Cytolysis and karyopyknosis in postmenopausal vaginal smears as markers of endometrial cancer, diabetes and obesity. Studies based on a ten-year follow-up.

The vaginal cytology of 507 postmenopausal women was followed prospectively for ten years. Of the subjects, the 207 with cytolytic or karyopyknotic vaginal smears constituted the study group and the 300 with atrophic smears (indicating an absence of estrogenic activity) constituted the control group at the beginning of the follow-up. A woman whose initial smear was cytolytic usually had a cytolytic smear ten years later, which implies that high postmenopausal estrogenic activity is constitutional. Both at the beginning of the study and ten years later, the mean body weights were higher in the study group than in the control group. The mean karyopyknotic index and the prevalence of cytolytic smears were significantly higher among women with impaired glucose tolerance than among subjects with a normal glucose tolerance test. During the follow-up period, 3.6% of the women in the study group and 0.7% of the women in the control group developed endometrial cancer (P less than .02). The incidence of 3.6% of endometrial cancer is significantly higher than the corresponding age-specific incidence (P less than .001). We conclude that obese and/or diabetic postmenopausal women with cytolytic or markedly karyopyknotic vaginal smears exhibit a high intrinsic estrogen activity and may thus be at risk for endometrial cancer.