Cytologic evaluation of hormonal dynamic in the postmenopause

Effects of intravaginal dehydroepiandrosterone on vaginal histomorphology, sex steroid receptor expression and cell proliferation in the rat

OBJECTIVE

Recent clinical studies have shown that postmenopausal hormone therapy with estrogen plus progestogen increases breast cancer risk. Moreover, intravaginal estrogen-containing pills, creams and rings lead to significant systemic exposure to estrogen, thus indicating the need for a completely novel approach to alleviate vaginal atrophy in postmenopausal women.

DESIGN

We have studied the effect of intravaginal application of dehydroepiandrosterone at daily doses of 0.33 mg, 0.66 mg or 1mg in ovariectomized animals for 2 weeks, with the objective of inducing local beneficial effects in the vagina without significant systemic action.

RESULTS

After 2 weeks, serum dehydroepiandrosterone, androst-5-ene-3beta,17beta-diol and dehydroepiandrosterone-sulfate were increased over a 4h time period, but serum testosterone, estradiol, estrone and dihydrotestosterone remained below detectable levels. The suppository vehicle alone produced minimal epithelial thickening limited to the vaginal distal half. The morphological effects of dehydroepiandrosterone on vaginal mucosa were observed at the lowest dose and consisted mainly of a typical androgenic effect of epithelial mucification. No change in morphological features related to cell proliferation was observed at any dehydroepiandrosterone dose on uterus, mammary gland and skin. At the highest dose, body weight showed a significant decrease, thus indicating a systemic effect on lipid accumulation. Immunohistochemistry for androgen, estrogen alpha and progesterone receptors did not reveal any significant systemic effects in the uterus, mammary gland and skin except some suggestion of increased androgen receptor labeling in mammary gland and skin at the highest dehydroepiandrosterone dose.

CONCLUSION

The present data show that intravaginal dehydroepiandrosterone can exert beneficial effects limited to the vagina.

Cigarette smoking and other correlates of cytologic estrogen effect in postmenopausal women

Cigarette smoking and other factors associated with estrogen-related diseases may influence risk through hormonal mechanisms. To investigate the sex hormone associations of these risk factors, vaginal scrape cytology specimens and questionnaire data were obtained on 215 postmenopausal women at the time of routine pelvic examination. All specimens were read blindly by one cytologist, and the relationships between the indices of maturation and risk factors were assessed with regression techniques. Current cigarette smoking and obesity were associated with increased maturation. In contrast, years past menopause, parity, and coffee and tea consumption were all unrelated to vaginal epithelial maturation. These results elucidate the mechanisms underlying the antiestrogenic effect of cigarette smoking and support the concept that obesity is associated with an estrogenic effect.