Pessaries commonly refer to devices which are inserted into the vagina to support the pelvic musculature. They are used in the treatment of a variety of gynecological conditions such as vaginal and uterine prolapse, rectocele, cystocele, urinary incontinence and so on. These are called Mechanical Pessaries.
However, pessaries also refer to drug preparations which are inserted into the vagina. Commonly, these drugs are soft but solid substances designed to melt as the body temperature warms them up. They are then slowly absorbed into the body. They are called Pharmaceutical Pessaries or Inserts. The drugs commonly applied in this manner are female hormones like estrogen and progesterone and are called Hormone Pessaries.
There are advantages to the administration of drugs as hormone pessaries.
Benefits of Hormone or Pharmaceutical Pessaries
– Some drugs can only achieve adequate concentrations in the body when administered through this route.
– Optimal drug concentration can be achieved in the desired area without causing systemic side effects which occurs with oral, intramuscular or intravenous drug administration.
– The administered drug is applied exactly where its maximal effect is needed.
Uses of Hormone Pessaries
– Progesterone pessaries are used in fertility treatment such as in vitro fertilization (IVF) to prepare the uterus to receive the implanted embryo. They are also used to maintain the pregnancy. (1)
– Estrogen pessaries are used in post-menopausal women to prevent and treat vaginal dryness and irritation (hormone replacement therapy).
– Estrogen pessaries can be used to treat painful sexual intercourse. (2)
– Progesterone pessaries are used to treat irregular periods and amenorrhea.
– Contraceptive hormone pessaries are used to prevent pregnancy.
– Estrogen pessaries are used to treat ulcerations or lesions due to mechanical pessaries.
– Some women (e.g. post-menopausal women) may require estrogen to be applied as a pessary for some time before a mechanical pessary can be inserted. (3)
Side Effects of Hormone Pessaries (1) (2)
Side effects from drugs administered as pharmaceutical pessaries are usually less marked than when those same drugs are administered orally or intramuscularly. Thus, the side effects listed below do not commonly occur and some of them are rare.
Side Effects of Progesterone Pessaries:
– Vaginal and labial irritation
– Discharge from the melting drug
– Can delay a woman’s period which may be a welcome or unwelcome experience
– Dry mouth and unusual thirst
– Loss of appetite
– Delay in return to fertility after contraceptive use
Side Effects of Estrogen Pessaries:
– Unusual vaginal bleeding or spotting
– Enlarged breasts and breast pain
– Itching, stinging and redness of the vagina and genital area
– Vaginal discharge which may have and odor
– Headache and nausea
The above are only some of the possible side effects of using hormone pessaries.
Note: When a drug is inserted into the rectum (as opposed to the vagina), it is called a Suppository.
1. Progestin Oral, Parenteral, Vaginal consumer information from Drugs.com
2. Estrogen Vaginal consumer information from Drugs.com
3. Pessary insertion: Choosing appropriate patients