What concentration of estrogen does the estrogen type of smear show?

Home / Other

Back

Published: 10/23/2020

Reading time: 7 min

0

28

• How does the mucous membrane change with the onset of menopause?
• Types of strokes
• Estrogen smear type: what is it? Peculiarities
• Cytology of the condition
• Changes during menopause

How does the mucous membrane change with the onset of menopause?

During menopause, the vaginal mucosa has the following types of cells: superficial, intermediate, parabasal, basal and keratinized. Squamous epithelial cells continue to mature and reach the surface layer of the vagina. Therefore, they predominate in the smear.

With a decrease in estrogen levels, cells from the deeper layers of squamous epithelium begin to appear: intermediate, parabasal and basal. With age, their number in a smear only increases. Against the background of reduced estrogen levels, smaller cells appear. They have an atypical shape, usually more elongated and sometimes bizarre.

Such cells have unclear outlines and different colors. They are not located separately, but in clusters. They have enlarged nuclei in which the nucleolus is not visible, although the membrane and chromatin are clearly visible. The cells have an increased amount of keratin, a protein that gives strength. Thus, they become rougher and partially keratinized.

The reduced level of estrogen during menopause leads to the fact that not all epithelial cells mature to the superficial row of the vagina and histiocytes and leukocytes begin to perform a protective function. It is important to know what the predominance of these elements in the mucous membrane indicates during menopause.

This is a signal that a woman has developed atrophic colpitis without an inflammatory process in the genitals. Therefore, not antibacterial treatment is prescribed, but hormonal drugs. At the same time, medications are prescribed to restore the normal level of acidity in the vagina, which is in the range of 3.8-4.4 pH.

Changes during menopause

Because epithelial cells are still “mature” and often reach even the surface layer of the vagina; they will be isolated in a smear in very large quantities.

When estrogen synthesis decreases, squamous epithelial cells appear. With age, their concentration increases more and more. When estrogen levels are low, the cells decrease in size and their shape becomes unusual and elongated. The shape and color may also vary.

They are localized in whole groups, and not separately. The cell nuclei are enlarged, but the nucleolus is not visible, only chromatin and the membrane can be seen. Due to the increase in keratin in their composition, i.e. protein, their density increases, which leads to partial coarsening and keratinization.

The decrease in estrogen concentration, which is observed during menopause, contributes to the fact that not all cells manage to fully mature to the superficial row of the vagina, so the protective function is performed by leukocytes and histiocytes.

Estrogen type of smear, what does it mean? In many women during menopause, the appearance of the smear remains unchanged; it contains squamous cells, which belong to the surface epithelium of the functional type.

In this case, the body’s high ability to compensate is noted, or hormonal therapy is carried out, in which the lack of estrogen is normalized by the artificial introduction of their analogues.

Types of strokes

Depending on the level of hormones and epithelial cells, cytological analysis can show several types of smears, in particular:

1. Estrogenic. This smear consists of flat surface cells that have degenerative changes in the cytoplasm (vacuolization) and basal folding of cell membranes. Individual nuclei and cell fragments are observed in the material.
2. Progesterone. It shows an increased number of intermediate layer elements that are prone to clumping.
3. Proliferative is characteristic of the first five years of menopause. It is characterized by a separate position of surface epithelial cells and a low concentration of leukocytes. Such smears are detected when progesterone production decreases, but estrogen is still synthesized in sufficient quantities.
4. The mixed type combines an approximately equal proportion of cells from the intermediate and superficial layers. Often this type of smear occurs in the initial period of menopause.
5. Atrophic (regressive). It is characterized by a predominance of parabasal epithelial cells over elements from other layers of the epithelium. Very often this type occurs in postmenopause.
6. Androgenic. It is determined when a collection of intermediate, parabasal and basal cells correlates with a small number of superficial ones. Such a smear may indicate the development of tumors of the ovaries and adrenal glands.
7. Inflammatory. This type of smear indicates the presence of fungi, trichomonas, cocci, and leukocytes. At the same time, the number of epithelial cells in the smear is sharply reduced.

During the period of menopausal changes, accompanied by large-scale restructuring in organs and systems, a certain imbalance is observed in the hormonal background. Very often, to assess it, as well as to exclude the development of pathological changes, it is necessary to conduct a study on estrogen levels. Information about estrogen saturation is provided by the estrogen type of smear.

Cytological evaluation of vaginal smears

The ovarian-menstrual cycle is associated with the formation and physiological action of hormones - estrogens.

The largest amount of them is produced in the middle of the cycle, i.e. before ovulation, least at the beginning and end of the cycle.

This leaves its mark on the cellular composition of the vaginal wall, which can be observed in smears prepared from vaginal discharge.

