICIQ-VS, vaginal abrasions and vaginal bleeding between the 2- and 14-week follow-ups.

Conclusions

This study shows no benefit of intravaginal estrogen in reducing bacterial vaginosis, vaginal abrasions, vaginal bleeding and pain in postmenopausal women using a vaginal pessary for pelvic organ prolapse treatment.

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Acknowledgements

The authors gratefully acknowledge Ms. Sumanee Nilgate, Department of Microbiology, King Chulalongkorn Memorial Hospital, and the Thai Red Cross Society for assistance with the normal flora index interpretation.

Funding

This study was funded by the Ratchadapisek Sompoch research grant (RA61/027).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Keerati Chiengthong, Purim Ruanphoo & Suvit Bunyavejchevin

  2. Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Tanittha Chatsuwan

  3. Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Suvit Bunyavejchevin

Authors
  1. Keerati Chiengthong
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  2. Purim Ruanphoo
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  3. Tanittha Chatsuwan
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  4. Suvit Bunyavejchevin
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Contributions

Chiengthong: Project development, Data Collection, Manuscript writing.

Ruanphoo: Project development.

Chatsuwan: Project development.

Bunyavejchevin: Project development, Manuscript editing.

Corresponding author

Correspondence to Suvit Bunyavejchevin.

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Chiengthong, K., Ruanphoo, P., Chatsuwan, T. et al. Effect of vaginal estrogen in postmenopausal women using vaginal pessary for pelvic organ prolapse treatment: a randomized controlled trial. Int Urogynecol J 33, 1833–1838 (2022). https://doi.org/10.1007/s00192-021-04821-y

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  • DOI: https://doi.org/10.1007/s00192-021-04821-y

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