Vaginal Estradiol Research Articles

Comparison of Vaginal versus Oral Estradiol Administration in Improving the Visualization of Transformation Zone (TZ) during Colposcopy.

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. The present study was conducted with the aim to compare the efficacy of vaginal versus oral estradiol administration in overcoming incomplete colposcopy. 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. 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. Both vaginal and oral estrogens had comparable efficacy and similar adverse effect profile in improving visualization of the TZ.

Role of vaginal estradiol pretreatment combined with vaginal misoprostol for cervical ripening before operative hysteroscopy in postmenopausal women.

ObjectiveTo assess the efficacy and safety of vaginal misoprostol after a pretreatment with vaginal estradiol to facilitate the hysteroscopic surgery in postmenopausal women.MethodsIn 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.ResultsDemographic 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.ConclusionIn 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.

Use of vaginal estrogen in Danish women: a nationwide cross‐sectional study

We know little about the use of vaginal estrogen in perimenopausal and postmenopausal women. We aimed to assess the prevalence of vaginal estrogen use in Denmark. The study was designed as a nationwide cross-sectional study of all Danish women aged 40-79 years, living in Denmark during the period 2007-2013. The Danish Prescription Register delivered data permitting us to assess the prevalence, age and regional geographical belonging of women purchasing prescribed vaginal estradiol. The number of women using over-the-counter vaginal estriol products was estimated from sale statistics from the same register. In 2013, 10.2% of all Danish women between 40 and 79 years of age used vaginal estradiol. The prevalence of women using this type of vaginal estrogen increased from 8.5% in year 2007 to 10.2% in 2013. The use peaked at 16.5% in women aged 60-74 years. The vaginal tablet was purchased more than the vaginal ring. We found no relevant difference in use between the five regions of Denmark. Taking the sale of vaginal estriol into account, the prevalence of vaginal estrogen use in 2013 could be estimated to a total of 12.1%. Comparing our result to the prevalence of urogenital atrophy-related symptoms reported in the literature, our study suggests an under-diagnosis and under-treatment of this condition. Teaching women and primary-care physicians about symptomatic urogenital atrophy and its treatment options may increase the quality of life for many women.

One-year treatment persistence with local estrogen therapy in postmenopausal women diagnosed as having vaginal atrophy.

Estrogen therapy is considered to be the most effective treatment of vaginal atrophy (VA) symptoms. This retrospective study compares rates of pharmacy refill-based treatment persistence in women treated for VA with local estrogen therapy (LET) creams versus low-dose vaginally administered tablets. Study cohort included treatment-naive women aged 45 years or older within the IMS PharMetrics Plus claims database who filled one or more prescriptions for a LET cream or tablet between January 1, 2010 and September 30, 2012. Index LET was the first observed LET claim in pharmacy records. Persistence was defined as the number of consecutive days of treatment available of the index LET during the 12-month follow-up period. In adjusted analyses, we compared the risks of discontinuation of index therapy. Of 30,197 women eligible for analysis, 12,187 (40.4%) initiated treatment with conjugated estrogens vaginal cream, 11,574 (38.3%) initiated treatment with estradiol vaginal cream, and 6,436 (21.3%) initiated treatment with 10-μg vaginal estradiol tablets (formulation introduced in 2010). Cohorts were comparable on age, geography, and baseline comorbidities. During the 12-month follow-up period, 86.2% to 89.4% of cream users discontinued LET after the first prescription compared with 57.8% of tablet users (P < 0.0001). A greater proportion of tablet initiators than cream users were fully (100%) persistent during the 12-month follow-up period. Mean treatment duration was 103.4 days for tablets versus 44.6 to 48.1 days for creams (P < 0.0001). After adjustment for baseline characteristics, tablet initiators had a lower risk of discontinuation compared with cream users (P < 0.0001). Low-dose LET tablets, compared with cream formulations, are associated with greater persistence in the treatment of VA.

