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Basal vaginal physiologic study, including pH values in various locations, transvaginal electropotential difference, and blood flow estimation, was done twice in a group of 34 untreated postmenopausal women. Plasma hormone levels (gonadotropins and estrogens) and vaginal cytology were also obtained to confirm the estrogen deficiency state. The pH values in the vaginal fornices were significantly lower than those in the middle portion of the vagina. Sexually active women had significantly lower pH values than sexually inactive women. The transvaginal electropotential difference and estimated blood flow values were lower than those of premenopausal women reported in the literature, indicating impaired vaginal transport mechanism and decreased vaginal blood flow. The close approximation of the data obtained in the two measurements one month apart attests the reproducibility of the methods used.

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Twenty-one post-menopausal women on no other medication were treated with a low dose (0.625 mg/day) of conjugated equine estrogen (CEE) for a mean (+/- SEM) period of 2.6 +/- 0.2 mth (range 1.75-4.75). Blood samples were collected before and at the completion of therapy, and alterations in the levels of prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG) and certain steroid hormones, including the free testosterone (T) index (T/SHBG) were studied. Following treatment, a significant increase in SHBG levels produced a significant decrease in the free T index (P less than 0.005). As expected, no changes were observed in the levels of PRL and steroid hormones other than estrone (E1) and estradiol-17-beta (E2). Our observations indicate that treatment of post-menopausal women with low-dose estrogen lowers the unbound T.

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Vaginal physiology was evaluated in 23 postmenopausal women before estrogen replacement therapy and at 1, 3, 6, 12, 18, and 24 months while receiving conjugated equine estrogens (Premarin). Reversal of hormonal levels (17 beta-estradiol, gonadotropins) and vaginal cytology occurred within one month. Vaginal pH levels significantly decreased from a baseline mean of 5.2 to a level of 4.2 at 24 months (P less than .05). Women who were sexually active showed a greater decline in pH levels than did women who were sexually inactive. Maximum increases in amount of vaginal fluid and potassium levels were observed after three months of therapy. Vaginal blood flow and vaginal electropotential difference were significantly increased over baseline values at one month and again at 12 months (P less than .05) with a slow progressive improvement continuing throughout 24 months of estrogen replacement therapy. This study provides documented laboratory evidence to suggest that restoration of vaginal tissue function requires 18 to 24 months and explains why dyspareunia may persist in the early months of replacement therapy despite hormonal and cytologic return to premenopausal values.

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A physiological study of the effects of menopause on vaginal function involving 14 postmenopausal women aged 51 to 70 years is reported. Initial evaluations in the estrogen-deprived state were hormonal and cytological studies, vaginal pH, quantity of vaginal fluid, transvaginal electropotential difference, and vaginal blood flow. A significant fall in vaginal pH and increases in transvaginal potential difference, the quantity of vaginal fluid, and vaginal blood flow were observed after estrogen replacement therapy. The results before and after treatment are compared with norms established for women younger than 40 years.

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The liver extraction of indocyanine green in concentrations of 0.2 mg./kg. and 0.5 mg./kg. in women taking oral contraceptive (norethindrone 2 mg. with mestranol 0.1 mg., and norethindrone 1 mg. with mestranol 0.05 mg.) is reported. No major alteration was noted in the hepatic function with the plasma concentrations of the dye employed. The probability of increased hepatic arterial flow or increased cardiac output due to norethindrone-mestranol combination is noted. The value of indocyanine green in the study of liver dysfunction is stated and its relative sensitivity at various concentrations is mentioned. The use of indocyanine green to predict early hepatic changes in toxemia of pregnancy, especially in those patients with excessive weight gain, is suggested.

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