Nisa Kaiho1, Laitonjam Sushila Devi2, Laiphrakpam Ranjit Singh3

In postmenopausal women, risk of uterine cervical dysplasia and malignancy is increased, especially in those with no history of previous Papanicolaou (Pap) smears. Therefore, routine screening can help in reducing morbidity and mortality.
To study the uterine cervical cytomorphology in symptomatic postmenopausal women, prevalence of dysplasia/malignancy, to observe the relation of cervical cytomorphology with urogenital symptoms, age of onset and duration of menopause.
A total of 102 symptomatic postmenopausal patients underwent Pap smear examination and reporting was done based on The 2001 Bethesda System.
Out of 102 smears, 101(99.02%) cases were satisfactory for reporting. Age ranged from 44 to 79 years with mean and median age of 54.3±6.8 and 52.5 years respectively. Maximum cases were in the 50-59 age group, 57(56.5%) cases. Age of onset of menopause varied from 40 to 56 years with mean and median age of 48.6±3.4 and 49 years respectively. Duration of menopause ranged from 1 to 26 years with mean and median duration of 5.78±5.7 and 4.0 years respectively. Negative for intraepithelial lesion or malignancy (NILM) and epithelial cell abnormalities (ECA) were 86(85.1%) and 15(14.9%) cases respectively. ECA were most commonly seen in the 60-69 years’ age group, 7(46.7%) cases. Overall prevalence of cervical dysplasia was 9(8.9%), with highest prevalence in the 60-69 age group, 5(27.7%); and carcinoma was 3(2.9%) with highest in the 60-69 age group, 2(11.1%) cases. Vaginal discharge was the commonest urogenital symptom, 40 (39.8%) cases. Reactive cellular changes (RCC) was the commonest finding in vaginal discharge, 24(60%) cases. Maximum cases of ECA, 12(44.4%) cases, were associated with postmenopausal bleeding (PMB). Mean age in dysplasia and malignancy (58.6±7.3 years) was significantly higher (P<0.019), with higher proportion in women >54 years (P<0.030). Significant correlation of dysplasia and malignancy was seen with duration >5 years (P<0.011).
Pap smear examination in symptomatic postmenopausal women will definitely bring about better management of cases thereby improving the quality of life.


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