A new solubilized vaginal estradiol in a VagiCap™ for the treatment of vaginal atrophy

approved by regulatory agencies worldwide for these indications. The use of HT has declined during the past 12 years in response to the Women’s Health Initiative (WHI) trials. Paradoxically, the use of non-FDAapproved compoundedhormone therapy (CHT) has increased. Recent studies reported that up to 2.5millionUSwomen use non-FDA approved compounded HT containing 17 -estradiol and progesterone annually [1]. The use of compounded HT in the European Union (EU) is not well characterized but is also likely increasing. Non FDA-approved compounded 17 -estradiol and progesterone are often used in varying combinations without the benefit of adequate testing for safety, efficacy and quality of manufacturing. This is a public health issue of great proportion and is often occurringwithout the recognitionofhealth careproviders and their patients as many of them lack knowledge about the differences in testing and oversight of FDA approved and regulated products versus compounded products [1,2]. Up to now, no single product combining natural 17 -estradiol and progesterone has been approved by the US Food and Drug Administration (FDA) or the European Medicines Agency (EMA). The phase 3 REPLENISH trial is underway to study a novel oral formulation of solubilized 17 -estradiol and natural progesterone combined in a single softgel capsule (TX-001HR; TherapeuticsMD) for treating vasomotor symptoms (VMS) in postmenopausal women. The REPLENISH trial evaluates the efficacy and safety of 4 doses of TX-001HR versus placebo for the reduction of moderate to severeVMS frequency and severity at 4 and12weeks andevaluates the endometrial safety of the combinations at 1 year. TX-001HR contains hormones that are molecularly identical to endogenous estradiol and progesterone and is intended as an option for women who prefer bioidentical hormones; further, it does not contain peanut oil, a common allergen. Published data suggest a safer profile of estradiol and natural progesterone compared with HT containing conjugated equine estrogens and progestins [3]. The type of progestogen included in HT may influence the incidence of breast cancer [4]. Observational studies have reported that oral estrogens natural and progesterone has no effect on increasing breast cancer risk as opposed to oral estrogens combined with various progestins [4].

Failure to improve a thin endometrium in the late proliferative phase with uterine infusion of granulocyte-colony stimulating factor

Purpose: To determine if the treatment with uterine infusion of granulocyte colony-stimulating factor (G-CSF) can improve endometrial thickness in an infertile woman with a double uterus, who consistently showed a thin endometrium in the late proliferative phase either in controlled ovarian hyperstimulation (COH) IVF-ET cycles or with graduated estrogen/sildenafil protocols for frozen embryo transfer (ET). Materials and Methods: A single uterine infusion of G-CSF was performed in the late proliferative phase in a woman who only attained a five-mm thickness despite a high dose vaginal and oral estradiol regimen plus sildenafil. Results: No increase was found within a couple days. Conclusions: A previous four-case study in another center found 100% improvement in the endometrial thickness in women with consistently thin endometria. Perhaps the uterine anomaly in the present case prevented the response of the endometrium.

Endometrial preparation protocol of the frozen-thawed embryo transfer in patients with polycystic ovary syndrome.

To assess which is the optimal protocol in terms of endometrial preparation prior to frozen-thawed embryo transfer (FET) in women with polycystic ovarian syndrome (PCOS) and to explore the effect in stimulated cycle with the addition of vaginal 17-β oestradiol. Five hundred and seventy-six patients with PCOS were prepared for FET using artificial cycle induced with oestradiol and progesterone supplementation (n = 291) and stimulated cycle induced by human menopausal gonadotrophin (HMG) within or without the addition of vaginal 17-β oestradiol (n = 285). Then the FET was performed in a receptive endometrium. Endometrial thickness was similar (9.03 ± 1.65 vs. 9.12 ± 1.58, P > 0.05) in artificial and stimulated cycle. The two protocols resulted in clinical pregnancy rate (41.0 % vs. 41.6 %, P > 0.05), ongoing pregnancy rate (36.6 % vs. 34.7 %, P > 0.05), live birth rate (30.0 % vs. 31.7 %, P > 0.05), which were not statistically different. Nevertheless, the cancelled cycle rate made a significant difference (2.2 % vs. 5.4 %, P < 0.05). There is no significant difference in the clinical pregnancy rate in HMG, HMG added with vaginal oestradiol and HMG switch to vaginal oestradiol group (42.6 %, 41.1 %, and 33.3 %, respectively). The mean endometrial thickness, clinical pregnancy rate, ongoing pregnancy rate, live birth rate and implantation rate were similar in artificial and stimulated cycle for endometrial preparation prior to FET in PCOS. It was fine to add vaginal 17-β oestradiol to stimulated cycle when necessary. However, stimulated cycles had a significantly higher cancelled cycle rate. We should follow the principles of individualization, securitization and optimization in endometrial preparation of the FET in patients with PCOS.