The epithelial layer lining the vagina consists of 3 (4) layers:

• Surface
• Intermediate
• Parabasal. (4. Basal)

Accordingly, in smears we find 3(4) types of epithelial cells (types):

1. Parabasal and basal – atrophy cells.
2. Occurs with hypo- and ovarian dysfunction, and during menopause.
3. Parabasal and basal cells are sometimes combined into one species (subgroup).
4. Based on the types of epithelial cells, 4 types of colpocytogram (cellular reactions) are distinguished, which can serve as a criterion for the hormonal function of the ovaries (the so-called hormonal mirror).

The first type: severe estrogen deficiency, the smear is dominated by cells of the basal and parabasal layer, many leukocytes - “atrophic smear.” In this condition, the vaginal mucosa is thin and consists of several layers of cells. Under physiological conditions, it occurs in childhood and late menopause.

Second type: In the smear, a significant number of parabasal cells, many intermediate cells, a significant number of leukocytes. Moderate severe degree of estrogen deficiency.

Third type: intermediate cells predominate in the smear, sometimes in layers, single parabasal cells, superficial cells appear - “mild estrogen deficiency” (or “moderate estrogenic activity”).

The fourth type: “normal smear”, consists of superficial cells. It is detected with good estrogen stimulation during a normal menstrual cycle at the time of ovulation.

Cyclic processes occurring in the ovaries (maturation of follicles, ovulation, development of the corpus luteum) and the formation of hormones cause phase changes in the vaginal mucosa. In a healthy woman of childbearing age, changes in the cellular composition of the vaginal smear occur throughout the two-phase 28-day menstrual cycle.

• As the follicle grows in the ovary and the production of hormones (estrogens) increases, the number of cells of the surface epithelium of the vagina increases (follicular phase).
• During the formation and dawn of the corpus luteum, the hormone progesterone manifests its activity, causing an increase in the number of intermediate cells and a decrease in the number of superficial cells of the vaginal epithelium (luteal phase).

Quantitative assessment of colpocytological data.

At different phases of the menstrual cycle in women of childbearing age, in vaginal smears, different ratios of 3 types of squamous epithelium are found in connection with which the corresponding indices are determined.

“Maturity index” is the percentage of parabasal, intermediate, superficial cells. A total of 200 cells are counted, the result is recorded as a percentage, as follows: on the left - the number of parabasal cells, on the right - superficial cells, in the middle - intermediate cells.

If any type of cells is missing, then the number zero (0) is placed in the corresponding corner. For example: 0/15/85, 0/10/90, 0/0/100.

The “karyopyknotic index” is the percentage of mature superficial cells with a pyknotic nucleus and superficial cells with a nucleus larger than 6 µm.

100 or 200 superficial cells are counted and the number of cells with nuclear pyknosis is noted among them. The result is expressed as a percentage.

This index characterizes the estrogen saturation of the body, since only estrogenic hormones cause proliferative changes in the vaginal mucosa, leading to condensation of the chromatin structure of the nuclei of epithelial cells.

“Eosinophilic index” is determined in smears stained with the polychrome method. This is the percentage of all mature superficial cells with eosinophilic cytoplasm and mature superficial cells with basophilic cytoplasm. Eosinophilia of the cytoplasm appears due to the accumulation of glycosaminoglycans in it under the influence of estrogens.

The “fold index” is the percentage of all folded mature surface cells and the number of flat mature surface cells. Twisting or folding of the edges of the cytoplasm of cells appears mainly with progesterone stimulation.

“Index of crowding, or grouping, of cells” - reflects progesterone stimulation of the vaginal epithelium. Progesterone causes desquamation of cells in layers, groups, clusters (4 or more). The grouping index is assessed descriptively or in points and pluses: severe crowding ( ), moderate ( ), weak ( ).

Degenerative changes in epithelial cells (cytolysis, autolysis), the number of leukocytes, erythrocytes, Dederlein rods, microorganisms and mucus are described.

Recently, fluorescent microscopy has been used to study the cytological picture of a vaginal smear.

Cytogram of a normal menstrual cycle.

Menstrual phase (1-5 days).

The cytological picture is blurred due to the presence of erythrocytes, leukocytes, histiocytes, and shapeless remains of cellular elements.

Early follicular phase (5-10 days).

The smears are dominated by cells of the intermediate layer, single parabasal cells, and single leukocytes. CI=30-40%, EI – up to 30%.

Late follicular phase (10-14 days).

The smear is dominated by mature superficial cells, which are located separately or tiled-like, only their edges overlap each other. Cell nuclei undergo pyknosis. White blood cells disappear. CI=60-80%, EI – up to 80%. The background of the stroke is light, transparent, there are Dederlein sticks.

Ovulation phase (14-15 days).

Estrogen levels reach the peak. Leukocytes and bacteria disappear from the smear. Superficial cells predominate with a pyknotic nucleus, abundant transparent cytoplasm, which do not form groups and are located separately. CI=80-90%, EI=70-80%.

Early luteal phase (15-18 days).

