Cervical intraepithelial neoplasia in postmenopausal women with negative cervical cytology Four cases of cervical intraepithelial neoplasia were detected among 50 postmenopausal women in whom cytological examination of a cervical smear yielded negative results, indicating the need for cytological surveillance of women into old age. Patients, methods, and resultsCytological and colposcopic examination of the cervix was performed in 50 women presenting to a menopausal clinic with symptoms of the climacteric before they began hormone replacement treatment. The mean (SD) age was 50-38 (4.51) years with a mean postmenopausal time of 31 (33'87)

Summary. The squamocolumnar junction is frequently not visible in the postmenopausal patient. This study attempts to identify some of the changes in the cervix that may account for this observation. Twentyfour cervical biopsy samples taken at the squamocolumnar junction were analysed for hydroxyproline (collagen) and water content. There was significantly more hydroxyproline (collagen) in the premenopausal woman than the postmenopausal woman. Similarly, there was higher percentage of water in the biopsies in the premenopausal woman than the postmenopausal woman. Further samples obtained deeper in the cervical stroma did not confirm these differences. It appears likely that differences in cervical water and cervical collagen near the surface of the cervix account, at least in part, for the lack of visibility of the squamocolumnar junction in the older woman.

Summary. Polyglycolic acid (PGA) sutures and traditional catgut were compared in 190 patients undergoing episiotomy. Each group was also randomly allocated to a double blind comparison of therapy with oral proteolytic enzymes (Chymoral) and placebo. The combination of Chymoral and polyglycolic acid sutures was shown to reduce the level of pain, assessed subjectively, and there was a significant reduction in analgesic requirements in the Chymoral/PGA group.

A group of 55 women with endometriosis was studied before and during danazol therapy. An unexpectedly high proportion (36%) had a raised serum prolactin level before treatment which was reduced after 50 days of danazol (before treatment 783 \m=+-\333 mU/l; on danazol 243 \ m=+-\113 mU/l, P < 0.001). In contrast patients with normal serum prolactin levels showed no significant drop on danazol therapy. In all patients serum oestradiol was significantly reduced during treatment (before treatment 449 \ m=+-\188 pmol/l; on danazol 207 \ m=+-\117 pmol/l, P < 0.001). In one patient with hyperprolactinaemia danazol reduced both basal and stimulated prolactin levels, whereas in 5 women with normal prolactin levels we could detect no gross alteration in metoclopramide or TRH stimulated prolactin levels associated with danazol therapy. The possibility that normalisation of raised prolactin levels may be secondary to reduced oestrogens and that patients with endometriosis have an increased sensitivity to oestrogen-induced prolactin secretion is discussed.Danazol is one of the most successful medical treatments for endometriosis. Exactly how the drug improves this condition is uncertain but it is undoubtedly related to the inducement of a hypooestrogenic-hypoprogestational state. Earlier inve¬ stigations into the endocrine pharmacology of danazol suggested that it acts as a seletive antigonadotrophin but more recent studies indicate a wide range of direct effects on hypothalamic-pituitary function, steroid receptors, gonadal steroido¬ genesis and endogenous steroid metabolism (Bar¬ bieri & Ryan 1981).Detailed information on the effect of danazol on serum prolactin levels is sparse and contradictory.

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