| BackgroundCervical cancer is one of the main causes of cancer death among women in developing countries,and its prevalence and mortality are closely related to age.According to statistics,70%of cervical cancer patients are postmenopausal women,so it is very important to strengthen cervical cancer screening in this group.Colposcopy is at the core of cervical cancer screening strategy,which is used to evaluate abnormal cytology and screening results of high-risk HPV,which is helpful to identify possible cervical precancerous lesions and invasive cancer for early treatment.However,the changes of genital atrophy caused by low estrogen in postmenopausal women not only increase the difficulty of colposcopy,but also have a great impact on the reliability of colposcopy.This not only increases the pain suffered by patients during colposcopy,but also reduces the ability of colposcopy to detect early cervical lesions,or increases the risk of bleeding,infection and cervical adhesion atresia caused by unnecessary random biopsies or diagnostic cervical conization.The relevant guidelines suggest that the use of estrogen before colposcopy in postmenopausal women can improve the effect of colposcopy,but some systemic adverse reactions associated with the use of estrogen make this practice have some limitations.A series of problems such as how to improve the drug intervention scheme and the specific effects of estrogen therapy on the feasibility and accuracy of colposcopy need to be further studied.In this study,estrogen with strict local action,such as promestriene,was selected as an intervention drug to explore the significance of short-term clinical application of promestriene vaginal capsule in improving the quality of colposcopy in postmenopausal women.ObjectiveTo explore the effect of short-term local application of promestriene vaginal capsule on reducing pain and discomfort during colposcopy,improving the visibility of cervix and transformation area under colposcopy,and enhancing the ability to detect suspicious lesions under colposcopy.the role of improving the accuracy,sensitivity and positive predictive rate of colposcopy diagnosis.MethodsA prospective study was conducted on 168 postmenopausal women who were treated in the gynecology clinic of Shandong Provincial Hospital from October 2020 to December 2021.After the initial colposcopy evaluation,the subjects were treated with promestriene vaginal soft capsules(Lang Yi Geng Bao fen).The drug was given intravaginally one tablet per night,and the drug was stopped after continuous administration for 14 days.Colposcopy examination and questionnaire evaluation were carried out again within a week.Follow up the whole examination and treatment process of the patients,record the basic information,cytological results of the first diagnosis,high-risk HPV infection,colposcopy and so on.The changes of subjective pain score,the adequacy of colposcopy,the visibility of SCJ and the type of conversion area before and after treatment,the accuracy,sensitivity and predictive rate of lesions were compared before and after treatment,and the adverse reactions were collected and statistically analyzed.Results1.The average subjective pain score of patients in the initial colposcopy before drug intervention was 6.30 ± 1.86,and 89.0%of the patients had moderate or more pain.After drug intervention,the average subjective pain score was 3.69±1.45,and the patients with moderate or more pain accounted for 53.7%.There were significant changes in subjective pain score before and after treatment(P<0.001).2.10 patients(6.1%)received adequate colposcopy and 154 patients(93.9%)had inadequate colposcopy before drug intervention.After drug intervention,124 patients(75.6%)were assessed as adequate for the second colposcopy,and 40 patients(24.4%)were still assessed as inadequate.The adequacy of the second colposcopy was significantly improved after drug intervention,and the difference was statistically significant(χ2=163.97,P<0.001).Before drug intervention,6(3.7%)were visible in SCJ,33(20.1%)were partially visible in SCJ,and 125(76.2%)were invisible in SCJ.After drug intervention,10 cases(6.1%)were visible in SCJ,50(30.5%)were partially visible in SCJ and 104(63.4%)were invisible in SCJ.Compared with before and after treatment,the visibility of SCJ was increased,and the difference was statistically significant(Z=6.408,P<0.05),but it was significantly lower than that of colposcopy.Before drug intervention,the number of people assessed by colposcopy as type 1 conversion area was 6(3.7%),type 2 conversion area was 6(3.7%),and type 3 conversion area was 152(92.7%).After medication intervention,the number of people assessed by colposcopy as type 1 conversion area was 6(3.7%),type 2 conversion area was 10(6.1%),and type 3 conversion area was 148(90.21%).There was no significant difference before and after the intervention(Z=1.053,P>0.05).3.After drug intervention,23 patients were transferred to low-risk group for follow-up observation.In 76 patients who could not determine the location of the lesion by the first colposcopy,the location of the lesion was identified and localized biopsy was performed in the second colposcopy.The second colposcopy biopsy of 65 patients after treatment was basically the same as before.After medication intervention,the ability of located biopsy under colposcopy was improved,and unnecessary random biopsy under colposcopy was avoided in some patients,and there was a significant difference before and after treatment(Z=71.621,P<0.001).4.Before medication intervention,the overall coincidence rate of vaginoscopy diagnosis was 66.7%;the positive predictive value for HSIL and above lesions was 69.2%,the sensitivity was 70.9%,and the specificity was 80.0%.After medication intervention,the overall coincidence rate of vaginoscopy diagnosis was 74.5%;the positive predictive value for HSIL and above lesions was 85.7%,the sensitivity was 83.7%,and the specificity was 74.5%.After drug intervention,the accuracy of secondary colposcopy,the positive predictive rate of HSIL and above lesions and the sensitivity of colposcopy examination were improved.5.No clear reports of adverse reactions were obtained.Conclusion1.The short-term application of promestriene vaginal capsule to postmenopausal women before colposcopy can reduce the difficulty of colposcopy operation and reduce the pain of patients during the examination,which improves the feasibility of the examination to a certain extent.2.Short-term local application of estrogen can improve the visibility of neutron cervix and transformation area examined by colposcopy,enhance the ability to detect suspicious lesions under colposcopy,and improve the accuracy,sensitivity and positive predictive rate of colposcopy diagnosis.finally,the quality of colposcopy examination was improved.3.Compared with other drugs,the advantage of short-term use of promestriene vaginal capsule in postmenopausal women before colposcopy is that it shortens the treatment time and reduces the systemic adverse reactions of estrogen.it should be used as a recommended drug to improve colposcopy in postmenopausal women. |
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