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Volume 7, Issue 2 (March & April 2022)                   J Obstet Gynecol Cancer Res 2022, 7(2): 77-82 | Back to browse issues page

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Modares Gilani M, Yarandi F, Zamani N, Nowroozi S, Ramhormozian S, Shirali E. Comparison of Estradiol and Misoprostol in Transformation Zone Visibility in Colposcopy. J Obstet Gynecol Cancer Res. 2022; 7 (2) :77-82
URL: http://jogcr.com/article-1-421-en.html
1- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2- Professor, Department of Obstetrics and Gynecology, Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3- Gynecologist, Tehran University of Medical Sciences, Tehran, Iran
4- Department of Obstetrics and Gynecology Surgery, Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5- Professor, Department of Obstetrics and Gynecology, Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran , Eshirali@sina.tums.ac.ir
Abstract:   (129 Views)
Background & Objective: Estradiol and misoprostol have been used for the enhancement of transformation zone (TZ) visibility in vaginal colposcopy. However, no consensus has been reached on the superiority of one medication over the other. This study aimed to compare the efficacy of estradiol and misoprostol for the enhancement of TZ visibility in vaginal colposcopy of premenopausal and postmenopausal women.
Materials & Methods: In this clinical trial, 78 patients with unsatisfactory colposcopy were randomly divided into three groups. Group 1 (n=25) received 25 µg of vaginal estradiol for 14 days prior to colposcopy. Group 2 (n=27) received 400 µg of misoprostol 12 h prior to colposcopy. Group 3 (n=26) served as the control group and did not receive any medication. Visibility of the TZ, age, body mass index (BMI), history of vaginal delivery, history of sexually transmitted diseases, history of human papillomavirus (HPV), the reason for colposcopy, and drug-related side effects were compared among the three groups and also between premenopausal and postmenopausal women. Data were analyzed using analysis of variance (ANOVA), Kruskal-Wallis, Chi-square, and Fisher’s exact tests.
Results: The percentage of TZ visibility was 72%, 55.6%, and 26.9% in the estradiol, misoprostol, and control groups, respectively (P=0.005). These values were 70%, 33.3%, and 0%, respectively, in postmenopausal women (P=0.043) and 60%, 72.7%, and 33.3%, respectively, in premenopausal women (P=0.152). Regarding drug-related side effects, there was no statistically significant difference between the three groups (P=0.374).
Conclusion: Estradiol was significantly superior to misoprostol for the enhancement of TZ visibility, particularly in postmenopausal women, with no difference regarding side effects.
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Systematic Review: Original Research | Subject: Obstetrics and Gynecology
Received: 2021/05/12 | Accepted: 2021/08/16 | Published: 2021/09/26

