Cytohormonal and morphological alterations in cervicovaginal smears of postmenopausal women on hormone replacement therapy

Abstract

The objective of the study was to study the cytohormonal and morphological alterations in cervicovaginal smears associated with the use of hormone replacement therapy (HRT) and to assess the utility of vaginal cytology in determining the response to HRT. Ninety postmenopausal women (30 on estrogen-progesterone combination (HRT) for 1 to 24 mo (user 1), 30 on estrogen therapy (ERT) for 1 to 44 mo (user 2), and 30 not on any hormones (nonusers)) were included in the cross-sectional study. Their lateral vaginal wall smears and cervical smears were examined for hormonal and morphological assessments, respectively. The smear pattern showed predominance of parabasal cells in 46.6% of nonusers, while none of the users had >70% parabasal cells. A high percentage (>70%) of intermediate cells was found in 46.6% of users and only in 16.6% of nonusers. A high maturation value (MV) was found in more than 75% of users but in only 16.6% of nonusers. The women with high MV (>50) were significantly less symptomatic than did nonusers. Atrophic changes were present in cervical smears of 14/20 (46.6%) nonusers when compared with 1/60 (1.66%) users. Atypical squamous cells of undetermined significance (ASC-US) were diagnosed in seven users and three nonusers. It persisted on follow-up in four users and one nonuser. Histology revealed one mild dysplasia among users. Lactobacilli were more frequently observed in users. The cytohormonal pattern on vaginal smears correlates well with the response to hormonal therapy and clinical symptoms. Awareness of the morphological alterations associated with the use of replacement hormones would enable the cytologists to reduce the false-positive diagnoses while evaluating postmenopausal smears.

Effect of hyaluronic acid and vitamin E vaginal tablets on atrophic vaginitis: A randomized controlled trial

“…Then, for other 14 days, the administration of one suppository per day, one day in one day out. The results showed a marked effect of the tested product on the vaginal dryness and on all other symptoms and signs with statistically significant reductions since the first week of treatment (Gupta et al, 2006). We have also found comparable results with those two trials.…”

“…Consequently, women with atrophic vagina may have problems including sexual dysfunction, pain, bleeding, and loss of vaginal elasticity. The degree of estrogen deficient vaginal atrophy can be evaluated subjectively from the patients' symptoms and/or vaginal examination, and objectively from vaginal pH testing and/or vaginal cytology (van der Laak et al, 2002;Gupta et al, 2006;Nilsson et al, 1995). Brizzolara in the United States found that a vaginal pH > 4 is associated with the increase in number of parabasal cells (≥ 20%) in smears from the proximal to mid vagina.…”

Cytohistologic Correlation in Premenopausal and Postmenopausal Women

“…The incidence of finding dysplasia decreases with age [6,7]. The cervical mucosa undergoes morphologic variations with age, and practising cytopathologists must be keenly aware of these differences in order to make accurate diagnoses [8]. Atrophic changes in postmenopausal patients due to lack of estrogenic stimulation can pose diagnostic challenges because they may simulate high-grade dysplasia morphologically [9].…”

17β-Estradiol Protects Primary Macrophages Against HIV Infection Through Induction of Interferon-Alpha

“…Estrogen induces thickening of the vaginal epithelium in postmenopausal women on hormone replacement therapy (14,33) and in ovariectomized macaques (44,45). Additionally, in humans, it also rapidly keratinizes the inner foreskin, the site for HIV entry in the penis (38), and may protect men against HIV.…”