A Test For Vaginal Atrophy

Testing For Vaginal Atrophy The Maturation Index

A simple test, called a Maturation Index, performed at the time of your annual Pap smear can roughly indicate your body's overall estrogen level. Cells of the vaginal lining and cervix are less mature in the deeper tissue layers, and more mature in the most superficial layers. A Pap smear taken in the childbearing years shows mostly mature cells, which appear, under the microscope, as large, flat cells with small nuclei. Immature cells appear small and round with large, dark nuclei. A Pap smear taken before puberty, during menopause, or at any time when estrogen levels are low, would show a preponderance of these immature cells. By comparing the number of mature to immature cells, the pathologist can assign a maturation index to the Pap smear. Your doctor may choose to run this test initially to check your estrogen status when you are perimenopausal. He or she may also perform the test once you have started on estrogen therapy to see if the estrogen dose is adequate. It is interesting to note that 10% of menopausal women will retain an estrogenic smear, even if they are not on estrogen therapy. This is probably due to the production of estrone, a form of estrogen produced in fat cells in the body.
            Several factors affect the accuracy of the Maturation Index. If the smear is taken when a woman is bleeding, when a vaginal infection is present, or when the woman is on certain medications (e.g., digitalis), an incorrect assessment may be made. Most doctors do not rely too heavily on this test, preferring to trust the patient's evaluation of her symptoms. If symptoms of low estrogen resolve with hormone therapy, it is considered successful, regardless of what the maturation index shows.
            Vaginal and vulvar dryness begin 1 to 2 years after your periods have stopped. Women who take estrogen, and women who maintain an active sex life may never experience these symptoms. However, most women in their 60s and 70s begin to notice these vaginal changes. Smokers may notice the change earlier as they generally have lower estrogen levels. Smokers have the earliest and most severe complaints of vaginal dryness.


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