The level of estrogens drops, intermediate and superficial cells begin to gather in groups, the cytoplasm of the cells curls up, like the corners of an envelope. CI=60-70%, EI about 50%.

Late luteal phase (18-24 days).

Intermediate cells with large nuclei predominate in the smears. The cells are exfoliated in layers, the edges of the cytoplasm of the cells coagulate, mucus and leukocytes appear. CI=60-40%, EI=30-20%.

Premenstrual phase (24-28 days).

Characterized by desquamation caused by progesterone influence. Small cells of an intermediate type appear without clear contours with an oblong nucleus. Cells form large groups, sometimes layers without clear boundaries. The cells are stained basophilic. Cellular detritus, leukocytes, and a dirty background of the smear are observed. CI=40-30%, EI=20-10%.

Assessment of the degree of proliferation and progesterone activity

Hyperestrogenism. Increased production of estrogen can be observed during puberty or at the beginning of menopause, with small cystic degeneration of the ovaries, persistent follicle and other diseases.

Estrogen smear type: what is it?

The test that reveals the estrogenic type of smear is called colpocytology . The woman's secretions are collected from the lateral vaults of the vagina . Estrogen saturation is determined by stretching the vaginal mucus. With a large amount of estrogens, it is quite viscous.

The material is studied based on several types of reactions. These include:

• Deep type reaction;
• Mixed – deep type of reaction;
• Medium – mixed type;
• Surface type reaction;

With an estrogenic type of smear, a superficial type reaction is observed. With it, there are no basal cells . But there is a very high number of keratinized cells. There are practically no leukocytes. Normally, this condition occurs in the follicular phase of the menstrual cycle. The luteal phase is characterized by a medium-mixed type of reaction.

The estrogen type of smear in this period indicates the presence of hormonal problems in the woman’s body. In this case, competent treatment is necessary.

Peculiarities

If the results of the study reveal this type of smear, it means that there is an increased level of estrogen in the woman’s body, and, on the contrary, there is not enough progesterone. There is constant growth and division of the epithelium and its intermediate layers.

An estrogenic type of smear means that serious hormonal changes are occurring in the patient’s body.

When the concentration of progesterone produced decreases, the hormone (in the first phase of the cycle) may not go beyond normal limits. However, this is accompanied by the following manifestations:

• bleeding;
• chest pain;
• hair loss;
• deterioration of skin condition;
• increase in body weight.

Cytology of the condition

Detection of an estrogenic type of smear leads to the fact that the ovaries are initially affected, which begin to work worse. Next, the vaginal mucosa changes.

Although for some time there are no obvious manifestations, because some functions of the gonads are transferred to other organs, in particular to the adrenal glands. This is especially pronounced during menopause.

What exactly changes occur in the reproductive system? This is what it looks like:

• the epithelium gradually dies;
• estrogen concentration decreases, but very slowly;
• the epithelial structure changes shape, its individual parts become smaller;
• the cells become irregularly shaped and no longer function.

Please note that there are different types of tests:

1. Sometimes the results show that there is not enough estrogen, but then the basal cells dominate and large white blood cells are visible.
2. The second version of the study is when estrogen is in small quantities, but the indicators are not critical. Then parabasal cells are visible in greater numbers, interspersed with the intermediate layer and leukocytes are present.
3. Another result of the analysis is when there is a slight lack of estrogen and a superficial, intermediate epithelium is present.
4. In the fourth option, there is a sufficient amount of hormone, but there is not enough progesterone.

Only an experienced specialist should decipher the results of the study; he will be able to correctly compare all the obtained indicators, taking into account the woman’s age and cycle period.

Changes during menopause

When ovarian activity decreases and menopause occurs, hormonal levels change, and tests clearly show this.

Estrogen component of the body

A decrease in the amount of progesterone is detected by the estrogen type of smear, when the number of cellular elements is reduced. The cells themselves in this case are in a divided state and lack layers. The prognosis of conditions when the value of the karyopyknotic index (KPI) in smears is close to or equal in percentage to the surface cells is most often unfavorable.

In young women with preserved reproductive abilities and a menstrual cycle consisting of two phases, smears taken from the vaginal mucosa include intermediate cellular elements, as well as superficial ones, located in varying proportions. If the hormone estrogen is produced in insufficient quantities or during hyperandrogenism, when its amount is unreasonably exceeded, cells belonging to the parabasal type can be detected in the examined smears. Based on the ratio of superficial keratinizing cells to the total number of superficial cells, the KPI or karyopyknotic index is determined, which characterizes the body’s fullness of estrogens.

At each stage of the menstrual cycle, the amount of estrogen hormones in the smear must correspond to:

• when passing the follicular stage, the CPI is 25 - 30%;
• during ovulation - up to 70%;
• in the last stage, during which the development and maturation of the corpus luteum occurs - from 25 to 30%.

The use of estrogenic medications causes an increase in the CPI, and therefore a cytological examination of vaginal smears with the calculation of the CPI helps to monitor treatment with hormonal therapy.

