These findings, if early, can make the difference between life and death.
We already gave you information about how Pap smear is done, now we’ll try and mention what procedures might be recommended if your Pap smear is interpreted as abnormal.
Such treatment options include colposcopy, conization, cryocauterization, laser therapy and so on …
All these procedures have a high cure rate (over 90%), but your OBGYN will recommend the ones that are more suitable for your current situation.
The most common procedures, after an abnormal Pap smear test
Colposcopy is a minimally invasive and painless procedure that allows your gynecologist to look closer at your cervix. During this procedure your doctor basically uses a magnifying glass (called a colposcope) to look at the cervical lesion.
For a better view, the cervix is cleaned and soaked with vinegar (3% acetic acid). This acid turns the cellular abnormalities white, this is why doctors call them acetowhite lesions or acetowhite epithelium.
If your doctor finds any suspicious areas, a biopsy will be performed. This means a sample is taken from your cervical tissue and send to the laboratory for further analysis. If the result is positive for cancer, specific treatment options will be presented to you.
After a biopsy your doctor will recommend at least 7 days of sexual abstinence, internal douche or using tampons, in order for your small lesion to heal. If you are pregnant, you can still have a colposcopy done, since it’s still a very reliable test (90% success rate).
After your OBGYN has performed a colposcopy (it’s usually done to properly view the affected area on your cervix), conization might be the next step.
This procedure is a little more invasive than just viewing your cervix, since it means removing of the abnormal tissue area. A small cone-shaped specimen is being taken from around the endocervical canal, hence the name conization.
Because it is a painful procedure, anesthesia is performed in a hospital, but you will be released home shortly after. In most cases conization does not lead to complications (except for possible anesthesia complications and bleeding – only in about 10% of the cases), this is why you won’t need hospitalization.
There can be adverse effects on fertility, this is why conization is usually prescribed on women whose Pap smear suggests they may have invasion of cancer in nearby tissues or have severe changes on biopsy.
Cure rate is close to 100% with conization, as long as the cells along the margins are normal. You will be advised to abstain from douching internally, sexual activity and using internal tampons for about 3 weeks after the procedure.
Large-loop excision (LEEP) of the transformation zone
Large-loop excision of the transformation zone (LEEP) is a procedure done with a thin-wire loop that cauterizes the affected area on your cervix and the transformation zone (where the vaginal lining changes to the uterine lining).
Electrocautery is being administered and various tissue samples are being collected for analysis. The procedure is one of the most common used for Pap smear abnormalities and can be performed even under local anesthesia.
This is the most invasive treatment option for abnormal Pap smears and appropriate only for the women who are no longer interested in bearing a child. Your doctor will probably recommend this procedure only if other previous attempts have failed, as a last resort.
The treatments available after an abnormal Pap smear are various and effective. Your OBGYN will be able to recommend the best options for you.
Don’t forget that, even after you have been successfully treated, regular Pap smears are mandatory.
Do not forget to inform your medical examiner in the future about these results and the course of treatment your gynecologist used, since your medical history is very important.
As soon as your Pap smear has been collected, it will be sent to the laboratory for interpretation (reading).
Since there are many labs in the US alone and each could have its own standard interpretation, a medical terminology system was created at the National Institute of Health (NIH) in Bethesda, Maryland.
The system is called The Bethesda System and allows all labs to analyze Pap smears under the same standard and produce correct results.
Back in 1988, the National Cancer Institute held a workshop to standardize Papanicolau smear results, the result is The Bethesda System. It has been improved in 2001 and now is universally accepted in the US.
Abnormal Pap smear categories
ASC-US – atypical squamous cells (thin, flat cells on the cervical surface) of undetermined significance.
This is the mildest form of cellular abnormality of the spectrum of cells from normal to cancerous. In this case the cells appear abnormal, but are not yet malignant.
One of the main causes for these cells appearing is the human papilloma virus (HPV). In most cases (80-90%) the condition is solved on its own, without treatment.
LSIL – low grade squamous intraepithelial (surface level of the cells) lesion.
Using the term lesion means abnormal tissue is being found. You might have known this as CIN grade I years ago, under the old classification.
If you have such a result on your Papanicolau test, you should consult with your gynecologist and make further investigations. Up to 30% of the women who have this result will find a more serious one once biopsy of the cervix is performed.
The course of treatment is colposcopy (examination of the cervix with a special scope) and also a cervical biopsy, which allows further sampling of the abnormal cells and finding if they are cancerous or not.
This abbreviation stands for high-grade squamous intraepithelial lesion. In the old classification it was known as CIN grade II, CIN grade III or CIS.
This is serious already, even if not cancer in all cases. High-grade squamous intraepithelial lesion means more evaluation and treatment.
