False positive pap smear may be early signal of genitourinary syndrome, suggests study

The study was led by Alberto Dominguez-Bali, MD, from the Miami Center for Obstetrics, Gynecology and Human Sexuality in Miami, Florida.

Starting in 2010, researchers in Antigua and Florida observed a rise in the number of perimenopausal women with no history of cervical abnormalities and low risk for sexually transmitted infections (STIs) presenting with abnormal Pap smears at their clinics.

The Papanicolaou test, also known as the Pap test or the Pap smear, was developed by Georgios Papanikolaou in the 1940s. It has been the mainstay of cervical cancer screening for the last 60+ years and involves exfoliating cells from the transformation zone of the cervix to enable the examination of these cells microscopically for the detection of cancerous or precancerous lesions.

They investigated 1500 women aged 30-70 from several clinics. The women had a low risk for sexually transmitted infections, a maximum of two sexual partners, and the presence of cervical dysplasia over 12 years.

The researchers reported the following findings:

• Nearly all (96.7%) of the women who received local estrogen treatment had a normal Pap smear following therapy.
• A high number of patients who initially presented with cervical dysplasia underwent interventions such as biopsies, colposcopies, cryotherapy, LEEP excisions, cone biopsies, and hysterectomies because of cervical atrophy.
• Local estrogen treatment could save patients money spent on treatments for cervical atrophy.
• Some women who underwent cone biopsies and hysterectomies and did not receive local estrogen still had vaginal dysplasia.

The researchers reported an early sign of genitourinary syndrome of menopause: false positive cervical dysplasia caused by cervicovaginal atrophy resulting from reduced estrogen levels during perimenopause.

"We also demonstrated how the use of local estrogen therapy can prevent a significant number of procedures and interventions, leading to significant cost savings," the researchers wrote. "This is particularly relevant as the number of Pap smears conducted in this population represents 50-60% of all Pap smears performed on women.

The authors of the study reported no limitations.

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The data were presented at the 2023 Menopause Meeting of the North American Menopause Society on September 27.