Serum progesterone concentration on day of embryo transfer in donor oocyte cycles

To evaluate the association between serum progesterone (P) levels on the day of embryo transfer (ET) and pregnancy rates in fresh donor IVF/ICSI cycles. Fresh donor cycles with day 3 ET from 10/2007 to 8/2012 were included (n = 229). Most cycles (93%) were programmed with a gonadotropin releasing hormone (GnRH) agonist; oral, vaginal or transdermal estradiol was used for endometrial priming, and intramuscular P was used for luteal support (50-100mg/day). Recipient P levels were measured at ET, and P dose was increased by 50-100% if <20ng/mL per clinic practice. The main outcome measure was rate of live birth (> = 24weeks gestational age). Generalized estimating equations were used to account for multiple cycles from the same recipient, adjusted a priori for recipient and donor age. Mean recipient serum P at ET was 25.5 ± 10.1ng/mL. Recipients with P < 20ng/mL at ET, despite P dose increases after ET, were less likely to achieve clinical pregnancy (RR = 0.75, 95% CI = 0.60-0.94, p = 0.01) and live birth (RR = 0.77, 95% CI = 0.60-0.98, p = 0.04), as compared to those with P ≥ 20ng/mL. P dose increases were more often required in overweight and obese recipients. Serum P levels on the day of ET in fresh donor IVF/ICSI cycles were positively correlated with clinical pregnancy and live birth rates. An increase in P dose after ET was insufficient to rescue pregnancy rates. Overweight and obese recipients may require higher initial doses of P supplementation. Future research is needed to define optimal serum P at ET and the interventions to achieve this target.

Vaginal Misoprostol versus Vaginal Estradiol in Overcoming Unsatisfactory Colposcopy

Background: Unsatisfactory colposcopy, an inability to visualize the entire transformation zone, is found in about 10-20% of the patients undergoing the procedure. These patients usually require conization for a comprehensive evaluation of the cervix. Our study aims to compare the efficacy and safety of vaginal misoprostol versus vaginal estradiol in overcoming unsatisfactory colposcopy. Methods: We studied 48 women with unsatisfactory colposcopy. They were randomized into two groups: group I (n = 24) received 200 µg misoprostol vaginally and colposcopy was repeated after 6 h, while the subjects in group II (n = 24) were prescribed a 7-day course of 50 µg estradiol for vaginal insertion followed by a repeat colposcopy. The efficacy and safety of these two drugs were compared. Results: Repeat colposcopy was satisfactory in 70.8% of the women given vaginal misoprostol compared to 82.6% of the women who used vaginal estradiol. The difference was not statistically significant. The adverse effects were reported more often by the women in the misoprostol group (41.6%) as compared to those in estradiol group (13%) (p = 0.04). Conclusion: Both estradiol and misoprostol were comparable in overcoming unsatisfactory colposcopy. However, a higher incidence of adverse effects was noted with misoprostol as compared to estradiol.

Nonsurgical Management of a Rectovaginal Fistula Caused by a Gellhorn Pessary

Pessaries are generally thought to be a safe, well-tolerated treatment for pelvic organ prolapse. An 85-year-old woman had a Gellhorn pessary placed for pelvic organ prolapse. Although she was seen regularly for care, the pessary had not been removed for several years. She presented stating that she felt the pessary had shifted. On examination, the patient's pessary stem had eroded through the vagina into the rectum. The pessary was removed and the patient was treated with vaginal estradiol cream. One month later the fistula tract had resolved and the patient continued to desire a pessary to manage her pelvic organ prolapse. Pessaries require care and maintenance. Patients' desires for conservative management should be coupled with education and routine follow-up.

