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Abnormal Pap Smears-Post Menopausal
Frances76114 posted:
I'm 56 and post menopausal. I had an very abnormal pap smear , a colposcopy and another pap test. The colposcopy didn't show up anything but the pap test was still very abnormal. I go back this week for a endo. biopsy and a biopsy of the inside of the cervix. The doctor thinks it is due to menopause but wanted to be sure. How often does this happen to post menopausal women? I haven't had any problems that I know of so I was very surprised and now I am very worried. If it is due to menopause, what would the next step most likely be?

I have tried to find some answers but can't find very much info on this.

Is there anyone out there with a similar problem?

Thanks for your input.

J_Harrison_Hohner responded:
Dear Frances: I can think of two specific situations where being postmenopausal can contribute to abnormal PAP smear results.

1. Low estrogen levels (ie not using hormone therapy) can prompt the cells in the vagina and on the face of the cervix to have some unusual appearances. Usually these are reported back on a PAP as atypical cells of undetermined significance. If the GYN suspects this is an issue the woman may be asked to use a vaginal estrogen cream/ring/pellet before the follow up PAP or colposcopy.

2. Abnormal cells from either the cervical canal or the lining of the uterus can "drift down" and be picked up on a PAP smear. In this instance the tie in to menopause is that one would not expect to see many endometrial (uterine lining) type cells in a non-estrogenized/postmenopausal woman. The usual procedure is to do an endometrial biopsy to check the lining of the uterus, and an endocervical canal curettage (scraping of the cervical canal) to look for abnormal cells in the lining of the canal.

It sounds like your GYN is taking your PAP smear results very seriously--which is a good thing. Hopefully this is truly tied to either a too thick lining of the uterus (can happen even from being overweight) or from being so low in estrogen that the cells appear abnormal to the pathologist reading your PAP smear slides. Please write us back when you get your results and put my name in the subject line so I can find you.

Yours, Jane
donnakl replied to J_Harrison_Hohner's response:
Hello Jane, Frances, I was researching this as I too, am concerned. I am 53, post menopausal, just over 1 1/2 years ago, had an abnormal pap, had the colposcopy ( ouch), had 3 more apps every 3 months..all was fine. Went for my annual this year, 2 months ago, abnormal agin.. ???...while waiting for the appt. for 2nd colposcopy, I started so slightly spotting for 8 days. Doctor had me get internal and external ultrasound, showed 7mm endometrial strip, scheduled a D&C, had some polyps, no cancer. Now, I go in for the colposcopy in 2weeks. I've occasionally had abnormal paps before peri-menopause, but never this colposcopy and never this frequent. That's why I was researching, wondering if it's becoming as common practice, like knee replacement! Seems unnecessary? Any thoughts? I was never on Estrogen or any other hormone replacement therapy.
Anon_6061 replied to donnakl's response:
Odd - when I click on the discussion title, I can only see the two 7 year old posts and not yours. I assume you saw Jane's explanation that estrogen deficiency to the urogenital tissues can itself cause abnormal pap smears. A course of vaginal estrogen can be tried to see if that results in a normal pap.

Post-menopausal changes to the urogenital tissues (vagina, cervix, urethra) due to low estrogen can cause abnormal pap smears that typically are not precancerous and therefore do not require treatment. The use of vaginal estrogen for a period of time (it seems I read a month or two) will usually result in a normal pap.

This link corroborates that:
"Many times, ASC-US cell changes in the cervix go away without treatment, especially if there is no evidence of infection with high-risk HPV. Doctors may prescribe estrogen cream for women with ASC-US who are near or past menopause . Because ASC-US cell changes can be caused by low hormone levels, applying an estrogen cream to the cervix for a few weeks can usually help to clarify their cause."

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