Ask Dr Marie: Less Frequent Pap Tests May Be Good For Women
Dr. Marie Savard says changing cervical cancer screening recs is a welcome step.
But the truth is, it isn’t.
The new guidelines from the ACOG recommend the following:
All women should begin receiving a Pap test at age 21. Previously, the recommendation was that women begin Pap tests at age 18.
Women ages 21 to 30 should have a Pap test every other year. The previous recommendation was for an annual screening.
Women ages 30 and over should have a Pap test every three years. Previously, the ACOG recommendation urged screenings every two to three years in this age group.
The Good News About Waiting Until Age 21
Waiting to first test women with the Pap test until they are 21 will protect so many young women from unnecessary anxiety, biopsy of their cervix and potentially harmful treatment. We now know that most of these abnormal Pap tests in young women are caused by one of the many strains of the human papillomavirus and will go away on their own without treatment in one to two years.
Furthermore, and even more important, women who are aggressively treated for an abnormal Pap test have a much greater risk of premature birth and other pregnancy complications. I have cared for many women over the years who had prior cone biopsies and other treatments to their cervix which led to difficult pregnancies.
My Big Concerns About Less Frequent Screening
Results Of A Pap Smear
Most times, the results of a pap smear return as normal however, it is not uncommon for the results to come back as abnormal. The specialists in the lab will label abnormal cells according to how different they are from normal cells. Knowing the type of abnormality will help your doctor at All Women’s Care decide on your treatment. Minor cell changes can disappear without the need for treatment, moderate to severe cell changes are more likely to be an indication of precancerous and could turn into cervical cancer.
These are some of the terms used to define the results of a pap smear:
A normal test result indicates that your cervix is healthy. Your doctor will then schedule your next pap smear at All Women’s Care.
An unsatisfactory test result indicates a technician in the lab could not read the sample of cells taken during your pap smear. Your doctor will need to reschedule a pap smear with you to get another sample.
- Benign changes
This test result indicates your pap smear was basically normal, but there is an infection present that has caused inflammation of your cervical cells. You may need another pelvic exam to find the cause of the infection and receive treatment.
These are some guidelines used in young women under the age of 24:
What it Means to Have an Abnormal Pap Smear
Causes of an Abnormal Pap Smear
Should I Be Worried About Menstrual Clots
While menstrual clots can be extremely frustrating, they are rarely problems in and of themselves. If accompanied by other symptoms, talk to your doctor about treatment options that may be right for you. For many women, birth control is a useful tool for reducing clots.
If youre interested in adopting a new method of birth control, touch base with the Nurx medical team. Well find one that works for you.
Common Causes Of Menstrual Clots
Menstrual clots are normal for some women. But an increase in the frequency of clots, period length, or in the volume of menstrual flow can be a red flag for other concerns.
If symptoms become inconvenient or serious, check with your healthcare provider. Ask them to rule out other conditions that could be associated with excessive menstrual bleeding. Those include:
- Endometriosis. Endometriosis is a painful condition in which tissue usually inside the uterus grows outside of it. Women with endometriosis experience irregular and painful periods, often accompanied by unusual bleeding.
- Fibroids. Fibroids are noncancerous growths that are often associated with heavy periods. The bleeding caused by fibroids can be serious enough to cause anemia.
- Hormonal imbalances. Although imbalances have many causes, a few are common: Hypothyroidism, menopause, and polycystic ovarian disease may affect the duration and intensity of the menstrual cycle, leading to abnormal clot formation.
- Cancer. Cancer of the cervix or uterus can result in abnormal bleeding associated with blood clots. However, this bleeding tends to occur out of cycle.
Let your doctor know if you experience menstrual clots during your period, but dont be alarmed. Remember that menstrual clots are very different than blood clots in veins or arteries, which can be very serious.
Your body can pass menstrual clots with relative ease. But if they become a problem, ask whether birth control might be a good solution.
Symptoms Of Cervical Cancer
If a woman does notice the following symptoms, she should schedule an appointment with a gynecologist oncologist. Weill Cornell Medicines Womens Health Center can also lend support in providing integrated care:
- Abnormal Bleeding: Any abnormal bleeding demands attention, say doctors. A woman who bleeds between her regular menstrual periods may have cause for concern, as do women who experience post-menopausal bleeding, bleeding after intercourse, or bleeding after douching. While often benign caused by anything from pregnancy to polyps to hormonal imbalances irregular bleeding may indicate a more serious problem such as cancer, which is why doctors recommend that women schedule an exam if they notice any unusual spotting or blood flow.
- Unusual Pelvic Pain: If a woman feels pelvic pain outside of her normal menstrual cycle, it may indicate a problem. The pain could be sharp or dull, diffuse or concentrated in one specific area. Either way, pain is the bodys way of sending a warning signal. Other worrying signs? Pain while urinating or having sex.
- Increased Urinary Frequency: Cervical cancer sometimes changes a womans urinary habits and bowel movements. Be aware if you have a persistent and increasing need to pee, or if your stools change consistency over an extended period of time.
