Estriol suppositories enhance colposcopy sufficiency and diagnostic accuracy in postmenopausal women: a comparative study

OBJECTIVES: Postmenopausal estrogen deficiency leads to atrophy of the urogenital tract and atrophic vaginitis, which can impact the results of colposcopy. This study evaluated the benefits of estriol suppositories on colposcopy sufficiency, diagnostic accuracy, and patient comfort in postmenopausal women. METHODS: A prospective intervention group of 95 postmenopausal women was enrolled. All participants received 0.5 mg estriol suppositories for 20 days before colposcopy. This prospective intervention group was compared with a historical control group of 101 women who had received other medications. Outcomes, including colposcopy sufficiency, visibility of the squamocolumnar junction (SCJ) and transformation zone (TZ), diagnostic agreement rate between colposcopy diagnosis and histopathology, and pain degrees, were assessed. The diagnostic agreement rate between colposcopic diagnosis and pathological diagnosis was analyzed using Kappa analysis. RESULTS: Within the prospective intervention group, colposcopy sufficiency was significantly improved after pretreatment (χ 2 =85.011, P <0.001). However, no significant change was found in visibility of the SCJ (2.11% vs. 4.21%, P =0.683) and TZ types (χ 2 =0.167, P =0.683). The weighted kappa was 0.584 ( P <0.001), indicating a moderate degree of consistency. Pain degrees were significantly reduced after pretreatment ( P <0.001). 10.53% of participants experienced adverse events. After propensity score matching (n=58 per group), the prospective intervention group demonstrated a significantly higher sufficiency compared with the historical control group (94.83% vs. 67.24%, χ 2 =14.360, P <0.001). There were no statistically significant differences in SCJ visibility or TZ type between the two groups (both P >0.05). The weighted kappa between the two groups was 0.001 ( P =0.011), indicating an extremely low degree of consistency. CONCLUSIONS: Pretreatment with estriol suppositories significantly improves colposcopy sufficiency, enhances diagnostic agreement rate with histopathology, and alleviates procedure-related pain in postmenopausal women, while maintaining an acceptable safety profile.