title: Effect of vaginal estrogen on pessary use.
abstract: OBJECTIVE
  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 postmenopausal 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.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA, USA.|Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
authors.forename: Sybil G
authors.initials: SG
authors.lastname: Dessie
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Armstrong
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Modest
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA, USA. lhota@mah.harvard.edu.|Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA. lhota@mah.harvard.edu.|Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. lhota@mah.harvard.edu.|Boston Urogynecology Associates/Mount Auburn Hospital, 725 Concord Ave. Suite #1200, Cambridge, MA, 02138, USA. lhota@mah.harvard.edu.
authors.forename: Lekha S
authors.initials: LS
authors.lastname: Hota
mesh_terms: D000282:Administration, Intravaginal; D000368:Aged; D000369:Aged, 80 and over; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010349:Patient Compliance; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010570:Pessaries / Q000009:adverse effects*; D017698:Postmenopause; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000209:etiology / Q000517:prevention & control; D019522:Vaginal Discharge / Q000209:etiology / Q000517:prevention & control
chemical_list: D004967:Estrogens
keywords: Pessary; Prolapse; Vaginal estrogen