Short-term oral estriol for cervical stenosis, labial adhesion, and challenging intrauterine contraceptive device removal in postmenopausal women: A case series

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.