Bulchandani Supriya, Toozs-Hobson Philip, Verghese Tina, Latthe Pallavi
Birmingham Women's NHS Foundation Trust, Birmingham, UK
Birmingham Women's NHS Foundation Trust, Birmingham, UK.
Post Reprod Health. 2015 Dec;21(4):141-5. doi: 10.1177/2053369115614704. Epub 2015 Nov 3.
Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use.
We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz).
Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge.
Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse.
盆腔器官脱垂在老年女性中常与生殖道萎缩并存，这类女性倾向于选择阴道子宫托治疗脱垂。一些人在使用支撑性子宫托治疗脱垂时会同时使用阴道雌激素疗法，但目前尚无有力证据支持这种做法。我们旨在评估绝经后女性在使用或不使用阴道雌激素的情况下，使用支撑性子宫托治疗阴道脱垂的并发症差异。
我们前瞻性地评估了到泌尿妇科门诊更换子宫托的绝经后女性。我们询问了她们在更换子宫托时的不适程度（疼痛视觉模拟评分）、分泌物、出血和感染情况。由于这是一个服务评估项目，无需伦理批准。进行了相对风险的统计分析，包括对“环形子宫托”和“非环形组”（支架式、盖尔霍恩式、沙茨式）的亚组分析。
2013年7月至2014年12月期间，我们评估了120名使用支撑性子宫托治疗脱垂的绝经后女性。平均年龄为70岁；45%的患者使用阴道雌激素。使用或不使用阴道雌激素的患者在并发症方面没有统计学上的显著差异，尽管未使用者的并发症趋势更高。未使用阴道雌激素的“非环形”亚组发生阴道溃疡、出血和分泌物增多的风险更高。
绝经后女性在使用支撑性子宫托治疗脱垂时同时使用阴道雌激素，可能会减少并发症，尤其是使用非环形子宫托时。需要进行一项有足够样本量的随机对照试验，以最终评估阴道雌激素是否能提高舒适度并减少支撑性子宫托治疗脱垂的并发症。