1. Shrestha AD, Neupane D, Vedsted P, Kallestrup P. Cervical Cancer Prevalence, Incidence and Mortality in Low and Middle Income Countries: A Systematic Review. Asian Pac J Cancer Prev. 2018;19(2):319-24. [DOI:10.1111/ecc.13207] [PMID]
2. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-e203. [DOI:10.1016/S2214-109X(19)30482-6]
3. Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. Current problems in cancer. 2018 Sep 1;42(5):457-65. [DOI:10.1016/j.currproblcancer.2018.06.003] [PMID]
4. Zhang S, McNamara M, Batur P. Cervical Cancer screening: What's new? Updates for the busy clinician. Am J Med. 2018;131(6):702-e1. [DOI:10.1016/j.amjmed.2018.01.020] [PMID]
5. Pimple SA, Mishra GA. Global strategies for cervical cancer prevention and screening. Minerva Ginecol. 2019;71(4):313-20. . [DOI:10.23736/S0026-4784.19.04397-1]
6. Bhatla N, Singhal S. Primary HPV screening for cervical cancer. Best Pract Res Clin Obstet Gynaecol. 2020;65:98-108. [DOI:10.1016/j.bpobgyn.2020.02.008] [PMID]
7. Hirai CM, Kaneshiro B, Hiraoka MK. The Effect of the 2012 ASCCP Consensus Guideline for Abnormal Cervical Cytology on Resident Colposcopy Training. Hawaii J Med Public Health. 2018;77(1):3-6.
8. Burness JV, Schroeder JM, Warren JB. Cervical Colposcopy: Indications and Risk Assessment. Am Fam Physician. 2020;102(1):39-48. PMIid: 32603071.
9. Manley KM, Simms RA, Platt S, Patel A, Bahl R. Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty. BMC Med Inform Decis Mak. 2017;17(1):125. [DOI:10.1186/s12911-017-0516-3] [PMID] [PMCID]
10. Chevreau J, Carcopino X, Foulon A, Preaubert L, Lanta-Delmas S, Sergent F, Gondry J. Risk factors for unsatisfactory colposcopy after large loop excision of the transformation zone: The results of a four-year multicenter prospective study. Eur J Obstet Gynecol Reprod Biol. 2019;240:156-160. [DOI:10.1016/j.ejogrb.2019.07.001] [PMID]
11. Ciavattini A, Delli Carpini G, Moriconi L, Clemente N, Montik N, De Vincenzo R, Del Fabro A, Buttignol M, Ricci C, Moro F, Sopracordevole F. Effect of age and cone dimensions on cervical regeneration: an Italian multicentric prospective observational study. BMJ Open. 2018;8(3):e020675. [DOI:10.1136/bmjopen-2017-020675] [PMID] [PMCID]
12. Beniwal S, Makkar B, Batra S, Gandhi G, Goswami D, Zutshi V. Comparison of Vaginal versus Oral Estradiol Administration in Improving the Visualization of Transformation Zone (TZ) during Colposcopy. J Clin Diagn Res. 2016;10(7):QC18-21. [DOI:10.7860/JCDR/2016/19492.8201] [PMID] [PMCID]
13. Vallikad E, Siddartha PT, Kulkarni KA, Firtion C, Keswarpu P, Vajinepalli P, et al. Intra and Inter-Observer Variability of Transformation Zone Assessment in Colposcopy: A Qualitative and Quantitative Study. J Clin Diagn Res. 2017;11(1):XC04. [DOI:10.7860/JCDR/2017/21943.9168] [PMID] [PMCID]
14. Ayensu-Coker L, Sanchez J, Zurawin R, Dietrich JE. Use of misoprostol for management of unsatisfactory colposcopy in the adolescent: a case report and review of the literature. J Pediatr Adolesc Gynecol. 2009;22(5):e139. [DOI:10.1016/j.jpag.2008.12.001] [PMID]
15. Allen R, O'Brien BM. Uses of misoprostol in obstetrics and gynecology. Rev Obstet Gynecol. 2009 Summer;2(3):159-68.
16. Chong YS, Su LL, Arulkumaran S. Misoprostol: a quarter century of use, abuse, and creative misuse. Obstet Gynecol Surv. 2004;59(2):128-40. [DOI:10.1097/01.OGX.0000109168.83489.66] [PMID]
17. Nakano FY, Yela DA, Pinto JPL, Riegas T, Benetti-Pinto CL, Pedro AO, et al. Efficacy of misoprostol before diagnostic hysteroscopy in postmenopausal women: a randomized clinical trial. Menopause. 2018;25(7):789-94. [DOI:10.1097/GME.0000000000001074] [PMID]
18. Polyzos NP, Zavos A, Valachis A, Dragamestianos C, Blockeel C, Stoop D, et al. Misoprostol prior to hysteroscopy in premenopausal and postmenopausal women. A systematic review and meta-analysis. Hum Reprod Update. 2012;18(4):393-404. [DOI:10.1093/humupd/dms014] [PMID]
19. Al-Fozan H, Firwana B, Al Kadri H, Hassan S, Tulandi T. Preoperative ripening of the cervix before operative hysteroscopy. Cochrane Database Syst Rev. 2015;(4):CD005998. [DOI:10.1002/14651858.CD005998.pub2] [PMID]
20. Casadei L, Piccolo E, Manicuti C, Cardinale S, Collamarini M, Piccione E. Role of vaginal estradiol pretreatment combined with vaginal misoprostol for cervical ripening before operative hysteroscopy in postmenopausal women. Obstet Gynecol Sci. 2016 May;59(3):220-6. [DOI:10.5468/ogs.2016.59.3.220] [PMID] [PMCID]
21. Hwang JY, Song SH. Optimal Dose of Vaginal Misoprostol for Cervical Ripening before Hysteroscopy: A Randomized Double-Blind Study. J Minim Invasive Gynecol. 2018;25(6):1031-4. [DOI:10.1016/j.jmig.2018.01.022] [PMID]
22. Thanapprapasr D, Wilailak S, Ayudhya NI, Lertkhachonsuk AA, Likittanasombut P, Chittithaworn S, Charakorn C, Weerakiet S. Can vaginal misoprostol effectively increase rate of a satisfactory colposcopy? A randomized double-blind placebo-controlled trial. Jpn J Clin Oncol. 2010;40(3):203-7. [DOI:10.1093/jjco/hyp140] [PMID]
23. Aggarwal R, Suneja A, Agarwal N, Mishra K. Role of misoprostol in overcoming an unsatisfactory colposcopy: a randomized double-blind placebo-controlled clinical trial. Gynecol Obstet Invest. 2006;62(2):115-20. [DOI:10.1159/000093623] [PMID]
24. Pergialiotis V, Vlachos DE, Pitsouni E, Perrea D, Vlachos GD. Vaginal Misoprostol for Overcoming Inadequate Colposcopies: A Meta-analysis of Randomized Controlled Trials. J Low Genit Tract Dis. 2015;19(3):257-61. [DOI:10.1097/LGT.0000000000000066] [PMID]
25. Makkar B, Batra S, Gandhi G, Zutshi V, Goswami D. Vaginal misoprostol versus vaginal estradiol in overcoming unsatisfactory colposcopy. Gynecol Obstet Invest. 2014;77(3):176-9. [DOI:10.1159/000358391] [PMID]

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