Will cervical abnormalities affect my future pregnancy?

You’ve got the results back from your Pap smear and it says you have abnormal cervical cells. No doubt you’re flooded with lots of questions and emotions: Do I have cancer? Is it treatable? Will it affect me falling pregnant? Can I carry a baby to full term?

It’s important to know that an abnormal Pap smear result does not mean you have cancer. It means there has been a change in some of the cells in the cervix and they no longer look ‘normal’. Many of these cases are either easily treatable or they go away on their own. There is a risk that a small number can eventually develop into cervical cancer so it’s important to be screened regularly.

First, let’s understand what your test results mean. The medical term for these changes is cervical dysplasia, and you’ll likely find one of the following phrases on your report:

• Possible low-grade squamous intraepithelial lesion
• Low-grade squamous intraepithelial lesion
• Possible high-grade squamous intraepithelial lesion
• High-grade squamous intraepithelial lesion
• Around one in 10 Pap tests return an abnormal result, with most low- and high-grade results most commonly found in women aged 25 to 35.

Low-grade abnormalities

Low-grade means there have been slight changes that are probably caused by an infection, such as human papillomavirus (HPV). This is very common and often clears on its own. Regardless, you’ll need to be monitored to make sure it doesn’t progress.

If you’re aged under 30:

• You should have a repeat Pap smear 12 months from the time of your abnormal smear.
• If this test is clear, you should have a repeat test in another 12 months.
• If the test results are normal again, you can return to biyearly screening.

If you’re aged over 30:

• A Pap smear in 12 months is recommended if you have had a normal result in the last two or three years.
• If you have not had a normal result in the previous two or three years, a repeat Pap smear in six months or a colposcopy (an examination with a colposcope, much like a microscope, to see the area close up) is usually recommended.

There is a difference in those under and over 30 because women aged over 30 may be more likely to have a persistent HPV infection which has caused the cells to change.

High-grade abnormalities

This means there have been moderate or severe changes in your cervical cells. Your gynaecologist may recommend a colposcopy and biopsy to examine the cervical tissue further. Even if you do have a high-grade result, this doesn’t mean you have cancer or will get cancer.

If further treatment is needed, the type used depends on several factors, including your age, if you’re currently pregnant, whether you’re intending to have children, what other gynaecological problems you have and how severe the problem is. The main treatments are:

• Cone biopsy. Your doctor removes a small cone-shaped area where the affected cells are. This is often used to treat early or small growths.
• Loop excisions (LEEP or LLETZ). This removes a smaller area than a cone biopsy and uses a small wire loop with an electrical charge.
• Laser therapy or laser ablation. This destroys abnormal cells by burning them away and to be replaced by healthy cells.

After this, you’ll need:

• A colposcopy and Pap smear, four to six months afterwards.
• A Pap smear and HPV testing 12 months after treatment, and again every 12 months until there have been two consecutive negative tests.
• A return to your normal biyearly schedule.

Other abnormalities

There are other, far less common, results including glandular abnormalities. Your doctor will discuss this and the appropriate treatment if you receive these results.

Can I get still pregnant?

The good news is, yes, you can still get pregnant. Treatment does not affect your fertility. If possible, check with your doctor or specialist before becoming pregnant to make sure you are up to date with your screenings. This way, you can have any necessary treatment beforehand.

Will cervical abnormalities affect a pregnancy?

Whether you need treatment before trying to fall pregnant depends on the cell change severity. Women with low-grade abnormalities who are up to date with their Pap smears are fine to go ahead and conceive.

Women with high-grade abnormalities should talk through their options with their doctor first. This is because some treatments can complicate a pregnancy. Cone biopsies and LEEP/LLETZ weaken the cervix so there is a small risk of premature birth, miscarriage and difficulty during labour.

Most women do go on to have safe pregnancies and healthy babies but it’s still wise to discuss this with your doctor before receiving either treatment or if you intend to become pregnant and you’ve already had either treatment. You may also need to wait several months before trying to fall pregnant.

Laser ablation does not carry the same warnings.

What if I’m already pregnant?

If you’re due for your regular biyearly Pap or you have an abnormal result that hasn’t been monitored recently, Pap smears are safe to perform on pregnant women up until 20 weeks.

If something is discovered, it can be very distressing for the mother-to-be. In general, low-grade results do not require treatment and a Pap smear in 12 months is recommended. If a high-grade result is returned, a colposcopy while pregnant can be discussed with your doctor.

Changes to cervical screening

There will be changes to cervical screening in Australia, beginning December 2017. Find out more about the changes at the Department of Health or sit down with your doctor or specialist to see how this relates to your personal circumstances.

Article supplied by Ramsay Health Care