Improved compliance and patient satisfaction with estradiol vaginal tablets in postmenopausal women previously treated with another local estrogen therapy

Up to half of all postmenopausal women will experience changes in the genitourinary tract induced by the hypoestrogenic state, collectively known as vaginal atrophy. Vaginally administered local estrogen therapy (LET) is the standard of care for symptoms of vaginal atrophy that do not respond to nonhormonal interventions. Several LET formulations are available, and choice of therapy is based largely on patient needs and preferences. This online survey of postmenopausal LET users was conducted to investigate reasons for switching to vaginal estradiol tablets from other formulations and to evaluate factors associated with patient preference for and compliance with use of LET. Data was analyzed from 73 respondents currently using estradiol vaginal tablets who have previously used the estradiol vaginal ring, estradiol vaginal cream, and/or conjugated estrogen vaginal cream. Patients in this survey rated vaginal symptoms of vaginal atrophy as being more bothersome than urinary symptoms. Respondents preferred their current treatment with the vaginal tablet to their previous treatment with a cream or ring. The preference for tablets over creams was mainly related to formulation and application rather than to any perceived safety issues. Tablets were perceived as efficacious, convenient, and neat to apply. The study participants also reported a longer duration of tablet use compared with creams or rings, and greater compliance with vaginal tablets than with vaginal cream. This study provides new insights into reasons for patient noncompliance with estrogen cream or ring therapy that can be used to maximize patient adherence with LET.

Juvenile granulosa cell tumor presenting as isosexual precocious puberty: A case report and review of literature

The differential diagnosis for precocious puberty in a young female includes peripheral causes. This case report documents a rare cause of isosexual precocious puberty, a juvenile granulosa cell tumor of the ovary–and a brief literature review. A 7-year-old girl presented with rapid onset of pubertal development and elevated estradiol levels. Abdominal ultrasound revealed a mass in the right adnexa. Other causes of precocious puberty were excluded. Elective surgery was planned, but the patient presented to the emergency room with torsion of ovary. She underwent an exploratory laparotomy for tumor resection and right salpingo oophorectomy. Pathology reported a juvenile granulosa cell tumor of the ovary. Postoperatively, she experienced a cessation of vaginal bleeding and estradiol levels normalized. Early stage disease has good prognosis. Adjuvant chemotherapy is not indicated in this setting.

Transdermal and vaginal estradiol for the treatment of menopausal symptoms

Transdermal and vaginal estradiol for the treatment of menopausal symptoms

Higher than expected estradiol levels in aromatase inhibitor-treated, postmenopausal breast cancer patients

ABSTRACTObjective Vaginal estradiol is considered contraindicated in aromatase inhibitor (AI)-treated patients because of the risk of elevated estrogen levels. This leaves limited treatment options for patients experiencing gynecological symptoms. However, in clinical practice, no precise estimation has been performed of circulating estrogens and aromatase index in postmenopausal breast cancer patients on long-lasting AI or tamoxifen treatment.Methods Steroid hormones were measured using liquid chromatography tandem mass spectrometry (LC–MS/MS) and extraction radioimmunoassay (RIA). Postmenopausal AI-treated patients (n =33) were compared with tamoxifen-treated patients (n =34) and controls without vaginal treatment (n =56), with vaginal estradiol (n =25), or with estriol (n =11) treatment.Results By use of LC–MS/MS, median (range) estradiol plasma concentrations were 16.7 (2.4–162.6), 31.0 (13.4–77.1), 27.2 (7.8–115.8) and 33.3 (20.3–340.1) pmol/l in AI-treated breast cancer patients, tamoxifen-treated breast cancer patients, postmenopausal controls and postmenopausal controls on vaginal estradiol, respectively. The AI-treated group and subgroups had significantly lower estradiol and estrone concentrations than all other groups (p <0.05). There was extensive interindividual variation in estradiol concentration within the AI-treated group, measured using both LC–MS/MS (2.3–182.0 pmol/l) and extraction RIA (2.4–162.6 pmol/l). The AI-treated group had lower aromatase index compared to all other groups (p <0.05–0.001).Conclusion Circulating estrogen levels may have been underestimated in previous longitudinal studies of AI-treated breast cancer patients. Additional studies are required to further evaluate the role of circulating estrogens in breast cancer patients suffering from gynecological symptoms.

