Cervical cytomorphological patterns in postmenopausal women aged 45–60 years: A comparative pap smear study

Suhas K. Thazha; Sukesh Sukesh; Shalini Kuruvilla; Shashidhar Kotian; Bibin Scaria

doi:10.53730/ijhs.v10n2.15984

Authors

Suhas K. Thazha
suhaskaniyarakkal@gmail.com
Srinivas University, Mangalore, India
Sukesh Srinivas University, Mangalore, India
Shalini Kuruvilla MIMS College of Allied Health Sciences, Malappuram, Kerala, India
Shashidhar Kotian Srinivas University, Mangalore, India
Bibin Scaria AKG Co-operative Institute of Health Sciences, Kannur, India

Keywords:

bethesda system, cervical cancer screening, cervical cytology, cytomorphology, epithelial atrophy, pap smear, postmenopausal women

Abstract

Background:Menopause is associated with declining estrogen levels that influence cervical epithelial maturation and exfoliation, resulting in cytological changes such as atrophy, inflammation, and reduced cellularity.Limited evidence is available comparing cervical cytomorphological patterns between symptomatic and asymptomatic postmenopausal women.Methods: A prospective comparative observational study was conducted from 2023 to 2025 among 300 naturally postmenopausal women aged 45–60 years participating in a community-based cervical cancer screening programme in Kerala, India.Women were grouped as symptomatic (n = 149) or asymptomatic (n = 151). Conventional Pap smears were collected, stained using the Papanicolaou technique, and evaluated according to the 2014 Bethesda System.Results: Atrophic smears were the most common finding (41.0%), followed by normal cytology (33.3%), inflammatory smears (16.7%), and atrophic smears with inflammation (7.7%). Overall, 98.7% of smears were negative for intraepithelial lesion or malignancy. Normal cytology declined with age, whereas atrophic and inflammatory changes increased. One LSIL case and two malignant smears were identified only among women aged 55–60 years. Cytomorphological findings were comparable between symptomatic and asymptomatic women. Conclusion: Benign atrophic and inflammatory changes predominated in postmenopausal cervical smears. Age had a greater influence on cytomorphological findings than menopausal symptom status, supporting the continued importance of cervical screening in older postmenopausal women.

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References

Arbyn, M., Weiderpass, E., Bruni, L., de Sanjosé, S., Saraiya, M., Ferlay, J., & Bray, F. (2020). Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health, 8(2), e191-e203. DOI: https://doi.org/10.1016/S2214-109X(19)30482-6

Castle, P. E., Schiffman, M., Herrero, R., Hildesheim, A., Rodriguez, A. C., Bratti, M. C., ... & Burk, R. D. (2005). A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica. The Journal of infectious diseases, 191(11), 1808-1816. DOI: https://doi.org/10.1086/428779

Cibas, E. S., & Ducatman, B. S. (2020). Cytology: Diagnostic principles and clinical correlates (5th ed.). Elsevier.

Compston, J., Cooper, A., Cooper, C., Francis, R., Kanis, J. A., Marsh, D., ... & Wilkins, M. (2009). Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas, 62(2), 105-108. https://doi.org/10.1016/j.maturitas.2008.11.022 DOI: https://doi.org/10.1016/j.maturitas.2008.11.022

Fontham, E. T., Wolf, A. M., Church, T. R., Etzioni, R., Flowers, C. R., Herzig, A., ... & Smith, R. A. (2020). Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: a cancer journal for clinicians, 70(5), 321-346. DOI: https://doi.org/10.3322/caac.21628

Gravitt, P. E. (2012). The known unknowns of HPV natural history. The Journal of Clinical Investigation, 121(12), 4593–4599. DOI: https://doi.org/10.1172/JCI57149

Kyrgiou, M., Koliopoulos, G., Martin-Hirsch, P., Kehoe, S., Flannelly, G., Mitrou, S., ... & Paraskevaidis, E. (2007). Management of minor cervical cytological abnormalities: a systematic review and a meta-analysis of the literature. Cancer treatment reviews, 33(6), 514-520. https://doi.org/10.1016/j.ctrv.2007.05.002 DOI: https://doi.org/10.1016/j.ctrv.2007.05.002

Monteleone, P., Mascagni, G., Giannini, A., Genazzani, A. R., & Simoncini, T. (2018). Symptoms of menopause—Global prevalence, physiology and implications. Nature Reviews Endocrinology, 14(4), 199–215. DOI: https://doi.org/10.1038/nrendo.2017.180

Nayar, R., & Wilbur, D. C. (Eds.). (2015). The Bethesda System for Reporting Cervical Cytology: Definitions, criteria, and explanatory notes (3rd ed.). Springer. DOI: https://doi.org/10.1007/978-3-319-11074-5

Nayar, R., & Wilbur, D. C. (Eds.). (2023). The Bethesda System for Reporting Cervical Cytology: Definitions, criteria, and explanatory notes (4th ed.). Springer.

Perkins, R. B., Guido, R. S., Castle, P. E., Chelmow, D., Einstein, M. H., García, F., ... & Wentzensen, N. (2020). Directrices de consenso de gestión basada en riesgos de la ASCCP de 2019 para pruebas de detección de cáncer de cuello uterino anormales y precursores del cáncer. Journal of Lower Genital Tract Disease24, 2, 102-131. DOI: https://doi.org/10.1097/LGT.0000000000000525

Portman, D. J., & Gass, M. L. (2014). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. The journal of sexual medicine, 11(12), 2865-2872. DOI: https://doi.org/10.1111/jsm.12686

Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The menopause transition: Signs, symptoms, and management options. The Journal of Clinical Endocrinology & Metabolism, 106(1), 1–15. DOI: https://doi.org/10.1210/clinem/dgaa764

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249. DOI: https://doi.org/10.3322/caac.21660

William, W., Ware, A., Basaza-Ejiri, A. H., & Obungoloch, J. (2018). A review of image analysis and machine learning techniques for automated cervical cancer screening from pap-smear images. Computer methods and programs in biomedicine, 164, 15-22. https://doi.org/10.1016/j.cmpb.2018.05.034 DOI: https://doi.org/10.1016/j.cmpb.2018.05.034

World Health Organization. (2021). WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention (2nd ed.). World Health Organization.