Title: Study of Cervical Cytology (Pap Smear) in Symptomatic Postmenopausal Woman in Tertiary Care Hospital

Authors: Dr Soma Thakur, Dr Manoj Kumar, Dr Raghvendra Kumar, Dr Mahesh Prasad

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.07

Abstract

Objective: The atrophic changes in menopause reflected in cytology is known, but relevance of other features in menopausal management is relatively unknown.  Present study was undertaken to evaluate the clinical profile and cervical cytomorphology in symptomatic postmenopausal woman.

Material and Methods: A total of 112 postmenopausal patients who presented with symptoms related to urogenital atrophy were studied. Adequacy, density of inflammation with numerical scoring, specific pathogens and predominant cell type were assessed in each smear and correlated with presenting symptoms and duration of menopause.

Result: The most Common presenting urinary symptom was dysuria, Increased frequency, Urgency and associated with fever and suprapubic pain. Smears of all patients showed inflammation, varying in intensity, irrespective of the presenting symptoms with a high incidence of candidiasis (12.5%). Two patients who had ASCUS (Atypical squamous cell of uncertain significance) on smears had carcinoma on follow up. 7 patients who opted for HRT were followed up with cytology.

Conclusion: Cytology (Pap Smear) in postmenopause can be used other than to assess hormonal status, to screen for malignancy, pathogens in inflammation and to monitor hormone replacement therapy.

Keywords: Postmenopause, Infections, Cytology, Urogenital Atrophy.

References

  1. Rich-Edwards JW, Manson JE, Hennekens CH, Buring JE. The primary prevention of coronary heart disease in women. N Engl I Med 1995; 332:1758-66.
  2. Deward F, Pot H, Tonckens-Nanniga NE, Baanders, van Halewin EA, Thijssen JHH. Longitudinal studies on the phenomenon of postmenopausal estrogen. ActaCytol 1972; 16:273-8.
  3. Anklesaria BS, Krishna UR, Sheriar NK. Climacteric symptoms and urogenital problem. In: Krishna UR, Shah D, eds. The menopause. Madras: Orient Longman Ltd., 1996:12-25.
  4. Enhoming G, Lars H, Mecen B. Abililty of cervical mucus to act as a barrier. Am J ObstetGynecol 1970; 108:532-7.
  5. Iosif CS, Bekassy Z. Prevalence of genito-urinary symptomsin the later menopause ActaObstetGynaecolScand 1984; 63:257-60.
  6. Gail A, Green D, Lee NP, Amola ER. The Menopause. Lancet 1999; 353:571-80.
  7. Wilson JD, Robinson AJ, Kinghorn S, Hicks DA. Implications of inflammatory changes on cervical pathology. BMJ 1990; 300:638-40.
  8. Parsons WI, Godwin M, Robbins C, Butler R. Prevalence of cervical pathogens in women with and without inflammatory changes on smear testing. BMJ 1993; 306:1173-4.
  9. Mendling W. Vulvo vaginal candidiasis. New York: Springer—Verlag, 1988:27-30.
  10. Larsen B, Galask RP. Vaginal microbial flora : composition and influences of host physiology. Ann Intern Med 1982; 96: 926-30.

Corresponding Author

Dr Soma Thakur

Tutor, Department of Pathology, Sri Krishna Medical College, Muzaffarpur