It means that atypical cells are present and high-grade squamous intraepithelial lesions cannot be excluded.
Abnormal / inadequate Pap spear reports usually have the following results
Absence of endocervical cells
When your doctor uses the sampling instrument to get the cells from the inside of the cervix, called endocervical cells, it sometimes cannot reach that area. In this case the Pap smear sample won’t include these so the test cannot be properly read.
Unreliable Pap smear due to inflammation
Vaginal irritation or infections can also ruin the Pap smear interpreting.
When inflammation is present, your doctor has to first find the causes and then treat the inflammation. Otherwise it can affect both the women and her sexual partner.
Vaginal irritation can also occur, especially in menopausal women, whose bodies don’t produce estrogen in the ovaries. The vaginal walls become red and irritated and this can also affect their Pap Smear.
After the condition is treated successfully, the Pap smear is repeated.
What’s included in a Pap smear report?
Your Papanicolau test report has to include identification information, patient history and details about the specimen taken:
- name of the woman
- name of the pathologist reading the test
- source of the specimen
- last menstrual period of the woman
- if the woman is menopausal or not
- number of slides
- details about the sample’s adequacy
- final diagnosis
- recommendation for follow-up, whether repeat or routine.
The Pap smear diagnosis takes into account
- the patient’s history
- sample adequacy
- presence or absence of cellular abnormalities.
The final Pap smear diagnosis is based on three determining factors:
What to do next after a Pap smear?
If the results are good and no abnormal cells were found, your gynecologist will advise you to come for routine Pap smears.
If your Pap smear is abnormal, your doctor will come up with a list of more medical exams to be performed and a plan of treatment.
A Pap smear (Papanicolau smear; also known as the Pap test) is a simple and painless screening test for cervical cancer. During a routine pelvic exam, your OBGYN will collect sample cells from your cervix (the end of your uterus, that extends into the vagina).
These cells are placed on a glass slide and stained with a Papanicolau stain, a substance that allows the doctors to notice, under the microscope, if there are any pre-malignant (pre-cancer) changes or even malignant ones (caused by cancer).
The Pap smear has a good sensitivity, even if not perfect.
In some cases false positives can happen (a normal smear is being classified as abnormal) and also false negatives (cancer cells not being noticed).
Even if not 100% accurate, only few women who regularly have Pap smears develop cervical cancer, this is why a Papanicolau smear is the best way to detect any anomalies, before the cancer is too advanced.
In most cases a Pap smear will identify cell abnormalities, even before they can turn malignant, making your condition easily treatable.
Ovarian, vaginal or uterine cancer cannot be detected with a Pap smear, but, since you are being given a complete pelvic (gynecologic) exam with your Pap test, this allows your doctor to notice any malignant changes in your reproductive system.
Cervical cancer can be diagnosed only with a biopsy.
It usually develops slowly, this is why regular Pap smears can allow your doctor to notice it before it reaches advances life-threatening stages.
How is a Pap smear performed?
The Pap smear is done during a regular pelvic exam, usually done by your OBGYN. Other healthcare professionals can also examine you, but it’s usually done by a gynecologist.
A speculum is inserted into the vaginal area, allowing the doctor to examine it.
A small swab/brush is inserted into the cervix opening and twirled around to collect a sample of cells. A second sample is collected from the cervix surface.
Samples are placed in a solution and then taken to the laboratory for further examination.
The results usually come within few days, up to 2 weeks.
Make sure you are being informed on the results, if your doctor fails to inform you within a month, ask for your Pap smear results.
If you already had positive Pap smear tests (a history of abnormal cells collected from your cervix), it’s important to inform your doctor. Make sure you can provide information about the procedures and treatments, so that it can be mentioned on the lab form.
Having had previous cell abnormalities will alert the medical professional who is interpreting your Pap smear look closer for any possible abnormalities.
Sometimes your Pap test results are inconclusive.
Here are some cases:
- inadequate sample – drying artifact or excessive blood, factors that can interfere with the sample being read
- unsatisfactory due to excessive inflammation – inflammation in the cervical area can be caused by infections or
- irritations. In this case treatment might be prescribed and, afterwards, a second Pap smear performed, to make sure it can be properly interpreted.
What you should know about Pap smear
- avoid sexual contact and vaginal irrigation 24-48 hours before your scheduled Papanicolau test
- the ideal time to have a Pap smear is between days 10 and 20 of your menstrual cycle (day 1is the first day of your period)
- collecting your cervical cells should be avoided during menstruation.
- having regular Pap tests can prevent cervical cancer. While the test itself is not 100% accurate, most women who are facing invasive cervical cancer (and many dying because of it), have not had a Pap smear in the past 5 years. Usually uninsured women or women from various poor rural areas are the ones being affected, but there are many from more privileged backgrounds in the same situation.
