Self-Management of Vaginal Pessaries: A Viable Alternative for Pelvic Organ Prolapse

By Staff Writer

May 21, 2024

Introduction

Pelvic organ prolapse (POP) affects up to 65% of women, particularly as they age. This condition, where pelvic organs descend into the vaginal canal, can significantly impact a woman’s quality of life. Traditional treatment options include both conservative measures and surgery. However, recent research highlights the potential benefits of self-management of vaginal pessaries, a conservative treatment option. The TOPSY trial compared self-management with clinic-based care for women using vaginal pessaries.

Understanding Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic organs, such as the bladder, uterus, or rectum, descend from their usual position into the vaginal canal. Symptoms include a sensation of something “coming down” into the vaginal space, urinary and bowel issues, sexual dysfunction, and pain. As the population ages, the prevalence of prolapse is expected to rise, making effective management strategies crucial.

Traditional Treatment Approaches

Prolapse can be managed conservatively or surgically. Conservative treatments often involve the use of vaginal pessaries, mechanical devices inserted into the vaginal canal to support the pelvic organs. Pessaries are widely used, with two-thirds of women in the National Health Service (NHS) opting for this method initially. However, traditional clinic-based pessary care requires women to visit a clinic every six months for removal and replacement, which can be inconvenient.

The TOPSY Trial: A New Approach

The treatment of prolapse with self-care pessary (TOPSY) study aimed to assess the clinical and cost-effectiveness of pessary self-management compared to clinic-based care. The trial involved 340 women from 21 UK centres, randomly assigned to either self-management or clinic-based care. The primary outcome was prolapse-specific quality of life, measured using the Pelvic Floor Impact Questionnaire-7.

Key Findings:

1. Quality of Life: There was no significant difference in prolapse-specific quality of life between the self-management and clinic-based care groups.
2. Complications: Women in the self-management group reported fewer pessary-related complications than those in the clinic-based care group.
3. Cost-Effectiveness: Self-management was more cost-effective, with lower mean costs (£578 vs. £728). The willingness-to-pay threshold of £20,000 per quality-adjusted life-year gained was £564 and a high probability of cost-effectiveness (80.8%).

Implementation and Training

For self-management to be effective, proper training and support are essential. The TOPSY trial provided women with a 30-minute teaching session, an information leaflet, a follow-up call, and access to a telephone helpline. Healthcare professionals also received training to ensure consistent and effective delivery of the intervention.

Future Research and Recommendations

While the TOPSY trial demonstrated the feasibility and benefits of self-management, further research is needed to:

1. Develop Sensitive Quality of Life Measures: Current measures may not fully capture the impact of self-management on women’s quality of life.
2. Assess Effectiveness Across Diverse Populations: Future trials should include a wider range of ethnic groups and women with different abilities.
3. Explore Follow-Up Strategies: Research should investigate whether follow-up can be initiated by women or if planned intervals are necessary.

Conclusion

The TOPSY trial provides robust evidence that self-management of vaginal pessaries is a viable alternative to clinic-based care. It offers women greater control, reduces complications, and is cost-effective. Healthcare professionals and policymakers should consider incorporating self-management into standard pessary care services, providing women with the training and support they need to manage their pelvic organ prolapse effectively.

Reference url

Recent Posts

HIV prevention injection
   

FDA Approval and Access Strategy for Lenacapavir (Yeztugo) Long-Acting HIV Prevention

🌍 Will Yeztugo Approval and Access Strategy Deliver an Inflection Point in HIV/AIDS?

Yeztugo (lenacapavir), a twice-yearly injection, redefines long-acting HIV prevention with 96–100% efficacy. Gilead’s access strategy—insurance, assistance, and generics for 120 countries—targets global impact. Can it balance $28,218 U.S. costs with equity for 1.3M annual infections? My article explores health economics, public health, and market dynamics.

📖 Read how Yeztugo’s access strategy could transform long-acting HIV prevention

#SyenzaNews #GlobalHealth #HIVPrevention #Yeztugo #PrEP

essential prescription drugs
       

Canada Launches Consultation for Essential Prescription Drugs List

💊 Are you curious about how Canada plans to make essential prescription drugs accessible for everyone?

Canada’s Drug Agency has launched a national consultation to create a list of essential prescriptions that aim to ensure equitable access, improve health outcomes, and reduce costs. This initiative marks a key step towards universal pharmacare and highlights the importance of evidence-based practices in healthcare.

Dive into our latest article to learn more about the implications for patients, policymakers, and the broader healthcare system!

#SyenzaNews #healthcare #HealthEconomics

ACIP vaccine policy concerns
     

ACIP Vaccine Policy Concerns

🛑 Is the future of vaccine policy at risk?

The recent overhaul of the US Advisory Committee on Immunization Practices (ACIP) raises critical concerns about the integrity and transparency in vaccine recommendations. The abrupt removal of longstanding members may disrupt the essential processes that have historically upheld public trust and immunization success.

Curious about the implications for health policy and public health? Dive into the full analysis to understand the balance needed between continuity and reform!

#SyenzaNews #HealthcarePolicy #HealthEconomics #Innovation

When you partner with Syenza, it’s like a Nuclear Fusion.

Our expertise are combined with yours, and we contribute clinical expertise and advanced degrees in health policy, health economics, systems analysis, public finance, business, and project management. You’ll also feel our high-impact global and local perspectives with cultural intelligence.

SPEAK WITH US

CORRESPONDENCE ADDRESS

1950 W. Corporate Way, Suite 95478
Anaheim, CA 92801, USA

© 2025 Syenza™. All rights reserved.