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) = navicular cells / glycogenation in 10 or more high‐powered fields (hpf); moderate (MGly) = 5–10 hpf; and focal (FGly) = 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 = 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. Diagn. Cytopathol. 2000;23:161–164. © 2000 Wiley‐Liss, Inc.

Reducing “atypical squamous cells” overdiagnosis on cervicovaginal smears by diligent cytology screening

“…A high ASC rate has been reported from postmenopausal women on hormone replacement and in premenopausal women who are pregnant, lactating, or receiving extrinsic hormones 21–24. It is probable that many of these are over interpreted as they have negative biopsy outcomes and the nuclear changes usually revert back once the hormonal balance is restored.…”

Oral contraceptive pills are associated with artifacts in ThinPrep Pap smears that mimic low-grade squamous intraepithelial lesions

“…Volk et al30 reported that there was extensive glycogenation of intermediate cells in premenopausal women who are pregnant or receiving intramuscular medroxyprogesterone acetate. Although they did not report on the Pap smear technique employed, they did note a much higher rate of ASCUS cytology than in the control women who did not receive replacement hormonal therapy.…”