Endometrial response to concurrent treatment with vaginal progesterone and transdermal estradiol

ABSTRACTObjective To describe the effect of the intermittent administration of vaginal progesterone and a low-dose estradiol patch on endometrial stability, as assessed by the rate of amenorrhea and endometrial stimulation.Methods This was an open study in which 64 moderately symptomatic, postmenopausal women were treated in the outpatient clinic of our University Hospital for different intervals up to 1 year. The treatment consisted of a combination of patches delivering 25 µg/day estradiol and intravaginal pills containing 100 mg of micronized progesterone. Patches and pills were administered concomitantly in a twice-a-week protocol. The endometrial response was assessed by endovaginal ultrasound completed with suction biopsy when required.Results Both cumulative amenorrhea and no-bleeding rates increased progressively and reached 88.9% and 100.0%, respectively, by the 12th month. Isolated or repetitive episodes of bleeding, bleeding and spotting, or only spotting were reported by three, four, and 12 women, respectively. Endometrial thickness remained unaltered. Endometrium was atrophic in the seven women in whom a biopsy was performed.Conclusion The substantially reduced progestogen load determined by this combination achieved an acceptable incidence of spotting or bleeding when associated with a low estrogenic dose. There was no apparent endometrial stimulation. Additional studies are required to confirm this observation.

Vaginal Misoprostol vs Vaginal Misoprostol With Estradiol for Labor Induction: A Prospective Double Blind Study

To compare the safety and effectiveness of vaginal misoprostol with combined vaginal misoprostol and estradiol for induction of labor in unfavorable cervix. A prospective study was carried out from Jan 2008 to Jul 2008 on total of 90 women with unfavorable cervix (Bishop's score was <5) and gestation >36weeks with clinical indication for induction of labor. They were randomly assigned to receive either vaginal misoprostol 25μg alone or vaginal misoprostol 25μg with vaginal estradiol 50μg. Misoprostol alone was repeated every 3h in both groups till ripening of cervix (Bishop's score was=8) and establishment of active labor. Main indications were post dated pregnancies (period of gestation >41weeks) and pregnancy induced hypertension. Age, parity and mode of delivery were not significantly different. No significant difference was found in pre induction Bishop's score, fetal outcome and maternal complications. However, doses of misoprostol required for cervical ripening (p=0.017), time required for cervical ripening (p=0.042), time required for starting of active labor (p=0.017) and time required for delivery in vaginal delivery cases (p=0.047) were found significantly less in combined estradiol and misoprostol group. Estradiol acts synergistically with misoprostol vaginally and significantly hastens the process of cervical ripening, initiation of active labor and vaginal delivery.

Live Birth After Allografting of Ovarian Cortex Between Genetically Nonidentical Sisters

Options available to preserve fertility in women who need to undergo aggressive chemotherapy include embryo, oocyte, and ovarian tissue cryopreservation. When none of these options are available or appropriate at the time of treatment, allografting should be considered for a patient who has not undergone previous oocyte, embryo, or ovarian tissue cryopreservation. Allografting has the potential to restore ovarian activity and natural fertility. In a recent report, allografting of ovarian cortex between genetically nonidentical sisters restored ovarian function in 3 cases. The present report describes the first pregnancy and live birth in one of these cases. The patient was a 32-year-old woman who had presented with homozygous sickle cell anemia in 1992 at 15 years of age and at that time received chemotherapy (busulfan, cyclophosphamide) and total body irradiation before bone marrow transplantation; the donor was her human leukocyte antigen (HLA) genetic-compatible sister. Subsequent HLA group analysis showed complete chimerism (HLA compatibility) between the sisters. To restore ovarian function in this patient who was planning to be married, an allograft was performed using ovarian tissue from the same sister who had donated bone marrow 17 years earlier. Immunosuppressive treatment was not required, and there was no sign of rejection. Three and a half months after reimplantation, restoration of ovarian function was demonstrated by increased vaginal estradiol levels and follicular development (detected with ultrasound). The patient showed regular ovulatory cycles for 9 months but failed to become pregnant because of proximal tubal occlusion (unknown at the time of the procedure); this made microsurgical anastomosis impossible. Therefore, in vitro fertilization was mandatory. Sixteen months after grafting, stimulation was initiated. Subsequently, 3 oocytes were retrieved and 2 embryos obtained; one was frozen and the other transferred, resulting in an ongoing intrauterine pregnancy. The patient was followed up every 3 weeks and delivered a healthy baby girl weighing 3.150 g at 37 2/7 weeks of gestation. These findings describe the first pregnancy to occur after ovarian cortex allografting between sisters who are genetically different but fully HLA compatible due to previous bone marrow transplantation.

