Cervical intraepithelial neoplasia in postmenopausal women: difficulties in cytology, colposcopy and treatment

REVIEW Cervical intraepithelial neoplasia in postmenopausal women: difficulties in cytology, colposcopy and treatment Paul G Carter MD FRCS MRCOG D...
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REVIEW

Cervical intraepithelial neoplasia in postmenopausal women: difficulties in cytology, colposcopy and treatment Paul G Carter

MD FRCS MRCOG

Desmond P Barton

MI) FRCSEd MRCOG FACOG

M o h a m e d A Mossa

Martin P Young

he National Health Service Cervical Screening Programme (NHSCSP) is based on the fact that detection and treatment of cervical dysplasia reduces the incidence of, and inortality from, cervical carcinoma. There is evidence that the mortality from cervical carcinoma is now falling faster since the formalisation of the programme.' Because of difficulties in training, colposcopy was not fully accepted at first, and for 25 years after being described by Hinselniann it was used almost exclusively in German-speaking countries. Other reasons for the delay in the acceptance of colposcopy in the UK and LJSA include a claim that Ilans Hinselmann was involved in human medical experimentation around the time of World War 11, which made his ideas about cervical disease unpopular, regardless o f their merit.2With the development of exfdiative cytology, it was thought that colposcopy would become obsolete; in fact, however, the opposite occurred. The objective of colposcopy nierely changed and it has become a niethod for topographical study of cervical, vaginal and vcilval lesions rather than a method of detection.3 cervical cytology and colposcopic assessment of the cervix are complementary to an accurate diagnosis of cervical intraepithelial neoplasia (GIN), yet specific problems are encountered in the postmenopausal age group. The low levels of circulating oestrogens cause a reduction in the thickness of the squamous epithelium, cytoplasmic glycogen. stromal vascularity and cervical mucus. There is also a decrease in the volume of the cervix and retraction of the squamocolumnar junction into the end

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