Cervical dysplasia in the postmenopausal female: diagnosis and treatment

Abstract

Thirty-two postmenopausal women, age 50 years or older, were colposcoped for abnormal Papanicolaou (PAP) smears. Sixteen had mild to moderate dysplasia, six severe dysplasia and the remainder had no dysplasia. Treatment included observation, topical estrogen, cryotherapy, conization or hysterectomy. Based upon our observations, satisfactory colposcopy can be performed in the majority of postmenopausal women. Oral or topical estrogen is a valuable adjunct in the initial evaluation and treatment of abnormal PAP smears in postmenopausal women. Criteria for adequate colposcopy in postmenopausal women are discussed and a management scheme is proposed.

Efficacy of Ki‐67 antigen staining in Papanicolaou (Pap) smears in post‐menopausal women with atypia—an audit

“…With an ageing population, more post-menopausal women are presenting for cervical screening, and the smears of elderly women often cause cytodiagnostic problems 9 . In this study of 555 smears with post-menopausal atypia only these 16 (2.9%) finally showed histologically confirmed abnormal changes and 15 smears out of these 16 showed Ki-67 positivity.…”

Atypical Squamous Cells of Undetermined Significance in Women Over 55

“…18 Teaff et al reported that 5 of 12 (41.6%) postmenopausal women with minimally abnormal cytology (Pap smear class II) had biopsy-proven dysplasia. 21 From these studies, the reported frequency of underlying dysplasia in a postmenopausal women seems to vary significantly, from 5.6% to 41.6%. 17,18,21 Possible explanations for this variability include the small number of patients studied and, in the case of Teaff's study, the fact that ASCUS had not yet been defined as a separate diagnostic category.…”

“…21 From these studies, the reported frequency of underlying dysplasia in a postmenopausal women seems to vary significantly, from 5.6% to 41.6%. 17,18,21 Possible explanations for this variability include the small number of patients studied and, in the case of Teaff's study, the fact that ASCUS had not yet been defined as a separate diagnostic category. Our study of women older than 55 determined the incidence of ASCUS and the frequency of SIL following the diagnosis of ASCUS.…”

“…6,18,19 Others, however, have reported a high incidence of dysplasia and carcinoma on cervicovaginal smears and biopsies in postmenopausal women. 5,16,21 The guidelines for clinical management of postmenopausal women with ASCUS are conflicting. The National Cancer Institute's (NCI's) interim guidelines for management of abnormal cervical cytology recommends a course of topical estrogen therapy for women not receiving hormone replacement therapy.…”

Glandular and Squamous Atypia and Intraepithelial Lesions in Atrophic Cervicovaginal Smears

“…8,19,23 Although abnormal Pap smears are reported more frequently in postmenopausal women when compared to younger women, 12,13 the frequency of underlying dysplasia in the elderly population seems to vary significantly. Several groups have reported a high incidence of dysplasia and carcinoma on cervicovaginal smears and biopsies in postmenopausal women, 13,15,24 while others have found that squamous atypia in postmenopausal women is rarely associated with either biopsy-proven dysplasia or human papillomavirus (HPV) DNA detection, 5,20,23 and it is generally thought that the incidence of biopsy proven intraepithelial lesions decreases markedly after menopause. 14 In review of atypical atrophic cervicovaginal smears, Kaminski et al 9 concluded that there was a strong correlation between estrogen deficiency and squamous atypia.…”