What estrogen reactions can be studied

The condition of the uterus can be assessed by the following estrogenic reactions:

1. Significant estrogen deficiency. Most cells are basal particles with small nuclei. There are also a small number of white blood cells.
2. Moderate deficiency. The mucus is dominated by parabasal cells with large nuclei. In addition to them, there are single cells of the basal and intermediate layers, as well as single leukocytes.
3. Minor deficiency. Intermediate cells predominate. Superficial cells are found in small numbers.
4. Good estrogen saturation. The biomaterial contains many cells of the superficial layer of the mucosa, which are well defined and have a small nucleus.

Thus, the estrogen type of smear shows how many superficial cells with small nuclei are in the mucous membrane. The best results are with the fourth type of reaction, when estrogen in the woman’s body is well saturated.

During menopause, the estrogen type of smear is quite common. It indicates the body’s ability to well compensate for the lack of estrogen produced by the ovaries by the adrenal cortex. Or it indicates that the woman receives the missing sex hormones from appropriate hormone-containing medications.

It is important to know that the estrogen type of smear during menopause may indicate the development of a tumor in the uterus or ovaries.

If in postmenopause the cytoplasm acquires an unhealthy granular structure, this may indicate the presence of a tumor or inflammatory processes in the genital organs. Therefore, it is important to always carry out a comprehensive diagnosis.

Quantity matters

Based on the smear data, the karyopyknotic index (KPI) is calculated. This is the ratio of keratinized intermediate cells to the number of all superficial cells.

There is a KPI norm:

• for the first half of the cycle – 25-30%;
• during ovulation – up to 60-80%;
• for the second half of the menstrual cycle – up to 30%;
• in the postmenstrual period – up to 25%.

Cell counting and determination of CPI are complex studies. A small inaccuracy can completely change the index value and affect the diagnosis. Therefore, gynecologists conduct a comprehensive examination. To determine the degree of estrogen saturation, an additional method is used - mucosal tension.

To do this, use a special tool that resembles scissors to grab the mucous membrane and stretch it. At the same time, they measure how long the mucous layer was stretched.

The level of estrogen in a woman’s body is sufficient when the mucous membrane is stretched to 8 cm. If the CPI value is normal, then this is good. When the estrogen saturation of the smear is high, this is bad. Estrogen-dependent tumors can develop in the female body.

The woman is prescribed hormonal medications. In some cases, medications are prescribed that suppress estrogen synthesis and maintain progesterone levels. In other cases, a course of treatment with oral contraceptives is prescribed. During this therapy, the ovaries rest.

After completing the course of treatment, they begin to produce female sex hormones estrogen and progesterone within normal limits. But this effect does not work for all representatives of the fair sex.

Karyopyknotic index (KPI)

The indicator indicates the ratio of intermediate keratinized cells to the total number of superficial cells.

The norm in the postmenstrual period is up to 25%.

This study is quite complex. Even a slight inaccuracy in the result can lead to an incorrect diagnosis. Therefore, an additional study is carried out, which has a name, mucosal tension.

To carry it out, a special tool is used that resembles scissors in appearance. With its help, the mucous membrane is captured and stretched. Then it is measured how long the mucous layer can stretch.

Estrogen type of smear in menopause: reasons

During menopause, the most common type of smear is mixed .
It combines almost the same number of intermediate and superficial cells. In the estrogenic type of smear, superficial cells predominate in number. In addition, they have a small hypnotic core. The beginning of the climatic period is characterized by the presence of the body's ability to fertilize. This period lasts on average up to two years. Then the woman's reproductive function declines. Therefore, the estrogen type of smear during menopause is quite common. At the same time, menstruation disappears or becomes shorter.

There is an opinion that women who suffer from polycystic disease or multifollicular ovary during their reproductive years enter menopause much later than their peers. This is due to a large supply of unspent eggs that did not leave the follicles during reproductive age.

Main research indicators

When taking a vaginal smear from a woman of any age, including during menopause, the main focus is on three indicators:

1. The maturation index is the ratio of three different types of epithelial cells. They are called superficial, intermediate and basal. The laboratory produces an indicator of three numbers, which can be used to determine: when parabasal cells appear, ovarian failure is present. And with an increase in the number of surface cells, we can talk about a high estrogen content in a woman’s body.
2. Karyopyknotic index is the ratio of the amount of surface epithelium with pyknotic nuclei to the total number of cells found in the smear. With a high value of this indicator, we can talk about estrogen saturation of the body.
3. Eosinophilic index is the ratio of stained cells to their total number. Typically, this indicator is always slightly lower than the karyopyknotic index, but if the eosinophilic index increases, it is worth paying attention to other reasons that provoke abnormal indicators in the smear.

Why is the smear procedure prescribed?

