Follow up after Sacrospinous Fixation

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I'm 16 weeks post op Sacrospinous Fixation to try and fix the severe Vault prolapse that had developed probably due to an early complete hysterectomy ( at age 40 ) and subsequent menopause ( now age 61). An earlier operation for Sacrocolpopexy had to be abandoned last year due to bowel adhesions,on my abdominal wall, but a small anterior repair was performed which helped, but only for a while. In the last few weeks I was aware of a further bulge, but not as bad as before. On examination, the back wall is holding up nicely at the moment, from the 'fixation', but the added pressure on the front wall is causing it to further prolapse :-(. Unfortunately the tissue is so thin there, that it is unlikely that a further repair would hold. Also my consultant does not like to use mesh now, because of the problems with erosion.....He has exausted all the  surgical options for me, but has recomended that I have a course of hormone treatment for 6 months or so, as I have Vaginal Atrophy. I have read that this can also help strengthen the tissues ? Has anyone had positive results from using local vaginal estrogen therapy?      

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  • Posted

    Hello ros. My Urogynaecologist confirmed I had vaginal atrophy when I saw him at the first appointment when I was referred for by my GP. I had at the time a rectocele and cystocele and he told me I would need progesterone pessaries (I couldn't have oestrogen because I'd previously had a hysterectomy) to strengthen the vaginal wall otherwise the repairs may not be successful. I started a course in the February and I had both prolapse repaired in July (almost 6 years ago). I still use the pessaries occasionally but I also take HRT but I'm told my vaginal wall has strengthened and I have  not had any problems. 
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    • Posted

      Thanks Matron. That sounds encouraging. I wish I had realised that the tissue was so thin before ! I was taking HRT tablets following my hysterctomy for many, many  years, as I also had my ovaries removed as It's probably since I have come off it, that the Prolapse  worsened. 
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    • Posted

      ros I was exactly the same. On HRT since 1991 yet still had a very thin vaginal wall but the pessaries or cream hits the spot basically and the hormone is applied to where it's needed most.
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    • Posted

      Fingers crossed. The results generally are good overall and this treatment is being used more and more.
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  • Posted

    Hi Ros2015, like you I also had an early hysterectomy at 40, now 61. When I went to see my consultant she also said that I needed to have pessaries, every day for 3 months and then twice a week thereafter. When I had my op she commented how much better it was looking. I had noticed a difference myself prior to my operation, so my opinion is that they do work.
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  • Posted

    I was prescribed Ovestan oestregen cream for vaginal atrophy by my consultant pre surgery - I wasn't aware I had it but afterwards realised I did have symptoms.  I'm now 14 weeks post surgery and find that it helps with incontinence so is obviously having an effect.  I stopped HRT some years ago as the GPs are not happy for anyone to be on it long once through the menopause, yet my Urogynaecologist thinks it's helpful to stay on it.
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  • Posted

    My journey a year ago started with a post-menopausal bleed. 2nd time it was worse so I went and saw GP who referred me to urogynae. I went in for D&C, Hysteroscopy. Firstly had scan and vag scan. Lab results were clear of any nasties. But when all this was happening I enquired about whether I had prolapses. Yip. A & P. He prescribed me vag pessaries (oestrogen I think). I HATED them and the ikkyness even onto my thighs as it dissolved. So he changed me to a cream. Still hate that ikkiness, but more tolerable than pessary. But every time I used the cream I got a yellow/green discharge which seemed to persist for too long. Got that same discharge post-op from anterior repair. I'm super careful inserting anything as I'm a nurse and very much into prevention of infections. So I didn't use the cream for long. Then had surgery Oct. 19. Still thinking I should be using that oestrogen cream but can't convince myself to be ikky from it. Jeeez. 
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    • Posted

      Hi robyn94818

      I'm due to start the vag tablets I think in the next couple of days. I probably won't like the 'ikkynes' if it happens either lol. Thanks for your posting as I will also ask for a different option to try if it doesn't suit me !

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    • Posted

      Hi Robyn, I've been using pesssries since Feb and I don't get any ikkyness, I'm not a nurse so hope I'm using them correctly. They come in a long tube like thing thing that I insert and then just press the end so the pesssry is inserted. Once in I just forget they are there.
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    • Posted

      Hi. Phew, it's not just me then. I am very very fussy cleanliness wise and love the post-menopausal need to not even wear a pantyliner! I had to when had stress incontinence for years before my anterior repair 6mths ago. Cream definately more pleasant to use. You just put it in in an applicator like thrush cream. I should really try it again I guess. Didn't want to for 1st 3mths due to fear of disturbing repair. I even tried only using 3/4 of recommended dose in applicator. I do know it will improve thin, atrophy of vag, but have to convince myself to use it. The pessary was all slippery & oily and my whole pelvic area felt all oily & yukk about half hour onwards after putting it in. I put it as high as my finger would go to. I don't want to use HRT due to risks of cancer as my Sis has had breast cancer, plus I believe not much, if any of the pessary or creams hormone actually makes it into bloodstream, but works well locally. I totally understand that for some menopause symptoms are too severe to avoid HRT. But I coped ok with menopause.
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    • Posted

      Oh interesting, thanks. I live in New Zealand & my ones were these fat ended, pointy greasy things which you had to put in like a tampon with your finger. I asked Chemist if I could buy an applicator after using 1st one & hating it. I thought maybe I wasn't putting it up inside far enough. But Chemist said there isn't an applicator. So I changed to cream as at least it came with plastic applicator. We probably have antiquated cheaply funded by Pharmac here, knowing our health system. I would love to try your ones. Are you UK? Are they Dr. prescription or over counter? I'm going to USA for 1mth in 3wks so might investigate over counter idea at Rite Aid, CVS, & Walgreens. Can buy loads of over counter stuff in USA compared to here. I will be in UK for all of Nov. leading up to going to Royal Variety Performance in London on Dec. 6th! So can try and buy some there too if I can't get them in USA. Melatonin 3mg tablets here are prescription only & not funded by Govt. so I was paying $36 for 30 tablets. In USA I found them over counter for between $7 & $10 USD! I get stock of them for my GP each time I go as she same age as me (57) & they help menopausal & post-menopausal get to sleep at night. Her Son-In-Law is Policeman & does shift work so uses them too. Plus the bottle of them in USA is 100 tabs.
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    • Posted

      Yes they do ros. Easy to use. Had a few problems when I first started but all settled and no issues now at all.
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    • Posted

      Oh man. Wish I could get those here. The pessary is flat at one end and pointy at other & suppository sized. Heinous. The cream was better but mucky.
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    • Posted

      Thanks Carolyn. Sounds okay then. Have now picked up, but chemist only had 8, so have to get the rest tomorrow !  
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    • Posted

      I don't think they are available in New Zealand Matron. Just the big greasy ones Urogynae gave me & no applicator. Chemist said there isn't an applicator. The cream is Ovestin 1mg. Pessary is 0.5mg.
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    • Posted

      Hello robyn. Do you have a website that doctors and nurses use to check the availability of drugs for example MIMS? That lists everything available because I would have thought something like that would be readily available. 
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    • Posted

      No don't think we have an accessible drug website. What exactly are the UK ones called? Are you allowed to put brand here, and manufacturer?
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    • Posted

      Are they like glycerin suppositories  no applicator, or more like a pill in an applicator?
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    • Posted

      No they are like a very small tablet and there's a plastic tube that inserts it into the vagina
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