Yuge Ayano, Ishikawa Hiroshi, Okuya Rie, Goto Yuki, Kaneko Meika, Koga Kaori
Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Japan.
SAGE Open Med Case Rep. 2025 Aug 11;13:2050313X251358978. doi: 10.1177/2050313X251358978. eCollection 2025.
Cervical stenosis and labial adhesion associated with vulvovaginal atrophy (VVA) obstruct access to the uterine cavity and reduce quality of life. Removal of intrauterine contraceptive devices (IUD) is challenging without adequate cervical ripening in postmenopausal women. Local estrogen administration and mechanical dilatation are performed to improve these conditions; however, alternatives are necessary for those who have difficulty with vaginal medication. We report five cases of short-term oral estriol administration in postmenopausal women. Case 1 was a 60-year-old woman with an endometrial lesion requiring differentiation from malignancy. Endometrial examination was challenging because of cervical stenosis and VVA. Case 2 was an 82-year-old woman who had a giant ovarian tumor with fluid retention in the cervical canal owing to complete obstruction of the cervical external os. Case 3 was an 80-year-old woman who presented with pain during urination due to recurrent labial adhesion despite undergoing a surgical incision. Case 4 was a 58-year-old woman with suspected cervical cancer. Magnetic resonance imaging and conization were challenging owing to the difficulty in removing a metallic IUD from the uterine cavity. Case 5 was a 56-year-old woman who presented with abnormal uterine bleeding with a metallic IUD embedded in the myometrium and cervical canal. Improvement of cervical stenosis and obstruction after oral estriol administration allowed cervical and endometrial examinations, including cytology, biopsy, and hysteroscopy, and removal of IUD. Furthermore, incision followed by oral estriol administration prevented re-adhesion of the labia and improved urinary symptoms. Adverse events involving grade 1 abnormal genital bleeding and urinary urgency in two women were tolerable. Although this is a preliminary observation requiring confirmation, short-term estriol administration improved VVA, induced cervical ripening, prevented re-adhesion of the labia, and facilitated IUD removal in postmenopausal women in this case series.
宫颈狭窄和阴唇粘连合并外阴阴道萎缩（VVA）会阻碍子宫腔的探查并降低生活质量。在绝经后女性中，如果宫颈未充分成熟，取出宫内节育器（IUD）具有挑战性。局部应用雌激素和机械扩张用于改善这些情况；然而，对于那些阴道用药困难的患者，需要其他替代方法。我们报告了5例绝经后女性短期口服雌三醇的病例。病例1是一名60岁女性，患有子宫内膜病变，需要与恶性肿瘤相鉴别。由于宫颈狭窄和VVA，子宫内膜检查具有挑战性。病例2是一名82岁女性，患有巨大卵巢肿瘤，由于宫颈外口完全阻塞，宫颈管内有积液。病例3是一名80岁女性，尽管接受了手术切开，但因阴唇反复粘连而出现排尿疼痛。病例4是一名58岁女性，疑似宫颈癌。由于难以从子宫腔取出金属IUD，磁共振成像和锥切术具有挑战性。病例5是一名56岁女性，出现异常子宫出血，金属IUD嵌入子宫肌层和宫颈管。口服雌三醇后宫颈狭窄和阻塞得到改善，从而能够进行宫颈和子宫内膜检查，包括细胞学检查、活检和宫腔镜检查，并取出IUD。此外，切开后口服雌三醇可防止阴唇再次粘连并改善尿路症状。两名女性出现的1级异常生殖器出血和尿急等不良事件是可耐受的。尽管这是一项需要确认的初步观察，但在本病例系列中，短期应用雌三醇改善了VVA，诱导了宫颈成熟，防止了阴唇再次粘连，并促进了绝经后女性IUD的取出。