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Women At Greatest Risk Of Iuds Causing Heavy Periods
Certain women are at greater risk of developing heavy periods after getting an IUD than others. You may want to consider an alternative birth control choice if you are in one of the following categories.
Copper IUDs arent recommended for women with the following conditions:
- Heavy or irregular periods.
Copper and hormonal IUDs arent recommended for women with the following conditions:
- Current or previous pelvic inflammatory disease.
- A past abnormal pap smear.
- Unusual cervixes, uteruses, ovaries, or fallopian tubes.
- A history of narcotic use.
If you fall into one of the following categories, discuss your birth control options with one of the friendly Nurx medical team. They can provide personalized advice about the best birth control choices for you.
Pap Tests: What Women Should Do
Here is a quick review of what I would recommend:
All young girls and women should begin an every other year Pap test, starting at age 21.
Any inconclusive or mildly abnormal Pap test result should lead automatically to an HPV test. Women who have a mildly abnormal Pap test and also test positive for high-risk HPV need more testing, such as a colposcopy and closer follow up. Women who don’t have high-risk strains of the virus and, therefore, test negative with an HPV test can simply have their Pap test repeated in 6-12 months.
Starting at age 30, women who have had three consecutively normal Pap tests can have a Pap test every three years . If they have a normal Pap test and no high-risk strains of HPV, they can safely have a repeat check for cervical cancer every three years. It takes about three years from the time a woman is exposed to HPV to develop serious cell changes that can be detected with the Pap test. That doesn’t get women off the hook for the all-important regular checkup, including a pelvic exam, however.
Women who have had a hysterectomy and their cervix removed for benign conditions, such as fibroids or heavy bleeding, can stop having Pap tests altogether.
Women who have had a hysterectomy for cancer should continue with regular Pap testing. The vulvar, vaginal and, rarely, anal tissues can also develop precancerous cell changes and even cancer from high risk strains of HPV.
As always, I welcome your thoughts and suggestions.
How Is A Pap Smear Performed
Your physician at All Women’s Care will insert a speculum into your vagina, so they are able to examine your cervix. Using a small plastic wand with a brush attached, they will then gently scrape a sample of cells from your cervix for testing. The pap smear should not be done during your menstrual cycle, as this can affect the results of the test. You should also not douche or use any other products to clean your vagina before having the smear.
Most women experience a small amount of cramping when their cervix is brushed, but this sensation should last only a minute or less. The cell samples will be placed in a glass bottle or on a glass slide and sent to the lab. A trained technician will examine the cells under a microscope to check if there are any abnormalities and report the findings to your doctor.
Testosterone And Acne: Are They Connected
Yes, testosterone and acne are connected. Hormonal acne usually occurs in response to a rise in certain hormones, especially testosterone. During puberty, the production of testosterone increases and can prompt hormonal acne in teenagers. Rising testosterone may stimulate more sebum production from glands in the skin. Then, excessive sebum combines with dirt and dead skin cells, clogging the skin pores. The infection of these clogged pores by acne-causing bacteria may lead to pimples. Your bodys immune system may react to the bacteria and its metabolites and produce inflammation, which looks like redness alongside acne lesions.
Acne during menopause can occur because of hormonal fluctuations. People who develop acne around menopause usually have normal androgen levels but reduced levels of estrogen. Due to this imbalance, sebum production increases, and acne may flare.
For some people, hormone replacement therapy can actually trigger acne.
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Does Progesterone Cause Acne
Yes, fluctuation in the levels of sex hormones during your menstrual cycle may also contribute to acne before your period.
Progesterone levels rise during the middle of the cycle. This may stimulate the sebaceous glands in the skin. However, the role of progesterone in sebum production is uncertain.
Increased progesterone may also raise your body temperature and worsen sweating, leading to clogged pores. This buildup of sebum beneath the skins surface along with dirt, dead skin cells, and bacteria results in breakouts of acne before and during your period.
Misconceptions About Hpv: Learning The Facts So You Can Reverse Hpv
05.26.2020 by Dr. Doni
There are many misconceptions about HPV, and they can have a negative impact on courses of treatment. Lets look at the facts about HPV so you can devise a sound treatment plan.
If youre still reeling from your doctors appointment after being diagnosed with HPV, Youre head might be swimming with questions. Why me? How? What did I do wrong? Who should I tell? What does this mean? Will I get cervical cancer?
Your questions and concerns are all valid.
Furthermore, your doctor likely said, come back in 6 months to a year to see if its gone.For most people, this is NOT a comforting idea. After all, HPV is a virus. Who wants to allow a virus to remain in their body untreated? Isnt there something you can do BEFORE it causes cancer?
And if your pap smear also shows abnormal cells, your doctor may recommend that you get a biopsy . This is to address the abnormal cells as soon as possible. This sounds good, but the options arent ideal though. A cone biopsy, a LEEP procedure, or a hysterectomy are all invasive procedures.
You might be confused, afraid, and alone. You might be wondering, isnt there a better way?
