A review of referrals of postmenopausal women to a colposcopy clinic

Abstract

Aims
Although evidence supports offering cervical screening in postmenopausal women, the impact of low oestrogen levels on the cervical and vulvovaginal epithelium can present challenges for cervical screening and colposcopy. The aim of this audit was to evaluate the reason for referral and colposcopic and histological findings for postmenopausal women.

Methods
A retrospective cohort study of 275 consecutive postmenopausal women who had their first visit to a colposcopy clinic between 2020 and 2023. Eight cases were excluded from analysis due to missing data.

Results
Of the 275 referrals, 44 were referred for screening due to difficulties taking a sample in primary care and did not require colposcopy, the remaining 231 colposcopy referrals were analysed. Reasons for referral included HPV positivity with normal cytology (n=77, 33%), HPV positive low-grade cytology (n=83, 36%), HPV positive high-grade cytology (n=14, 6%) and a finding of "Suspicious cervix" at time of screening (n=46, 20%). A satisfactory colposcopic examination was performed in 86% (199/231). Cervical biopsies were performed in 53% (123/231). Histological findings included low-grade CIN (n=21, 17%), high-grade CIN (n=16, 13%) and no CIN (n=81, 66%). A diagnosis of cervical cancer or high grade disease was found in 8.6% (20/231) of this cohort.

Discussion
Whereas screening in the postmenopausal population can be challenging, this study shows evidence of significant pathology in this cohort.