The analysis is prescribed in cases where a simple ultrasound and manual examination becomes insufficient. The procedure allows you to identify and determine all abnormalities occurring in the female body, diagnose inflammatory processes and tumor formations in the early stages. By calculating the norm and deviation from the norm of certain cells, you can make a correct diagnosis and prescribe competent treatment. Without this data, it is impossible to diagnose the disease: one general blood and urine test does not provide the information necessary to prescribe a course of treatment.

Consequences

During menopause, the functioning of the ovaries decreases. With the development of estrogen deficiency, various menopausal disorders occur:

1. Vascular . Blood pressure changes, tachycardia, hot flashes, confusion, and constant drowsiness appear.
2. Urological . There is dryness, itching and burning in the vagina, and urinary incontinence.
3. Exchange.

Such changes develop after 3-5 years, when bleeding during menstruation has stopped. Then changes occur (functional and anatomical type) in the area of ​​the vagina, urethra, ureters and cervix, therefore, all manifestations only intensify.

In the presence of estrogen deficiency, a disorder occurs in the vagina (epithelium), cell division occurs very slowly and rarely, and sensitivity decreases.

If you regularly check the KPI and analyze the data obtained, it is possible to identify possible diseases even at an early stage of their development. Proper treatment will make it possible to avoid various negative health consequences.

Share link:

How is the analysis carried out?

This procedure, let’s not hide it, is not pleasant, but in reality, it does not fall into the category of painful. The analysis is carried out using a special spatula that collects mucus without damaging the walls of the mucous membrane and a gynecological speculum, which allows the doctor to see the walls of the cervix and visually determine its condition (when examining virgins, a mirror is not used).

The biological material taken during the procedure is then transported to the laboratory, where it is dried, stained for easier study and examined for the presence of fungi, mycelium, inflammatory mucus and other pathogenic cells, as well as for the presence of flora necessary for a healthy female body, the lack of which also indicates disease.

Decoding

Usually the patient is faced with such a problematic issue as deciphering the received study. What do the letters mean, and how scary is it?

“C” is not the name of some disease, as most women think when they look at the diagnostic sheet, but just an abbreviation for the cervix. The numbers located next to the letter indicate the number of detected cells in the collected biological material. Since the norm is calculated using rather complex mathematical formulas, you should not be afraid of the numbers.

"L" - leukocyte. In small quantities, these cells are a reliable defense of the body against pathogenic flora. They capture pathogens and destroy them. But after such a “fight,” the leukocytes themselves die. Therefore, any viral attack forces the restoration of the leukocyte background by taking medications. In excess, leukocytes can themselves become pathogenic flora.

"El" - epithelium. This is the general name for the cells that make up the protective mucous layer of the internal organ system. But the shape of the layer the epithelium takes is a sign of the presence of a particular disease. Norma - flat ep shape. The study also takes into account factors influencing the number of epithelium, such as:

• menopause cycle;
• use of antibiotics;
• use of hormonal drugs.

And finally, another commonly used abbreviation is “abs”. This abbreviation indicates the absence of any indicator, both positive and negative.

The concept of a smear on the flora is complex, multifaceted, requiring deep medical knowledge and research into the holistic picture of what is happening in the body. Of course, it is quite difficult for an ordinary person to comprehend this without medical training. It is enough for patients to know one thing - a smear allows them to detect it at an early stage of development and, based on the data obtained, to prevent it by prescribing competent treatment.

And finally, it remains to wish you health and peaceful skies above your head!

The estrogenic type of smear is revealed by a decrease in the blood of the hormone progesterone, determined during examination of mucus from the cervical canal, when measuring basal temperature and as a result of cytological examination of vaginal smears. With a cytological examination of vaginal smears during menopause, one can objectively assess the ability of the ovaries to fully function. Normally, the vaginal mucosa consists of 5 types of cells: superficial, keratinizing, intermediate, parabasal and basal.

Types of Estrogen Response

Such a smear allows you to assess the condition of the uterus and ovaries according to four characteristic types of estrogenic reaction:

• with the first type of reaction, there is a clear lack of estrogen and an increased number of leukocytes and atrophic cells;
• the second is characterized by a moderate estrogen deficiency, as well as the presence of leukocytes and atrophic cells, but their concentration is less than in the case of the first type;
• the third is characterized by an equal ratio of all types of epithelial cells;
• with the fourth type, the estrogen content is excessive.

During the premenopausal period, a smear with a slight increase in estrogen content can be considered a variant of the norm, since the reproductive system has not yet lost its reproductive function and the amount of estrogen is synthesized by the ovaries in sufficient quantities, in addition, the influence of changes in the general hormonal background is added. In this matter, it is the quantitative characteristics of the indicators that mean a lot.

As menopausal changes progress, the estrogen type of smear reveals an increased content of dying cells. In this case, there is a significant decrease in the amount of progesterone.

By the time of entry into postmenopause, leukocytes and cells that make up the basal layer are not detected in the smear. This period is characterized by a change in the structure of the cytoplasm (the internal environment of the cell) - its granularity and heterogeneity are observed. This may be a symptom of trouble, for example, indicating the development of inflammation.

