title: Abnormal cervicovaginal cytology, unsatisfactory colposcopy and the use of vaginal estrogen cream: an observational study of clinical outcomes for women in low estrogen states.
abstract: OBJECTIVE
  To determine the effectiveness of vaginal estrogen cream to improve the rate of satisfactory colposcopy and subsequent smear result in patients in a hypoestrogenic state and an abnormal Papanicolaou smear. To delineate between abnormal smears secondary to atrophy and inflammation from preneoplastic change and suggest an effective treatment strategy to deal with this challenging situation.
  
  
  METHODS
  Patients with abnormal cervicovaginal smears who were in a low estrogen state (postmenopausal or amenorrheic postnatal) undergoing colposcopy were identified. All patients had an unsatisfactory colposcopy and were treated with vaginal estrogen cream twice per week for 6 weeks and underwent repeat colposcopy, smear and targeted biopsy where required.
  
  
  RESULTS
  Fifty-four patients had an abnormal smear and were clinically in a low estrogen state, with four having previously had a hysterectomy. After 6 weeks of vaginal estrogen therapy, 32 out of 50 patients' colposcopic examinations were satisfactory. Also, 40 out of 54 patients' smears returned to normal after treatment. Of the 14 patients with persistent smear abnormalities, only three were diagnosed with true high-grade pre-invasive disease.
  
  
  CONCLUSIONS
  The use of vaginal estrogen cream for patients with smear abnormalities and a low estrogen status improves the satisfactory colposcopy rate and improves the accuracy of the prediction of true high-grade pre-invasive disease. This treatment may then reduce the number of patients that require definitive treatment for their screen-detected abnormalities in this patient population.
authors.affiliation: Sydney Gynaecology Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Richards
authors.forename: Chris
authors.initials: C
authors.lastname: Dalrymple
mesh_terms: D000282:Administration, Intravaginal; D065309:Atypical Squamous Cells of the Cervix / Q000187:drug effects / Q000473:pathology*; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D004967:Estrogens / Q000008:administration & dosage* / Q000172:deficiency; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D065006:Papanicolaou Test; D017698:Postmenopause / Q000097:blood; D014621:Vagina / Q000473:pathology*; D014626:Vaginal Smears
chemical_list: D004967:Estrogens
keywords: Papanicolaou test; atrophy; unsatisfactory colposcopy; vaginal estrogen therapy