Mitra Modares Gilani - Department of Obstetrics and Gynecology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Fariba Yarandi - Professor, Department of Obstetrics and Gynecology, Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Narges Zamani - Department of Obstetrics and Gynecology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Shaghayegh Nowroozi - Gynecologist, Tehran University of Medical Sciences, Tehran, Iran
Sara Ramhormozian - Department of Obstetrics and Gynecology Surgery, Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Elham Shirali - Professor, Department of Obstetrics and Gynecology, Yas Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Background & Objective: Estradiol and misoprostol have been used for the enhancement of transformation zone (TZ) visibility in vaginal colposcopy. However, no consensus has been reached on the superiority of one medication over the other. This study aimed to compare the efficacy of estradiol and misoprostol for the enhancement of TZ visibility in vaginal colposcopy of premenopausal and postmenopausal women. Materials & Methods: In this clinical trial, ۷۸ patients with unsatisfactory colposcopy were randomly divided into three groups. Group ۱ (n=۲۵) received ۲۵ µg of vaginal estradiol for ۱۴ days prior to colposcopy. Group ۲ (n=۲۷) received ۴۰۰ µg of misoprostol ۱۲ h prior to colposcopy. Group ۳ (n=۲۶) served as the control group and did not receive any medication. Visibility of the TZ, age, body mass index (BMI), history of vaginal delivery, history of sexually transmitted diseases, history of human papillomavirus (HPV), the reason for colposcopy, and drug-related side effects were compared among the three groups and also between premenopausal and postmenopausal women. Data were analyzed using analysis of variance (ANOVA), Kruskal-Wallis, Chi-square, and Fisher’s exact tests. Results: The percentage of TZ visibility was ۷۲%, ۵۵.۶%, and ۲۶.۹% in the estradiol, misoprostol, and control groups, respectively (P=۰.۰۰۵). These values were ۷۰%, ۳۳.۳%, and ۰%, respectively, in postmenopausal women (P=۰.۰۴۳) and ۶۰%, ۷۲.۷%, and ۳۳.۳%, respectively, in premenopausal women (P=۰.۱۵۲). Regarding drug-related side effects, there was no statistically significant difference between the three groups (P=۰.۳۷۴). Conclusion: Estradiol was significantly superior to misoprostol for the enhancement of TZ visibility, particularly in postmenopausal women, with no difference regarding side effects.

Estradiol, Misoprostol, Colposcopy, Transformation Zone, Visibility