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The effect of Replens® on vaginal cytology in the treatment of postmenopausal atrophy: cytomorphology versus computerised cytometry
  1. J A W M van der Laak1,
  2. L M T de Bie2,
  3. H de Leeuw1,
  4. P C M de Wilde1,
  5. A G J M Hanselaar1
  1. 1Department of Pathology, University Medical Center, St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands
  2. 2Diagnostic Center Eindhoven, Stratumsedijk 28A, 5611 NE Eindhoven, The Netherlands
  1. Correspondence to:
 Dr J A W M van der Laak, Department of Pathology 437 PA, University Medical Center, St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands;


Background: After the menopause decreased concentrations of oestrogen may result in insufficient maturation of the vaginal epithelium, which can lead to a range of vaginal discomforts. This state of vaginal atrophy may be treated with oestrogen replacement treatment. Replens, a non-hormonal alternative to oestrogen replacement treatment has been shown to be effective in relieving symptoms related to vaginal atrophy in previous studies.

Aims: To study the effect of Replens on the maturation of the vaginal epithelium and morphology of the vaginal cells and to compare the results of a recently developed cytomorphometric method with manual assessment of the degree of maturation in vaginal smears.

Methods: Vaginal smears from 38 postmenopausal women suffering from symptoms related to vaginal atrophy were analysed manually and by cytomorphometry. The maturation value (MV) and the percentages of (para)basal, intermediate, and superficial cells (maturation index; MI) were measured by both methods before and after treatment with Replens. Cytomorphometry also measured mean cellular area, mean nuclear area, and mean area ratio.

Results: A correlation was shown between the two methods in the assessment of percentages of (para) basal and intermediate cells and MV. Cytomorphometric data showed a significant increase in mean cellular area, indicating a positive effect of Replens on the maturation of the vaginal epithelium. Changes in nuclear area and ratio between nuclear and cellular areas were not significant. Treatment with Replens did not influence MI or MV, as assessed by the two methods.

Conclusions: Replens did have an effect on vaginal morphology. The automated procedure may be useful for the assessment of maturation in vaginal smears and is more sensitive to small (subvisual) changes.

  • postmenopausal atrophy
  • vaginal maturation
  • maturation index
  • automated image analysis
  • CMA, cytomorphometric analysis
  • H&E, haematoxylin and eosin
  • I, intermediate cells
  • MI, maturation index
  • MV, maturation value
  • P, (para)basal cells
  • S, superficial cells

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  • Preliminary results of this work were presented as a poster at the 14th International Congress of Cytology, 27–31 May 2001, Amsterdam, The Netherlands.