Vaginal estrogen administration to prevent cervical os obliteration following cervical conization in women with amenorrhea

Our goal was to evaluate the use of vaginal estrogen cream in preventing cervical os obliteration in postmenopausal patients undergoing cervical cone biopsies.

This study is a retrospective review of postmenopausal women who underwent cervical cone biopsies (laser or electrosurgical loop excision) in the author's practice. All patients were treated with 2 g of vaginal conjugated estrogen cream daily for 1 month following cone biopsy. The patients were seen 4 months later, and the cervix was evaluated. The percentage of women whose cervical os was patent, stenotic, or obliterated was compared to historical controls and, within this series, laser and electrosurgical loop excision groups were compared.

Seventeen patients underwent conization (8 laser conizations, 9 electrosurgical loop excisions) and postcone treatment with estrogen cream. On average, the patients were 59.4 years old and 10.7 years postmenopausal. The follow-up interval ranged from 2 to 10 months, with a mean of 4.4 months. In 10 patients, the cervix was patent, in 4 it was stenotic, and in 3 it was obliterated. The transformation zone was visualized fully in three patients before the cone biopsy and in three different patients after the cone biopsy. The outcome for patients treated with vaginal estrogen was significantly better (p < .013) than that for historical controls not treated with vaginal estrogen. However, the laser and electrosurgical loop excision groups differed significantly. Four of the eight laser patients had previous cervical treatment, compared with one of nine for electrosurgical loop excision. The laser group was not different from historical controls with regard to stenosis or obliteration, but the electrosurgical loop excision group had significantly less stenosis or obliteration than did either (p < .016). No trend could be identified regarding the length of the cone specimen between the laser and electrosurgical loop excision groups. All 5 patients with previous cervical procedures (but only 2 of 12 without previous procedures) developed stenosis or obliteration.

Larger randomized control trials are needed to determine if vaginal estrogen cream is beneficial in preventing cervical os obliteration in postmenopausal patients undergoing conization procedures; to compare laser and electrosurgical loop excision; and to determine the effect of previous cervical procedures on the rate of cervical os obliteration in these groups of patients.