title: Comparison of Vaginal versus Oral Estradiol Administration in Improving the Visualization of Transformation Zone (TZ) during Colposcopy.
abstract: BACKGROUND
  Colposcopy is an important diagnostic tool in the evaluation of patients with abnormal pap smears. However, in 10-20% transformation zone (TZ)/squamo-columnar junction is not completely visualized and these patients are deemed to have an incomplete colposcopy examination. Such patients usually require conization, a procedure associated with significant morbidity. Various agents like misoprostol, estrogens and laminaria tents have been used in the past to overcome the non-visualization of TZ.
  
  
  OBJECTIVE
  The present study was conducted with the aim to compare the efficacy of vaginal versus oral estradiol administration in overcoming incomplete colposcopy.
  
  
  METHODS
  Forty patients with non/partially visualized TZ during colposcopy were recruited for the study. These patients were randomly distributed into two groups: In Group I, 25μg estradiol was administered intravaginally daily for seven consecutive days followed by a repeat colposcopy on day 8. In Group II, a seven day course of 25μg oral estradiol was followed by a repeat colposcopy on day 8. The efficacy of the two regimens in improving visualization of the TZ on colposcopy and their adverse effect profile was compared.
  
  
  RESULTS
  Vaginal estradiol had an overall efficacy of 70% in improving visualization of the TZ as compared to oral estradiol which was effective in 50% of patients (p-value-0.19). Major adverse effects in both the group of patients were nausea and vaginal discharge with no significant differences among the two groups.
  
  
  CONCLUSIONS
  Both vaginal and oral estrogens had comparable efficacy and similar adverse effect profile in improving visualization of the TZ.
authors.affiliation: Consultant, Karan Hospital , Bijnour, Uttarpradesh, India .
authors.forename: Seema
authors.initials: S
authors.lastname: Beniwal
authors.affiliation: Clinical Associate, Fortis Hospital , Shalimar Bagh, New Delhi, India .
authors.forename: Binni
authors.initials: B
authors.lastname: Makkar
authors.affiliation: Head of Department, Department of Obstetrics and Gynaecology, Hamdard Institute of Research and Medical Sciences , New Delhi, India .
authors.forename: Swaraj
authors.initials: S
authors.lastname: Batra
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, Maulana Azad Medical College , New Delhi, India .
authors.forename: Gauri
authors.initials: G
authors.lastname: Gandhi
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, Maulana Azad Medical College , New Delhi, India .
authors.forename: Deepti
authors.initials: D
authors.lastname: Goswami
authors.affiliation: Senior Specialist, Department of Obstetrics and Gynaecology, Safdarjung Hospital , New Delhi, India .
authors.forename: Vijay
authors.initials: V
authors.lastname: Zutshi
keywords: Cervical cancer; Estrogens; Squamo-columnar junction