(067) False Positive Pap Smear as The First Sign of Genitourinary Syndrome of Menopause

Abstract

Abstract Introduction Around 2010, we started to realize in our centers that we were receiving an increasing number of perimenopausal women with abnormal Pap smears (cervical dysplasia), going from ASCUS to low-grade squamous intraepithelial lesions or high-grade squamous intraepithelial lesions with or without positive HPV. With no previous history of cervical abnormality and almost all of them in a long-term stable sexual relationship with a maximum of 1 or 2 sexual partners. After talking with our pathologist, we asked if vaginal atrophy could produce such results. He answered affirmatively and provided us with a few recent articles that describe such findings. As an advocate for hormone replacement therapy, we decided to start using local vaginal estrogen for several months and then repeat the Pap smears. We were able to confirm that inclusively with those cases diagnosed with high-grade squamous intraepithelial lesions, the next Pap smear after the treatment with local estrogens was totally normal. The situation has been repeated in more than 96% of cases in around 1500 patients in the same conditions for the last 12 years. Objective Describe these new findings confirmed by a few articles in the pathology field and two articles on estrogen use, in women ranging between the ages of 30-70 years. Methods Prospective follow-up of perimenopausal patients with positive Pap smears and very low risk for STDs placed on local and/or systemic vaginal estrogen. A Pap smear was conducted at 4 months and then 1 year after, which was followed by the regular scheme of Pap smear follow-ups. Results 96.7% of all those patients with the described characteristics were successfully treated with local estrogens. During the study, we realized that the high number of patients who entered after the initial diagnosis of cervical dysplasia in the regular guidelines of colposcopies, biopsies, LEEP excisions, cryotherapy, and due to the persistence of the findings in more than 50% of those cases (because of the persistence of cervicovaginal atrophy) they finished having cone biopsies and/or hysterectomies. Conclusions We describe the early finding of another sign of genitourinary syndrome of menopause: false positive cervical dysplasias, secondary to cervicovaginal atrophy, due to the decrease in the level of estrogens that characterized the perimenopause. Also, how the management of local estrogens prevents a great number of interventions and patient procedures, saving billions of dollars per year, taking into account that the number of Pap smears in the named population is around 50-60% of all Pap smears practiced in the total population of women. Disclosure No