Effect of Concomitant Administration of Estroens and Proesterone on Vainal Smear in Man. ∗

Abstract

Of the changes in the vaginal secretion during the menstrual cycle 1 those occurring in the first half concurrent with the growth and ripening of the ovarian follicle are most clearly defined and best understood. The demonstration in this laboratory 2 that they are similar to the smear changes induced in menopause and amenorrhea by the administration of estrogens, indicates that during the first half of the cycle the vaginal epithelium and secretion are largely, if not entirely, under the control of the estrogenic hormones. The peak effect of the estrogens as seen in the fully expressed “follicular picture” induced after menopause can, therefore, serve as an index of the extent of spontaneous follicular activity during the normal cycle, and affords a simple histological measure of ovarian function. It can also be employed as a guide for replacement therapy with estrogens 2 and as a measure of ovarian stimulation by gonadotropic agents. 3

The changes in vaginal smear during the second half of the cycle from the time of ovulation up to the next menstruation are less clear cut and more difficult to evaluate. 1 The lack of uniformity nossibly arises from the more complicated hormonal pattern of this phase of the cycle. The estrogenic titer falls from its mid-menstrual peak and, except for a brief moderate rise about a week premenstrually, gradually sinks to the low levels characteristic of the premenstruum and the menstrual phase. The progestational hormone now appears for the first time, is elaborated for a period of about 10 days and then disappears one to 3 days before the flow. 4 If, as is likely, the structure of the vaginal epithelium is a resultant of the interaction of both groups of hormones, any variation in the tempo or the extent of their production could be expected to vary the cytology of the vaginal secretion.