Depending on your doctor’s recommendation you should have a Pap smear done at least every 2-3 years, if not annually. This gives you a chance to spot any cancerous cells before it spreads into your body and puts your life at risk.
Cervical cancer is one of the most common types of cancers and, fortunately, still one of the most preventable and treatable of all.
If your Papanicolau test comes abnormal, follow your gynecologist-obstetrician recommendation
If you were treated for cervical dysplasia it is advised to have regular Papanicolau tests, since the abnormal cells can reappear, even if properly removed in the first place.
For most women, finding out they are pregnant is one of the happiest news they’ll ever get. Unfortunately not all pregnancies end up with you holding your baby, there are also cases when a miscarriage can occur.
What is a miscarriage?
A miscarriage is the spontaneous loss of a pregnancy until 20 weeks since conception. If your pregnancy is older than 20 weeks, we talk about a stillbirth.
Some also call it a spontaneous abortion, since abortion means ending a pregnancy, whether intentional or not.
Most miscarriages occur in the first trimester of the pregnancy (from 7 to 12 weeks) and, in some cases, women don’t even know they were actually pregnant.
How common is miscarriage?
Experts claim that about half of all fertilized eggs die before implantation or are miscarried.
As already mentioned, there are also women who miscarry, but never knew they were pregnant, this means that, from the known pregnancies, about 10-20% end in miscarriage.
Most miscarriages occur because of genetic problems within the embryo. The resulting baby wouldn’t be able to survive after birth and develop anyway.
The good news is that these fatal genetic errors are not related to genetic problems in the mother.
Certain medical conditions can also cause miscarriage or increase the risks of having a spontaneous abortion.
Mothers with diabetes and thyroid disease are prone to miscarry. Infections that spread to the placenta can also increase the risk.
The most common risk factors for miscarriage include:
- age – older women risk more miscarriages
- cigarette smoking (over 10 a day). Ideally, if you want to get pregnant, you should stop smoking altogether, the risks don’t end here.
- alcohol consumption
- trauma to the uterus
- exposure to radiation
- previous miscarriage – women who had a miscarriage have an incidence of miscarriage of about 20%. If a woman had 3 or more consecutive miscarriages, the risk is as high as 43%.
- weight problems – severely underweight or overweight – BMI of under 18.5 or above 25)
- abnormal uterus
- drug abuse
- the use of NSAIDs (nonsteroidal anti-inflammatory drugs) around the time of conception
What are the types of miscarriage?
Doctors refer to miscarriages by tissue-specific names (reflecting the clinical findings) or the type of miscarriage.
- Threatened abortion – a woman is experiencing vaginal bleeding (or other sign of miscarriage), but hasn’t yet lost the pregnancy
- Incomplete abortion – some fetal and placental tissues have been expelled from the uterus, some remain.
- Complete abortion – all the tissue of the pregnancy has been expelled
- Missed abortion – the fetus has not developed; there is no viable pregnancy in this case. The plancental and fetal tissue are still in the uterus.
- Septic abortion – there is an infection in the retained fetal / placental tissue.
Miscarriage signs and symptoms
Should you experience ANY vaginal bleeding, consult with your OBGYN. While vaginal bleeding doesn’t always mean you are miscarrying, since it’s common in the first trimester, it should be investigated.
Similar to menstrual pain, but higher in intensity. The pain is dull and cramping, can be present constantly or come and go.
In most pregnancies some pelvic pain is normal, since the uterus is growing and it’s painful, but, if you are not sure, always consult with your OBGYN.
Pregnancy symptoms suddenly dissappearing
Morning sickness, tiredness, tender breasts, these are just few of the signs of a normal pregnancy, which are being experienced by most women. These will vane during the second trimester, but, if they suddenly cease, it can be the sign of a miscarriage.
Some vaginal discharge is normal at the beginning of your pregnancy, because of all the hormonal changes in your body, during that time. Should mucus, blood or an unpleasant smell appear, please go see your doctor.
How is miscarriage diagnosed?
- ultrasound examination – the most common way for your doctor to determine if you are having a miscarriage. It can also show if it’s an ectopic pregnancy (outside of the uterus, usually into the Fallopian tube)
- blood tests – for pregnancy hormones, blood counts (to determine the degree of blod loss, or if there is also an infection)
- pelvic examination
- blood type check – for Rh-negative women to receive an injection of rho-D immune globulin (RhoGam), to prevent further miscarriages.
What happens after a miscarriage?
There is no treatment to prevent a miscarriage, although, if the woman has not yet miscarried bedrest is advised. She should also abstain from sexual activity and restrict any physical activity, until the miscarriage signs are no longer present.
