Post-menopausal atrophy in elderly women: is a vaginal smear necessary for diagnosis?

The diagnosis of post-menopausal atrophy should preferably be confirmed before any trial of oestrogen treatment for genito-urinary symptoms. The ideal method, cytological analysis of a vaginal wall smear, is not always feasible in elderly women. Might physical examination alone be sufficient? This study aimed to determine which clinical features might best predict atrophy on the smear. Of 120 consecutive women admitted to an acute geriatric unit (mean age 82 years), satisfactory smears were obtainable from 70 (58%). Sixty per cent of these showed severe atrophy but almost one-fifth showed no atrophic changes. Degree of atrophy correlated with physical thinness (p less than 0.01), low parity (p less than 0.01) and dryness on vaginal examination (p less than 0.001). However, none of the other physical findings traditionally thought to indicate atrophy were found to be associated, nor were age or medication. In contrast, severe atrophy was present in only one of nine women with breast cancer (p less than 0.01). This merits further study.