The estrogenic type of smear in menopause is more common in women with increased body weight, which is probably explained by the fact that adipose tissue cells are also capable of synthesizing estrogens along with the adrenal glands.

To determine the quantitative ratio of epithelial cells, the karyopyknotic index (KPI) is used, which is calculated by the ratio of the number of surface cells with a pyknotic nucleus (that is, a wrinkled nucleus that has been exposed to a pathological factor) to the total number of all epithelial elements. It is the indicator of the quantitative ratio of elements that helps determine the estrogen saturation of the body. For the menopausal period, the level of the CPI should not be higher than 25%; during postmenopause, its indicators should be within 10-20%.

Possible diagnoses

Sometimes the estrogen type of smear in combination with certain indicators of leukocyte concentration can cause the diagnosis of atrophic colpitis. It must be remembered that the usual form of this disease is provoked by pathogenic microflora, which means that the therapeutic course involves taking antibacterial medications.

Atrophic colpitis is a diagnosis that does not require similar therapy. This is how it is customary to designate the natural biological processes occurring in the female body (the estrogen type of smear indicates them). Many people mistakenly believe that any colpitis is an inflammation that needs to be dealt with as early as possible. Atrophic does not belong to this category, so the doctor does not prescribe treatment similar to the usual form of the disease. If such a diagnosis is made and no specific therapy is prescribed, do not panic: it is not a matter of the specialist’s qualifications, he is doing the right thing.

Smear during menopause: interpretation and deviations of indicators

During menopause, a vaginal smear is given to all women who consult a doctor with symptoms of menopause. And this is not without reason, because a smear shows the state of health or unhealth of the genital tract. And when hormone levels decrease, this is reflected in the results of laboratory tests.

Main research indicators

When taking a vaginal smear from a woman of any age, including during menopause, the main focus is on three indicators:

1. The maturation index is the ratio of three different types of epithelial cells. They are called superficial, intermediate and basal. The laboratory produces an indicator of three numbers, which can be used to determine: when parabasal cells appear, ovarian failure is present. And with an increase in the number of surface cells, we can talk about a high estrogen content in a woman’s body.
2. Karyopyknotic index is the ratio of the amount of surface epithelium with pyknotic nuclei to the total number of cells found in the smear. With a high value of this indicator, we can talk about estrogen saturation of the body.
3. Eosinophilic index is the ratio of stained cells to their total number. Typically, this indicator is always slightly lower than the karyopyknotic index, but if the eosinophilic index increases, it is worth paying attention to other reasons that provoke abnormal indicators in the smear.

The activity of progesterone in a woman’s body during menopause is evidenced by the appearance of crowded cells, and sometimes even entire layers.

Smear cytology

Under the influence of decreased hormone levels, the ovaries are the first to suffer. Following the fading of their function, the vaginal mucosa begins to undergo changes.

Changes in the genital organs do not occur immediately, since some of the functions are transferred to other endocrine glands. In particular, during menopause, the adrenal glands support a function similar to that of the ovaries.

This allows a woman to feel menopausal changes less sharply.

That is why smear cytology in menopause at the initial stage shows cells of dead epithelium, still maturing due to the activity of the adrenal glands.

When estrogen levels decrease, cells from the deep layers of epithelial tissue first appear in the smear. The shape of the epithelial cells themselves also changes - their size decreases, they acquire an atypical shape, become more elongated, and sometimes just bizarre.

In a smear, epithelial cells are located either singly or in clusters. Single cells retain their clear boundaries, while cells clustered in groups lose their smooth lines.

The nuclei of epithelial cells become much larger, the membrane becomes clearly visible, and chromatin is noticeable. At the same time, the nucleolus of the epithelial cell cannot be identified. Epithelial cells acquire different colors, despite their uniformity.

In epithelial cells, you can notice an increased content of keratin - it is this protein that gives the cells elasticity. However, with an increase in keratin content, the cells become more coarse and keratinized.

Since insufficient estrogen is produced during menopause, epithelial cells do not mature completely. Thus, they cannot fully perform the function of surface cells, including protective ones.

To protect the vagina from various damages and infections, the body in menopause begins to secrete histiocytes and leukocytes in significant quantities, which take over these functions.

In some cases, when a significant number of leukocytes are detected, doctors diagnose atrophic colpitis. Indeed, leukocytes and histiocytes are markers of inflammation, and such a diagnosis is to some extent justified.

However, the nature of atrophic colpitis is somewhat different: if ordinary colpitis is caused by pathogenic microorganisms and requires the prescription of antibacterial drugs, then atrophic colpitis does not need such treatment, because this is a natural reaction of a woman’s body to the aging processes that occur in her.

In this case, you should not direct all your efforts to stop the inflammatory process, which is not such.

