How often should a pessary be changed?

Pessary Change Frequency Guidelines

Pessaries should be changed and cleaned every 3-6 months to minimize complications and ensure proper function. 1

Evidence-Based Recommendations for Pessary Management

The frequency of pessary changes depends on the type of pessary and individual patient factors. Based on the most recent evidence:

Ring Pessaries

• 35% of specialists recommend changing shelf/Gellhorn pessaries every 3 months
• 31% recommend changing them every 6 months 1
• For ring pessaries specifically, evidence supports safe continuous use with cleaning and monitoring every 6 months 2

Extended Use Considerations

• A 2022 study found no increase in complication rates with ring pessaries when cleaned and monitored every 6 months 2
• For long-term users, continuous use may be extended to:
  • 2 years in hysterectomized women
  • 4 years in non-hysterectomized women (if no complications occur) 3

Complications to Monitor

Regular changes are important to prevent complications such as:

• Vaginal discharge (most common - 26.5% of patients) 2
• Foul odor (13.3% of patients) 2
• Vaginal erosion or ulceration
• Embedding in vaginal epithelium (8.9% in long-term continuous users) 3

Practical Management Protocol

A simplified protocol for pessary management has shown good outcomes:

• Initial follow-up at 2 weeks after fitting
• Subsequent follow-ups at 3-6 month intervals 4

Special Considerations

• Patients using vaginal estrogen may have fewer complications and potentially longer intervals between changes
• Self-care is generally acceptable with ring pessaries but not typically with shelf/Gellhorn pessaries 1
• No serious complications were observed in patients following a protocol with 3-6 month follow-up intervals 4

Common Pitfalls to Avoid

1. Leaving pessaries in place too long (>6 months) without evaluation, which can lead to vaginal erosion or embedding
2. Failing to provide proper patient education about potential symptoms requiring earlier evaluation
3. Not considering the type of pessary when determining change frequency (shelf/Gellhorn typically require more frequent changes than ring pessaries)
4. Overlooking the need for vaginal estrogen in postmenopausal women using pessaries

While some evidence suggests longer intervals may be safe in certain populations, the most widely accepted practice based on expert consensus is changing pessaries every 3-6 months to minimize complications while maintaining effectiveness.