9 Things to Know About Pessaries as a Non-Surgical Option for Prolapse and Bladder Support in Menopause
There is something quietly devastating about the number of women who spend years avoiding trampolines, long walks, and laughing too hard at dinner — never knowing a fitted pessary could give them their body back. This is one of those topics where the gap between what exists and what women are actually told feels genuinely unfair. If this is new information, that is not a personal failing — it is a gap in the system.
Learn more about Rose →A pessary is a removable silicone device that provides internal structural support
A pessary is a small, medical-grade silicone insert placed inside the vagina to support pelvic organs that have shifted out of position due to prolapse, or to reduce leakage caused by urethral hypermobility. Unlike surgery, it does not alter anatomy permanently — it works mechanically, holding structures in a more functional position. Most women cannot feel a correctly fitted pessary during daily activities, and many describe the relief as immediate.
Prolapse and bladder leakage become more common in menopause for direct physiological reasons
Estrogen plays a critical role in maintaining the strength and elasticity of pelvic floor connective tissue, the vaginal walls, and the urethral lining. As estrogen declines during perimenopause and menopause, these tissues thin, lose collagen, and provide less structural support — a process called genitourinary syndrome of menopause (GSM). This is why prolapse symptoms and stress urinary incontinence often emerge or worsen significantly during this life stage, even in women who have had no previous issues.
There are multiple pessary types, and the right shape depends on the specific problem being addressed
Ring pessaries are the most commonly fitted and work well for mild to moderate uterine or bladder prolapse; they are also the easiest for women to manage themselves. Gehrung and Gellhorn pessaries are used for more advanced prolapse, while incontinence dish pessaries are specifically shaped to reduce stress urinary incontinence by supporting the urethra. A clinician — typically a urogynecologist, gynecologist, or specialist pelvic health nurse — will assess the type and severity of prolapse before selecting the most appropriate design.
Fitting is a clinical process that usually takes one or two appointments
Pessary fitting involves a pelvic examination to assess the degree of prolapse and vaginal dimensions, followed by a trial of one or more sizes to find the best fit — similar in concept to fitting a diaphragm. The woman is then asked to walk around, cough, and bear down to confirm the pessary stays in place and causes no discomfort. A follow-up appointment within two to four weeks is standard, and once the right fit is confirmed, many women go months between clinical check-ins.
Success rates are high, and many women use pessaries for years without problems
Studies show that between 60 and 90 percent of women who undergo pessary fitting are successfully fitted and continue using their pessary at one-year follow-up, making it one of the more effective conservative interventions in pelvic floor medicine. Long-term continuation rates vary depending on prolapse severity and individual preference, but many women use pessaries for a decade or more. Discontinuation is most often due to difficulty with self-management rather than device failure or discomfort.
Self-management — removing, cleaning, and reinserting the pessary at home — is achievable for most women
Ring pessaries in particular are designed for self-management; women can be taught to remove them for cleaning with mild soap and water, then reinsert them, typically on a weekly or fortnightly schedule. Self-management reduces the burden of frequent clinic visits and gives women greater autonomy over their own pelvic health. Research consistently shows that women who manage their own pessaries report high satisfaction and have comparable complication rates to those who rely on clinic-based care.
Vaginal estrogen significantly improves pessary tolerance and reduces complications in menopausal women
Atrophic vaginal tissue — thin, dry, and less elastic due to estrogen deficiency — is more prone to irritation, discharge, and minor abrasion from a pessary. Topical vaginal estrogen (cream, ring, or pessary form) restores tissue integrity, increases lubrication, and meaningfully reduces the risk of pessary-related complications including erosion and odour. Most specialists now recommend vaginal estrogen as a routine companion to pessary use in postmenopausal women, and the evidence for this combination is robust.
Pessaries are not just for older women or those who have given birth vaginally
While prolapse is more common in women who have had vaginal deliveries or who are postmenopausal, it can affect women across a wide age range, including those who are nulliparous or who delivered by caesarean section. Pessaries are used successfully across this full spectrum and are considered a first-line option before surgery is even discussed, regardless of age. The assumption that pessaries are only a last resort or only relevant to older women is one of the most persistent and unhelpful myths in this space.
A pessary does not prevent future surgical options and can be stopped at any time
One of the most common hesitations women express is a concern that choosing a pessary somehow closes off the surgical route — it does not. Pessaries are entirely reversible; stopping use does not alter the anatomy or affect surgical candidacy. For women who are undecided about surgery, or who want to delay it, or who simply prefer a non-surgical path, a pessary offers an effective holding option that can be used as long as it continues to work well.
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