It is important to provide the woman with such conditions to “grow” the epithelium to the top row or at least the intermediate one.

In this way, the vaginal lining will be restored to its maximum and begin to perform its natural functions, and the number of leukocytes and histiocytes will decrease on its own.

What is an estrogen smear?

Among gynecologists there is a stable expression estrogen smear. Is it good or bad when a woman has just such a smear?

Not all representatives of the fair sex have an estrogen smear during menopause. The essence of such a smear is that the number of cells of the surface epithelium, which performs the main protective function of the vagina, practically does not change. This means that the level of estrogen in a woman’s body is so high that it allows this type of smear to appear.

The reason for the estrogenic type of smear is the body’s ability to compensate for the lack of sex hormones and primarily estrogen.

Also, an estrogen smear may appear when a woman receives treatment aimed at maintaining hormonal balance.

Hormone replacement therapy helps to maintain normal vital parameters, so the smear will be “like a young person.”

However, such indicators do not always please doctors, who, based on objective indicators, see that the woman is approaching menopause.

In some cases, maintaining high estrogen, and therefore ensuring an estrogen smear, can be a consequence of malignant processes localized in the uterus or ovaries.

Classification of estrogen smears

Doctors distinguish several types of estrogen smears, each of which will characterize its owner in its own way.

1. The first type of smear determines severe estrogen deficiency. Cells of the basal layer predominate, but there are also single large leukocytes in the smear.
2. The second type is observed with moderate estrogen deficiency. In such a smear, parabasal cells with large nuclei will predominate. Single cells of the basal layer and intermediate layer, as well as single leukocytes, may be encountered.
3. Slight estrogen deficiency is observed when intermediate epithelium is detected with preservation of surface epithelial particles. This is what the third type of smear looks like.
4. If the body is well saturated with estrogen, doctors diagnose the fourth type of smear - it is dominated by surface epithelial cells with fairly small nuclei, the shape of most cells is correct. Thus, if a woman has such a smear result, doctors draw a conclusion either about increased estrogen production or about progesterone deficiency. A definitive diagnosis can be made after obtaining a blood test for hormones.

Consequences of changes in menopause

Hormonal disorders occurring in the body provoke not only changes in the smear, but also the standard symptoms of menopause: hot flashes, sweating, pressure changes, and depressed mood.

After about five years, these symptoms will be accompanied by unpleasant changes in the vagina, when itching and burning in the genital area begins. At this stage, estrogen deficiency can no longer be replenished by the body’s own forces, and cells begin to divide much more slowly.

The development processes of the epithelial layer are disrupted, the sensitivity of the receptors with which the vagina is equipped changes.

The progression of changes in menopause leads to an even greater change in the readings in the smear, and their norm can no longer be the same.

In particular, the norm of lactobacilli also undergoes changes. These bacteria are constantly present in the intestines and vagina. The main role of lactobacilli is to protect the vagina from unwanted microflora, which can provoke inflammatory processes.

By producing lactic acid, lactobacilli create an acidity level in the range of 3.8-4.4 - these are optimal indicators at which pathogenic microorganisms do not multiply. When the acidity boundaries shift, the vaginal flora suffers.

A vaginal smear shows a decrease in acid levels, and as a result, you can notice an increase in the level of leukocytes precisely from the activation of opportunistic microorganisms.

The consequences of a decrease in lactobacilli can be seen with the naked eye when examining a woman.

Menopause is accompanied by a decrease in blood supply, a decrease in collagen levels, a decrease in lactobacilli and glycogen levels, and an increase in vaginal acidity to 5 units or higher.

Reasons for increasing the level of leukocytes in a smear

If a vaginal smear shows a level of white blood cells that is atypical for this period, then this may indicate a number of diseases that women may suffer during menopause. Among the causes of leukocytosis we list the following:

• Nonspecific vaginitis - provoked by Escherichia coli, streptococci or staphylococci. With this disease, the level of leukocytes is significantly increased, cells of the surface layer of the epithelium are practically absent, and at the same time a significant amount of desquamated epithelium is determined.

• Bacterial vaginosis - outwardly has all the signs of an inflammatory process, but opportunistic microorganisms are not detected. Today the disease is classified as dysbacteriosis. A vaginal smear reveals many gram-positive cells - desquamated epithelium covered with small bacteria. Typically, such cells are not found in women, but in menopause, 94 percent of smears have this characteristic. The number of lactobacilli is also significantly reduced, due to which the acidity level increases, and anaerobes are present.

• In some cases, an increase in leukocytes indicates sexually transmitted infections - trichomoniasis, gonorrhea, candidiasis. In a vaginal smear, you can notice not only all the signs of the inflammatory process, but also identify the causative agent of the disease.

A vaginal smear during menopause is a powerful diagnostic indicator that allows you to assess a woman’s health.

The information content of a smear is valuable not only for assessing the condition of the vagina - a smear can also indicate the activity of the main female hormones - esterogen and progesterone.

