Priority 9 from the Pessary use for Prolapse PSP

None identified

The use of topical vaginal oestrogen (in the absence of any contraindications) in postmenopausal women and women with vaginal atrophy may be helpful in reducing pessary complications and is commonly prescribed, however, high level evidence for its use is lacking.  ~  
This review did not find any clear evidence to suggest whether oestrogens work. However, as they are often used, especially with pessaries or before and after prolapse surgery, research is needed to identify any benefits or risks.  ~  The consideration of vaginal estrogen supplementation to lengthen pessary use among postmenopausal women electing to use a pessary as the treatment modality for prolapse and/or urinary incontinence.  ~  To assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse.  ~  Should all post menopausal women use topical oestrogen while using pessarys?  ~  Should an oestrogen cream be used as routine, or only with atrophic changes?  ~  Is it recommended to always have the patient use premarin prior to having a pessary fitted?  ~  Should oestrogen creams always be used on a several times per week basis when pessaries are fitted. I know some consultants who state that this should be the case, but I now other consultants who do not prescribe it when they fit a pessary ?