Menopause and Pap Smear Flashcards
Pap Smear
Normal = negative for intraepithelial neoplasia
Atypical Squamous Cells of Undetermined Significance
ASC - H
Low-grade squamous intraepithelial lesion
High-grade squamous intraepithelial lesion
Squamous Cell Carcinoma
Atypical Glandular Cells
AGC - favor neoplasia
Endocervical adenocarcinoma in situ
Screening Recommendations
Annual at age 21, before 21 if pregnancy or other
>30 yrs with normal annual paps, every 3 years
- periodic screening if neoplasia high risk
High Risk Factors
Multiple Partners, early age intercourse, partner had multiple partners, HPV, HSV, HIV, STDs, smoker, drugs
Dysplasia
CIN 1 - mild dysplasia
CIN 2 - moderate dysplasia
CIN 3 - severe dysplasia
CIS - carcinoma in situ
HPV
> 100 types, lots of oncogenes
- All grades of CIN and invasive cervical cancer contain HPV DNA
- Peak age 14-24
Koilocytosis
cellular change from HPV –> perinuclear cavitation and nuclear atypia
Squamous Cell Carcinoma
most common, often HPV 16
Adenocarcinoma
2nd most common, HPV 18 and 45
HPV infection is atypical
NOT bloodborne, no viremic phase
- immunoevasive nature limits host immune response
Colposcopy
examination of cervix, vagina, vulva with magnifying instrument at 10-16x
- Acetowhite epithelium results from piling up of cells with increased nuclear-cytoplasmic ratio
- Mosaic pattern from neovascularization
- Punctation from perpendicular capillaries
Colposcopy criteria
- Sharpness of peripheral margin
- Color of acetowhite staining
- Type of vascular pattern
- Iodine staining reaction (mustard yellow)
- Adequate visualization of squamocolumnar junction
Dysplasia Treatment
Superficial techniques can be used if: - entire SCJ visualized, biopsy consistent with pap, endocervical curettage negative, no suspicion of occult invasion Other techniques - cone biopsy -> can't see SCJ, CIN 2-3 - hysterectomy
Atypical Glandular Cells
atypical enometrial cells -> EMBX
>35 years or abnormal bleeding -> EMBX
LSIL
No CIN/cancer -> cytology and coloposcopy
HSIL
No CIN/CIN 1 Bx ->
- no change = diagnostic excision
- change = manage per guidelines
HPV Vaccinations
HPV 6, 11, 16, 18
- recommended for girls age 11-12
Perimenopause
time before, during, after menopause (transition)
- uneventful or major symptoms
- irregular menses for about 4 years
Menopause
permanent cessation of menses after cessation of ovarian function
- amenorrhea in presence of signs of hypoestrogenemia and FHS >40
Postmenopausal
more than 1/3 of woman’s life!
CONCERNS:
- osteoporosis, skin, mood, hot flashes, CVD, sex, vaginal atrophy, incontinence, HRT
Hormonal changes
- follicles decrease, inhibin falls, FSH rises -> estradiol level decline -> endometrial development fails -> abscence of menses
- progesterone production ceases -> unopposed estrogen –> increased endometrial cancer early in menopause
- Androgens production decreases from both ovaries and adrenals -> libido?
Physiologic Changes
- Body mass -> weight and fat increase, CVD risk?
- Decreased Collagen -> thinning skin, tooth loss, atrophic vagina, poor uterovaginal support
- Hot Flashes -> pathognomonic for menopause, directly related to estrogen levels, GnRH pulses from hypothalamus
- Other symptoms - depression, libido, loss of youth, headaches, amenorrhea
Abnormal uterine bleeding
> 50% of women (perimenopausal)
- RULE OUT PREGNANCY!!!!!
Osteoporosis
post-menopause bone density decreases 1-2% per year
- age 60 -> 25% spinal compression
- age 80 -> 20% hip fracture, 15% die in 6 months
Tx = HRT, bisphosphanates, calcitonin, SERMs, calcium, Vit D
Hormone Replacement Therapy
Indications -> hot flashes, vaginal atrophy, osteoporosis, high risk
Contraindications -> pregnant, undiagnosed vaginal bleeding, active VTE, GB disease, liver disease