There is. Unfortunately, in todays world of instant information, there is also an abundance of misinformation. Lets focus today on highlighting some of the more common inaccuracies surrounding HPV. Having the facts opens the door to a personal treatment plan and smarter, natural approaches to addressing it.
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Pap Tests Help Detect Cervical Cancer Early
Two tests, the Pap smear and HPV test, can help detect cervical cancer. To conduct the tests, cells are gently scraped from the cervix with a swab during a pelvic exam, and the cells are then examined in the lab. The Pap test can find changes in cells and abnormal cells, while the HPV test simply checks for the presence of the HPV virus.
According to the National Cancer Institute, regular Pap screening can reduce the possibility of a woman being diagnosed or dying of cervical cancer by 80%. If the screening tests are abnormal, further testing is done.
Identification Of Cases And Follow
Cases of cervical intraepithelial neoplasia grade 3 /carcinoma in situ and invasive cervical cancer were identified through several methods, including a record linkage with population-based cancer registries , health insurance records, hospital-based cancer and pathology registries and active follow-up of subjects . Data on vital status were obtained from mortality registries at regional and national level. Cervical cancer cases included only those women with first primary incident cancer according to the International Classification of Diseases, 10th revision . Contrary to ICC, ascertainment of CIN3/CIS cases was not systematically done in all cancer registries and EPIC centers. Follow-up time was calculated between the date at recruitment and the date at diagnosis for cases or the date at censoring for non-cases. The end of follow-up ranged from December 2003 to December 2006, depending on the center. The median follow-up time in this cohort was around 9 years contributing a total of 2,775,235 person-year. Among the 308,036 women included in the final analysis 1,065 cases were identified: 261 ICC cases and 804 CIN3/CIS cases. Detailed tumor histology was specified for 953 cases , of which 901 were classified as squamous cell carcinoma and 52 as adenocarcinoma .
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The Epic Cohort Study
The EPIC study is a large prospective cohort study including 521,448 participants recruited between 1992 and 2000 through 23 centres in 10 European countries: Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom. Most of the EPIC participants were between the ages of 35 and 70 years. The study procedures have been described in detail elsewhere . At recruitment, participants gave their written informed consent and completed questionnaires on their diet, medical and lifestyle history. They were also invited to provide blood samples for future testing of markers of interest. The EPIC study was approved by the ethical review committees from each center.
How Is Hpv Diagnosed
Your physician can typically diagnose warts by means of visual inspection. However, because of their flatness, genital warts can be harder to detect. In some cases, your physician may apply an acetic acid solution to whiten any suspicious formations, which eases identification. There are two primary diagnostic tests for cervical cancer:
- Pap test: A pap test involves the collection of a cell sample from the cervix or vagina, which is sent to a medical lab for analysis. The analyst will be looking for abnormal cells signaling the possible presence of cancer.
- DNA test: The pap test is sometimes supplemented with a DNA test, particularly in women over 30 years old. The goal of the DNA test is identifying whether high-risk strains of the virus, including HPV 16 and HPV 18, are present as a precondition to cancer.
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A Little Background On Pap Tests
Until the Pap test was widely adopted in the United States in the late 1940s, cervical cancer was the number one cause of cancer death in women. After the widespread use of the Pap test, however, cervical cancer cases dropped by 70 percent. This is a huge success story.
Soon after the discovery of HPV as the cause of cervical cancer, a DNA test to look for the high-risk strains of HPV was developed. This simple test is done using the same scraping of cells used for the Pap test. Although most women are exposed to HPV at some point in their lives — which is why we suggest that all women undergo cervical cancer screening — most women will fight off the virus within a year or two, and the virus either disappears altogether or remains dormant. Only about 5 percent of women will not fight off the virus, and these women will continue to test positive with the HPV test and may eventually develop precancerous cell changes — and even cancer — if these cell changes aren’t treated.
Birth Control Options To Make Periods Lighter
If you find the heavy periods associated with an IUD inconvenient or you are concerned about them for a medical reason, such as an iron deficiency, dont worry. There are several birth control options which can provide the protection against pregnancy you want and reduce those heavy periods by regulating your hormones and reducing the thickness of the endometrium:
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Next Steps Follow Up With Your Practitioner
Pap testing is a screening tool and there is a margin of error each time it is performed. A false reading can be more favorable or worse than it should be. This is another reason for those at risk to have yearly Pap testing, and why repeat testing is done at shorter intervals after any abnormal findings.
If you have an abnormal Pap, your practitioner will likely repeat the Pap test or move on to one or more other diagnostic measures, such as colposcopy or endometrial biopsy. The results of colposcopy drive decisions about what is needed next and when. The colposcopy may also be repeated within a reasonable time-frame to ensure healing or for early intervention if precancerous changes are found. Repeat testing is routine and ensures that nothing was missed.
If you have any confusion about your follow-up plan after an abnormal Pap smear or colposcopy, call your practitioners office to clarify what to do next and when. Sometimes women have abnormal readings that return to normal once stress is reduced and the immune system is back on track! Close monitoring is always warranted to ensure this.