Effect of Local Estrogen Cream on Vaginal Health after Pessary Use for Prolapsed Pelvic Organ: A Randomized Controlled Trial.

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.

Intrauterine Adhesions: Causes and Treatment Outcomes among Thai Women

Objective: To explore the causes and treatment outcomes of intrauterine adhesions among Thai women. Material and Method: This retrospective cross-sectional study recorded and analyzed the demographic data, causes, and treatment outcomes of 75 patients who underwent hysteroscopic adhesiolysis between January 2004 and June 2015 at Maharaj Nakhon Chiang Mai Hospital, Chiang Mai, Thailand. Results: The most common etiology of intrauterine adhesions was a history of early pregnancy termination by curettage (68%). Sixty-nine percent of the patients had menstrual abnormalities. Twenty-two percent of the patients had severe adhesions. Tuberculous endometritis caused the most severe case. Sharp hysteroscopic adhesiolysis improved the condition in 77.7% of the patients. The outcomes of the patients with mild to moderate IUA were better than those with severe intrauterine adhesions (88.2% vs. 43.8%, respectively) (p = 0.001). Fifty-one patients planned to conceive, and 49% succeeded after hysteroscopic surgery. Conclusion: Menstrual abnormalities were the most common presentation of intrauterine adhesions. The most common cause of intrauterine adhesions was early pregnancy termination by curettage. However, tuberculosis endometritis caused the most severe case. Hysteroscopic adhesiolysis significantly improves menstrual function and fertility outcomes; mild to moderate cases have a better prognosis.