Cytologic findings in cervical smears in patients using intramuscular medroxyprogesterone acetate (Depo‐Provera) for contraception

Abstract

The purpose of the present study was to assess the findings in cervical smears associated with intramuscular depot medroxyprogesterone acetate (Depo-Provera) contraception. Seventy-four cervical smears of reproductive-age patients on Depo-Provera were reviewed for cytologic abnormalities, predominant cell type, and intermediate cell glycogenation (extensive (EGly) ϭ navicular cells / glycogenation in 10 or more high-powered fields (hpf); moderate (MGly) ϭ 5-10 hpf; and focal (FGly) ϭ less than 5 hpf). A control group of 38 nonpregnant patients without hormonal therapy was reviewed. Study group patients' (SGP) age ranged from 16 -44 years (average 28.1); control group patients (CGP) from 17-42 years (average 29.4). Time since last menstrual period (LMP) for the SGP was 16.9 months (range 1-96); LMP for CGP was 18.2 days (range 5-33). Four (5.4%) SGP had squamous intraepithelial lesions (SIL), four (5.4%) atypical squamous cells of undetermined significance (ASCUS), and one (1.4%) atypical repair. No CGP had SIL or ASCUS. Seventy-three (98.6%) SGP had intermediate cell (IC) predominance; one had parabasal cell predominance. Of the CGP, 28 (73.7%) had IC predominance, nine (23.7%) superficial cell (SC) predominance and one (2.6%) had near equal IC and SC. EGly was seen in 22 (29.7%) SGP; two (5.3%) in CGP (chi-square 7.53; 0.95 ϭ 3.84). MGly was seen in 29 (39.2%) SGP; 10 (26.3%) in CG. FGly was seen in 17 (22.9%) SGP; 14 (36.8%) in CGP. No glycogenation was seen in six (8.1%) SGP; 12 (31.6%) in CGP. Time since LMP was inversely proportional to glycogenation in SGP: EGly-LMP 11.6 months; MGly-LMP 14.9 months; FGly-LMP 15.0 months; and no glycogenation-LMP 22.5 months. Glycogenation of IC appears inversely proportional to Depo-Provera effect. EGly due to recent Depo-Provera administration mimics changes associated with pregnancy.

Atypical squamous cells, cannot exclude a high-grade intraepithelial lesion and its clinical significance in postmenopausal, pregnant, postpartum, and contraceptive-use patients

“…Overall, Pap tests from the pregnant, postpartum, and contraceptive‐use groups had an intermediate cell‐predominate pattern. An intermediate cell‐predominant pattern has been described by other authors in the setting of medroxyprogesterone acetate and oral contraceptive‐use 18, 19. Pregnancy and postpartum states have been described previously as having increased numbers of metaplastic cells 20, 21.…”

Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection

“…And third, hormones influence cervical epithelial differentiation and maturation 30–32. DMPA decreases cell maturation and promotes the appearance of atrophic epithelium30, 32, which could make histologic features of CIN more difficult to detect among DMPA users because the loss of glycogen and hydration will shrink the cytoplasm lessening the effect of acetic acid 33.…”

“…DMPA decreases cell maturation and promotes the appearance of atrophic epithelium30, 32, which could make histologic features of CIN more difficult to detect among DMPA users because the loss of glycogen and hydration will shrink the cytoplasm lessening the effect of acetic acid 33. If the colposcopist cannot see the acetowhite lesions then she/he cannot do a directed biopsy.…”