Immunoreactive plasma estrogens and vaginal hormone cytology in postmenopausal women

Vaginal pH is similar to follicle-stimulating hormone for menopause diagnosis

OBJECTIVE

This paper is intended to demonstrate whether vaginal pH value is associated with menopausal status and symptoms, to review the sensitivity of follicle-stimulating hormone or vaginal pH to diagnose menopause, to compare these findings to a group of practice patients, and to determine whether vaginal pH could be used in place of follicle-stimulating hormone as an initial screen to determine menopause.

STUDY DESIGN

Sixteen studies regarding vaginal pH and menopausal symptoms before and after estrogen administration were analyzed. Two epidemiologic studies that reported follicle-stimulating hormone or vaginal pH with menopause were reviewed. These findings were compared with similar data from the practice of one of the authors (J.C.C.).

RESULTS

Menopausal women who do not receive estrogen therapy have a weighted average vaginal pH of 6.0, which is reduced significantly to 4.5 with estrogen therapy. To diagnose menopause, follicle-stimulating hormone >or=15 or >or=20 mIU/mL in the Third National Health and Nutrition Examination Survey had a sensitivity of 65% to 68%. In a study in Costa Rica, where 3 definitions of menopause were used, a pH of >5.0 had a sensitivity of 64% to 67%. From the practice patients, the 95% confidence interval sensitivities and positive predictive values of vaginal pH and follicle-stimulating hormone to diagnose menopause overlapped, while a pH <or=4.5 indicated mid follicular phase estradiol levels.

CONCLUSION

In women without vaginitis and no estrogen therapy, a vaginal pH of > 4.5 indicates menopause, because it demonstrates a similar sensitivity as follicle-stimulating hormone in epidemiologic studies. In the practice patients, the sensitivity of follicle-stimulating hormone was no different than vaginal pH in the diagnosis of menopause. Furthermore, with estrogen therapy, a vaginal pH of <or=4.5 indicates a mid follicular phase estradiol.

The vaginal epithelium in the postmenopause--cytology, histology and pH as methods of assessment

In the study of postmenopausal vaginal oestrogen deficiency, an objective assessment of the vaginal epithelium is necessary. The present study was undertaken to evaluate different methods for assessing the vaginal epithelium, during atrophic and mature conditions. The vaginal epithelium was assessed by clinical examination, pH and vaginal cytology, including morphometric analysis, before and after oestrogen treatment. Biopsies of the vaginal wall were studied using descriptive histology and immunohistochemistry methods. The antigen Ki-67, a sensitive marker of cell proliferation, was detected using the monoclonal antibody MIB1. When comparing pre- and post-treatment values from the methods, a shift towards mature values was observed, but the magnitude of the shift differed to a considerable extent. Vaginal cytology, expressed as mean maturation index (MI) shifted significantly from 94/6/0 to 0/65/35. Likewise, mean pH was significantly shifted from 6.2 to mean 4.5. The increased presence of Ki-67 positive cells could be demonstrated after oestrogen treatment, but the range of data was wide, which was also found for the thickness of the epithelium and the number of cell layers. For objective assessment of the vaginal epithelium maturation index and pH can be recommended.

The correlation of serum estrogens and androgens with bone density in the late postmenopause

A pilot group of 16 women in the late postmenopause were evaluated for bone density by computerized axial tomography (CT) scanning and for hormonal milieu. A highly statistically significant positive correlation between lumbar-3 spongiosum density and both dehydroepiandrosterone-sulfate (DHEA-S), r = 0.67; P less than 0.005 and androstenedione (A), r = 0.56; P less than 0.03 was found. No such correlations were observed with estradiol (E2), estrone (E1) or an array of other hormones. The results of this preliminary report indicate a clear association of weak androgens with bone density in the late postmenopause.