Identifying and Treating Sexual Dysfunction in Postmenopausal Women: The Role of Estrogen

Sexual dysfunction is a common, but frequently overlooked, problem in postmenopausal women. At menopause, dramatic decreases in circulating estrogen concentrations cause physiologic changes that may affect sexual function, most notably the development of vulvovaginal atrophy. Vulvovaginal atrophy often leads to vaginal dryness, itching, irritation, reduced lubrication, dyspareunia, and vaginal bleeding associated with sexual activity. Estrogen deficiency also can affect other aspects of sexual function, including reduced vaginal blood flow and a reduced capacity for arousal and orgasm. As estrogen loss is a significant cause of sexual dysfunction in menopausal women, estrogen therapy is a logical treatment option in this population. Although both systemic and local estrogen therapy improve vaginal health and sexual functioning, local vaginal therapy with estrogen creams, rings, or tablets may be more appropriate for women without other indications for systemic estrogen therapy. These therapies are highly effective in reversing vaginal atrophy, improving vaginal symptomatology, and reducing dyspareunia, and may have effects on other dimensions of sexual function. Emerging treatments, such as ultra-low-dose vaginal estradiol tablets, new selective estrogen receptor modulators (SERMs), and intravaginal dehydroepiandrosterone (DHEA) are other promising options for postmenopausal women with vaginal atrophy and sexual dysfunction.

Female reproductive behaviour, ovarian hormones and vaginal cytology of the induced ovulator, Ctenomys talarum

In the present study, we evaluated whether reproductive condition affects female reproductive behaviour in the induced ovulator Ctenomys talarum. We also explored the effect of the interaction with a male on the reproductive condition of females. To evaluate this, we arranged mating trials and evaluated female reproductive behaviour. Reproductive status of females was evaluated using a combined approach of vaginal smears, urinary progesterone and oestradiol, and ovarian histology. Behaviours denoting attraction (‘male sniff’ and ‘mount attempts’) and mutual courtship behaviours (‘spin’ and copula) were correlated with vaginal cytology before and oestradiol and progesterone levels in urine 12 h after male–female encounter. After 24 h of the interaction, oestradiol levels and vaginal epithelization increased while progesterone levels decreased in soliciting females. C. talarum females’ reproductive behaviour was related to its physiological reproductive state and vaginal cytology. The kind of male interaction, whether couples copulated or remained indifferent affected the later status of females. Females are induced ovulators by mating but male presence and interaction also affected other components of their reproductive physiology such as ovarian hormones and vaginal cytology.

Current Overview of the Management of Urogenital Atrophy in Women with Breast Cancer

Systemic treatments for women with breast cancer frequently induce urogenital symptoms that can negatively impact a women's quality of life. Urogenital atrophy is frequently undiagnosed and untreated, particularly in breast cancer survivors. Symptoms of urogenital atrophy can usually be relieved with vaginal estrogen preparations, but risk of recurrence and safety is undefined in women with a history of breast cancer. Treatment with nonhormonal modalities including vaginal moisturizers or lubricants and lifestyle modification are the first lines of management. Low-dose vaginal 17 β-estradiol (vaginal estradiol tablets 10 μg or vaginal estradiol ring) can be considered for the treatment of symptomatic urogenital atrophy in women with a history of breast cancer after appropriate disclosure to the patient. While effective in treating the urogenital symptoms, the safety of such therapy remains uncertain. The decision to offer vaginal estrogen therapy needs to be individualized and should be made jointly with the oncologist.