Comparison of vaginal moisturisers with ultra-low-dose oestriol and lactobacillus vaginal tablets in women with POP who used a pessary: a randomised controlled trial

This study aim to compare the proportion of pessary users reporting satisfaction with ultra-low dose oestriol and Lactobacillus vaginal tablets and vaginal moisturiser. A randomised-controlled trial enrolled patients who were able to take care, insert, and remove a pessary themselves and did not use any local oestrogen or vaginal moisturiser for 3 months at a tertiary centre. Participants were randomised to receive either vaginal moisturisers or ultra-low-dose oestriol and Lactobacillus vaginal tablets for 2 months. A single-blinded evaluator assessed outcomes. The oestriol group received one vaginal tablet daily for 6 days followed by two tablets weekly for 8 weeks. The moisturiser group received one application every 3 days for 8 weeks. The primary outcome was the proportion of patients reporting high satisfaction, defined as ‘very much improved’ or ‘much improved’, using the Thai version of the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcomes were subjective and objective outcomes of vaginal health. Sixty patients were randomised, of whom one did not complete treatment. The majority of enrolled participants were postmenopausal women with a mean age of 65.54 years, mean BMI of 25.13 kg/m², and advanced-stage POP. The average duration of pessary use was 12-15 months. Patient satisfaction was not significantly different between the oestriol and moisturiser groups at 4 or 8 weeks (93.10% vs. 96.67%, P = 0.61 and 89.66% vs. 93.33%, P = 0.67, respectively). There were no serious adverse events. Vaginal moisturisers and ultra-low-dose oestriol and Lactobacillus acidophilus vaginal tablets provided high satisfaction in pessary users. Both preparations were comparable in both subjective and objective outcomes. This study compared two treatments to help improve comfort and satisfaction for women who use a pessary, a small device placed in the vagina to support weakened pelvic organs. Researchers tested two options: (1) very low-dose vaginal oestrogen tablets combined with healthy bacteria (Lactobacillus), and (2) a non-hormonal vaginal moisturiser. Sixty women participated and were randomly assigned to use one of the two treatments for two months. Women in the oestrogen group used tablets daily for the first week, then twice a week. Women in the moisturiser group applied the product every three days. After eight weeks, about 90–96% of women in both groups reported feeling very much improved or much improved. There was no major difference in satisfaction between the two groups. No serious side effects were reported. This study suggests that both vaginal moisturisers and very low-dose oestrogen tablets with Lactobacillus are safe and effective options for women using pessaries who want to improve vaginal comfort and health.