It is the failure in the production of these substances that is the first signs of menopause.

Therefore, even at a stage when the actual manifestations of menopause may not yet be noticeable, a vaginal smear becomes a valuable diagnostic material, on the basis of which it is possible not only to confirm or refute a preliminary diagnosis, but also to prescribe and monitor treatment for menopausal manifestations.

on this topic:

Source: https://VKlimakse.ru/mazok-pri-menopauze.html

What to do in this situation?

When, after studying the test, an estrogen type of smear was obtained, you must first understand whether it meets the standards.

Experts use the karyopyknotic index when the number of surface and epithelial structures is compared.

During menopause, the indicator should be within 25%, at the time of postmenopause - up to 20%.

The choice of therapy depends on the underlying cause and is chosen by the doctor taking into account the state of health:

• Inflammation and infections of the genital organs , which affect the condition of the epithelium. In this case, it is recommended to take antibiotics or immunomodulators.
• Benign neoplasms . They require monitoring and, if necessary, removal, for example, using laparoscopy.
• Malignant tumors . They require immediate removal and further chemotherapy.

The estrogen type of smear does not always indicate the presence of problems. It is important to take into account the period and age of the patient and, if necessary, conduct additional research. Only then can you get an accurate result and talk about the scale of the problem.

If there are tumors, hormonal disorders or inflammations, with timely treatment, they can be eliminated. After surgery, estrogen and progesterone levels return to normal.

The main thing is not to forget about preventive examinations and pay attention to changes in well-being (lack of ovulation, bleeding, pain).

When there is reason to worry

Sometimes the doctor may conclude that the estrogen type of smear is bad. As a rule, concerns arise when a woman is obviously approaching menopausal age, and the body’s indicators remain at the same level as they were in youth, while there are no external factors in the form of hormonal therapy and taking medications that affect the production of active compounds.

It is known that elevated estrogen levels can be provoked by malignant processes in the body. If such a cause is suspected, the ovaries and uterus are carefully examined to eliminate the possibility of such a diagnosis or confirm fears.

Is treatment required?

Therapy for estrogen saturation depends on the causes that provoked it. Determining the source that caused the increase in estrogen concentration in the smear and its elimination is the main focus of treatment.

If serious pathologies of the reproductive organs are not confirmed by a comprehensive examination, then to stabilize hormonal levels, as well as to prevent the development of pathological processes in the future, the woman may be prescribed hormone replacement therapy. Often, one of the treatment options may be the prescription of oral contraceptives. In this case, drugs are selected that allow harmonizing the ratio of estrogen and progesterone according to age indicators. As a rule, they act by suppressing the synthesis of estrogen and replenishing the lack of progesterone.

Cytological examination of mucous material from the cervix helps to recognize the development of abnormal processes in the early stages, saving time and providing more gentle treatment of gynecological diseases. To make the most of the essence of this diagnostic method, a woman should regularly visit her gynecologist: at least once a year during reproductive age, and after entering menopause - every six months. This need is explained by the instability of the hormonal background of a woman during menopause, which often becomes a provocateur of the development of hormone-dependent diseases, including cancer.

What treatment is needed?

A high degree of estrogen saturation in a smear may indicate the presence of serious diseases in a woman’s body. Most often, the nature of their appearance is hormonal in nature. Therefore, hormonal drugs are used as treatment. In some cases, a course of oral contraceptives .
During the treatment period, the ovaries rest, then the withdrawal effect kicks in. After a woman stops drinking OK, the ovaries begin to work with a vengeance. But this principle does not work in all cases. Drugs may be prescribed to maintain progesterone levels and suppress the growth of estrogen.

The complex of measures taken has some nuances, so in no case should you self-medicate. Only a gynecologist or endocrinologist has the right to prescribe the necessary medications. Since any hormonal drug is selected individually for each girl. It is important to determine the cause of estrogen saturation in the smear. Perhaps the woman has physiologically too thick ovarian walls, which does not allow the egg to leave the follicle. Due to this, there is no decrease in estrogen in the second phase of the cycle. In this case, laparoscopic surgery . It is not an abdominal operation; despite this, the woman is under anesthesia. Small punctures are made in the lower abdomen through which a special instrument is inserted. With its help, incisions are made on the ovaries. Thanks to this, ovulation appears in the next cycle, and the hormonal system returns to normal.

Therapy

With a sufficient level of estrogen, the mucous membrane can stretch up to 8 cm. If this value was obtained during the study, this is an excellent indicator. The presence of high estrogen saturation of the smear contributes to the development of estrogen-dependent tumors.

As a treatment, the woman is prescribed HRT. In certain cases, taking into account test results, medications are prescribed to suppress estrogen synthesis and maintain progesterone concentrations. It is also possible to stabilize the condition with the help of oral contraceptives, which allows the ovaries to “rest” a little.

When the course of treatment is completed, hormone synthesis stabilizes.