Smear patterns and spectrum of premalignant and malignant cervical epithelial lesions in postmenopausal Indian women: a hospital-based study.

Cervical cancer is one of the leading causes of morbidity and mortality among women but can be prevented through simple cost-effective measures, such as creating awareness, and regular screening with the Pap smear, both in the premenopausal and postmenopausal age group. This study was carried out to study the cervical smear patterns and type of cervical epithelial lesions in a group of postmenopausal Indian females and the relationship with clinical profile of patients. Pap smears were taken from 320 postmenopausal Indian females and meticulously screened. Lesions were classified according to type of postmenopausal pattern. 120 smears showed varying degrees of premalignant and malignant changes, which were classified using the Bethesda system. The findings were correlated with duration of menopause, parity, and duration of sexual activity and significance was derived. Histopathological correlation was conducted in those cases where biopsies were available. It was found that as the age of the patients increased, the incidence of low-grade and high-grade squamous intraepithelial lesions and carcinoma also increased with the relationship being statistically significant. The occurrence of these lesions also showed an association with increasing parity and period of sexual activity. Thus, it can be concluded that it is important to create widespread awareness about the necessity of regular screening, including the postmenopausal period. Conventional cytology or the Pap smear is a cost-effective and efficient method for screening of patients but requires training and experience to minimize errors. It is suitable for developing regions where costlier techniques are not in routine use.