Once the miscarriage occurs, there is no treatment for it.
It will take its course and, if there is no severe blood loss or cramping, no treatment is required.
If the pregnancy tissue has not been evacuated entirely, a dilatation and curettage (D&C) procedure will be performed. It’s most common for missed abortions, since the pregnancy material is still present in the uterus.
Women who are Rh-negative will receive a dose of rho-D immune globulin.
If an infection caused the spontaneous abortion, antibiotic treatment will be given.
Having a miscarriage doesn’t necessarily mean you won’t be able to become a mother. Most women recover easily after a miscarriage (as opposed to a molar pregnancy, for instance, when recovery takes longer), so they start trying to conceive weeks after.
Your doctor can advise you to wait for 2-3 menstrual cycles though, so that you are fully recovered. There are high changes of having a normal pregnancy and ending up with the baby you always dreamed of.
Miscarriage is a devastating event in the life of a woman, but, in most cases, physical recovery is fast.
Molar pregnancy is an exception to this rule.
It can lead to serious complications, this is why the patient has to stay under her OBGYN’s observation for more months, after the procedure: suction curettage, dilation and evacuation (D & C) etc.
Usually molar pregnancy is successfully treated, without severe complications, but the added stress can hinder psychological recovery.
Types of molar pregnancy
This type of ‘false’ pregnancy appears because the egg is incorrectly fertilized.
Normally, the cells in our body contain 23 pairs of chromosomes (one chromosome from each pair coming from the father, the other one from the mother).
Complete molar pregnancy
One egg, without any genetic information, is being fertilized by a sperm, but it doesn’t turn into an embryo, but grows into an abnormal tissue, which looks like grapes and can fill the uterus.
In this case, there’s no placenta or normal embryo, so we cannot talk about a viable pregnancy.
The chromosomes come only from the father, the ones from the mother are inactivated or lost after the fertilization, while the father’s chromosomes double.
Partial molar pregnancy
An egg is being fertilized by 2 sperm cells. The placenta turns into a mola. The embryo starts to develop, but it’s malformed and it will not survive.
In this case the mother’s chromosomes remain, while the father’s double, so the embryo will have 69 chromosomes instead of the normal 46.
About 20% of the women with molar pregnancy can develop 1 or 2 severe complications: myometrial invasion and Choriocarcinoma.
The risk of such complications gets higher, if the treatment is postponed. The more a patient is waiting, the bigger the chances for complications.
Invasive mole can appear pre and post treatment.
Choriocarcinoma is a neoplasic process starting at placenta level and rapidly expanding throughout the body. Even if this is a very severe complication, it can be cured with chemotherapy.
Both these complications appear with complete molar pregnancy, changes for a partial molar pregnancy to lead to these complications is as low as 2-4%.
Molar pregnancy risk factors
- age – under 20 and over 35 years
- race – for women of color, molar pregnancies are more common
- previous molar pregnancies – women who already had a molar pregnancy develop a higher risk of having another one.
- previous miscarriage(s)
- viral and parasitic infections, such as Toxoplasmosis
- hormonal imbalance
- immune disorders
Molar pregnancy symptoms
The women who develop molar pregnancy have no particular symptoms at first, but can show high HCG levels, an engorged uterus, bigger ovaries and early preeclampsia.
Vaginal bleeding appears in most molar pregnancy cases, but it can be a normal sign of miscarriage risk even in regular pregnancies.
Severe nausea and vomiting (but these can also occur in typical pregnancies).
How molar pregnancy can be diagnosed
- complete pelvic exam
- ultrasound examination
- hormonal dosage to find out the exact levels of serial β-HCG
In some rare cases a twin pregnancy can have a normal embryo and another one with molar transformation.
Continuing the pregnancy can determine severe complications for the mother.
How molar pregnancy is treated
A molar pregnancy is NOT a normal pregnancy and it won’t end with a viable fetus. This is why the only treatment option is to remove the mola.
A suction curettage is required. Only if serial HCG is high afterwards, cytostatic treatment would be required.
Monitoring the patient
In order to prevent serious life-threatening complications, the patient has to be constantly monitored with repeated serial HCG dosing, until it gets negative.
If for 3 months its level is negative, the patient is considered healed.
Please do consider using contraceptives for the next 6 months, since there is a very high risk of developing another molar pregnancy this soon.
If the serial HGC levels are high again, your doctor will prescribe a cytostatic treatment.
A molar pregnancy is a very traumatic experience for any woman, this is why we also recommend you get all the family support and, if needed, of a good therapist. The good news is that you can conceive afterwards, once you are fully recovered, so don’t lose hope.