colposcopy results

Hello.  I am 56 years old and menopausal.  I recently had an abnormal Pap Smear.  Then a colposcopy was performed.  The result showed very scant fragments of benign endocervix and squamous metaplasia with acute and chronic inflammation in the endocervix.  The report also showed squamous metaplasia with acute and chronic inflammation in the cervix.  One gynecologist said that the cryosurgery would be needed.  However, another gynecologist from the same office said that the cryosurgery would not be needed.  Please explain to me both of their reasonings.  Thank you.

[Elaine Brown, MD]

Hi!  I would not do cryotherapy in this situation, so I don't think I can explain that reasoning!  Your biopsy does not show any problem serious enough to warrant treatment. Metaplasia and inflammation are normal findings.

It would be useful to know what the PAP smear result was--If the PAP smear was significantly more abnormal than the biopsy (eg, HGSIL), it means that the person performing the biopsy has very likely missed the abnormal spot and has taken the biopsy sample from a normal part of the cervix.  My recommendation in that case would be  a leep procedure--which is a combination of a biopsy/treatment.  A leep procedure basically removes a quarter sized portion of tissue from the cervix which can then be submitted for analysis--a sample this large is fairly certain to contain the abnormal area.  Also, since most of the abnormal tissue is removed, there is no need for cryotherapy.

On the other hand, if the PAP smear was only mildly abnormal, and the biopsy was normal, I would be very tempted to repeat a pap smear in 6 months and defer any treatment.  Often I have the patient use some vaginal estrogen cream for several weeks prior to the exam, and that  helps clear up the pap.  It is a little unusual for someone your age to have her first abnormal pap, and often the changes that are reported are due to atrophy caused by the lower hormone levels that come along with menopause.

By the way, an HPV DNA test could and should also be run on your pap if it is only mildly abnormal.  Was it Atypical Cells of Uncertain Significance(ASCUS) by any chance?

If you have the PAP results and you want my recommendation--don't hesitate to make a new post.  Don't reply to this one, as I won't see it.  Or you could go back to the doctor who doesn't want to do cryotherapy and ask these questions as well!

Good luck!

Dr B

[rmowrey]

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