POSTMENOPAUSAL ATROPHY IN ELDERLY WOMEN - IS A VAGINAL SMEAR NECESSARY FOR DIAGNOSIS

The diagnosis of post-menopausal atrophy should preferably be confirme d before any trial of oestrogen treatment for genito-urinary symptoms. The ideal method, cytological analysis of a vaginal wall smear, is no t always feasible in elderly women. Might physical examination alone b e sufficient? This study aimed to determine which clinical features mi ght best predict atrophy on the smear. Of 120 consecutive women admitt ed to an acute geriatric unit (mean age 82 years), satisfactory smears were obtainable from 70 (58%). Sixty per cent of these showed severe atrophy but almost one-fifth showed no atrophic changes. Degree of atr ophy correlated with physical thinness (p < 0.01), low parity (p < 0.0 1) and dryness on vaginal examination (p < 0.001). However, none of th e other physical findings traditionally thought to indicate atrophy we re found to be associated, nor were age or medication. In contrast, se vere atrophy was present in only one of nine women with breast cancer (p < 0.01). This merits further study.