title: 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.
authors.affiliation: Division of Cytopathology, Institute of Cytology and Preventive Oncology, NOIDA, India. sanjaydr17@hotmail.com
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Neeta
authors.initials: N
authors.lastname: Kumar
authors.forename: Niti
authors.initials: N
authors.lastname: Singhal
authors.forename: Usha
authors.initials: U
authors.lastname: Manektala
authors.forename: Shyama
authors.initials: S
authors.lastname: Jain
authors.forename: Pushpa
authors.initials: P
authors.lastname: Sodhani
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000473:pathology; D002584:Cervix Uteri / Q000187:drug effects / Q000473:pathology*; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis; D004847:Epithelial Cells / Q000187:drug effects / Q000473:pathology; D004967:Estrogens / Q000494:pharmacology* / Q000627:therapeutic use; D005189:False Positive Reactions; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007778:Lactobacillus / Q000472:pathogenicity; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects*; D011374:Progesterone / Q000494:pharmacology* / Q000627:therapeutic use; D002578:Uterine Cervical Dysplasia / Q000473:pathology; D014621:Vagina / Q000187:drug effects / Q000382:microbiology / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods*
chemical_list: D004967:Estrogens; D011374:Progesterone