title: Role of vaginal estradiol pretreatment combined with vaginal misoprostol for cervical ripening before operative hysteroscopy in postmenopausal women.
abstract: OBJECTIVE
  To assess the efficacy and safety of vaginal misoprostol after a pretreatment with vaginal estradiol to facilitate the hysteroscopic surgery in postmenopausal women.
  
  
  METHODS
  In this observational comparative study, 35 control women (group A) did not receive any pharmacological treatment,26 women (group B) received 25 µg of vaginal estradiol daily for 14 days and 400 µg of vaginal misoprostol 12 hours before hysteroscopic surgery, 32 women (group C) received 400 µg of vaginal misoprostol 12 hours before surgery.
  
  
  RESULTS
  Demographic data were well balanced and all variables were not significantly different among the three groups. The study showed a significant difference in the preoperative cervical dilatation among the group B (7.09±1.87 mm), the group A (5.82±1.85 mm; B vs. A, P=0.040) and the group C (5.46±2.07 mm; B vs. C, P=0.007). The dilatation was very easy in 73% of women in group B. The pain scoring post surgery was lower in the group B (B vs. A, P=0.001; B vs. C, P=0.077). In a small subgroup of women with suspected cervical stenosis, there were no statistically significant differences among the three groups considered. No complications during and post hysteroscopy were observed.
  
  
  CONCLUSIONS
  In postmenopausal women the pretreatment with oestrogen appears to have a crucial role in allowing the effect of misoprostol on cervical ripening. The combination of vaginal estradiol and vaginal misoprostol presents minor side effects and has proved to be effective in obtaining satisfying cervical dilatation thus significantly reducing discomfort for the patient.
authors.affiliation: Section of Gynecology and Obstetrics, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Luisa
authors.identifier: 0000-0003-0962-5237
authors.initials: L
authors.lastname: Casadei
authors.affiliation: Section of Gynecology and Obstetrics, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Piccolo
authors.affiliation: Section of Gynecology and Obstetrics, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Manicuti
authors.affiliation: Section of Gynecology and Obstetrics, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cardinale
authors.affiliation: Section of Gynecology and Obstetrics, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Collamarini
authors.affiliation: Section of Gynecology and Obstetrics, Academic Department of Biomedicine & Prevention and Clinical Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Piccione
keywords: Cervical ripening; Estradiol; Hysteroscopy; Misoprostol; Postmenopause