QuestionMy husband and I are trying to conceive our 3rd child. Last year I had an abnormal PAP which caused me to have a colposcopy. The Dr. did not seem to concerned with the results and then we moved and I forgot about the 6 month later PAP. I went in in July of this year to have my early PAP before trying to conceive.
After several weeks I learn that it was abnormal again but not cancerous.
I just recently had a consult with another GYN about what our next steps would be and she wants to do another colposcopy and is sure she is going to do chryotherapy.
I have read that if you are pregnant and need a colposcopy that there will not be a biopsy.
I asked the Dr. and she told us we didn't have to prevent a pregnancy but to not be aggressive in trying. So, if I have the colposcopy and then the chryotherapy would it cause a miscarriage or hurt the pregnancy IF I wasn't far enough along to know I was pregnant?
AnswerDear Melissa,
Dysplasia is a term used to describe abnormal cells. Dysplasia is not cancer, although it may develop into very early cancer of the cervix. The cells look abnormal under the microscope, but they do not invade nearby healthy tissue. There are four degrees of dysplasia, classified as mild, moderate, severe, or carcinoma in situ, depending on how abnormal the cells appear under the microscope. Carcinoma in situ means that cancer is present only in the layer of cells on the surface of the cervix, and has not spread to nearby tissues.
Cervical intraepithelial neoplasia (CIN) is a term that is sometimes used to describe abnormal tissue findings. Neoplasia means an abnormal growth of cells. Intraepithelial refers to the layer of cells that form the surface of the cervix. The term CIN, along with a number (1 to 3), describes how much of the thickness of the lining of the cervix contains abnormal cells.
Atypical squamous cells are findings that are unclear, and not a definite abnormality.
Cervical cancer, or invasive cervical cancer, occurs when abnormal cells spread deeper into the cervix or to other tissues or organs.
Now, pregnancy adds a new dimension to abnormal smears. If a woman has not had a smear in the previous 3 years, she will typically be asked to have one done at her first prenatal visit. If you are up to date with your routine screening, then usually you won't need to have a smear until after your baby is born, even if a smear is due during your pregnancy. But if you've had an abnormal smear just before you got pregnant, then your doctor will want to do another one during the pregnancy - as it sounds is the case with you right now. Though you have not knowingly conceived yet, I will give you information as if you have since you are asking a question specific to treatment after pregnancy as occurred.
If your smear shows abnormal cells you will likely not have any treatment. Mildly abnormal cells can return to normal on their own after you have had your baby. This is the same for non-pregnant women too. Specialists don't recommend treatment for CIN 1, 2 or 3 during pregnancy. Your doctor may ask you to go for a colposcopy, which won't harm the pregnancy at all.
If your colposcopy confirms that you have mild changes (CIN 1), then you won't need to have anything else done until 3 months after you've had your baby, when you will have another examination. If you have moderate or severe cell changes (CIN 2 or 3) your doctor will do another colposcopy when you are about 6 months pregnant. This is so that your doctor can keep an eye on your condition. If the cells haven't returned to normal after you've delivered your baby, you can have treatment then. It is natural that you might worry about delaying treatment. But in practice, by the time the abnormality is found, you won't have much more than 6 months wait and the abnormal cells aren't likely to have changed much by then.
Remember - if your doctor tells you that you have abnormal cells or CIN 1, 2 or 3, you do not have cervical cancer. You have a pre-cancerous condition that can easily be treated.
I would suspect if any further treatment were required, cone biopsy would be considered. In general, cryotherapy should not be done if you are pregnant. If there is any chance you may be pregnant, tell your doctor so a serum beta hCG (pregnancy) test can be done before the procedure. Doctors typically advise complete abstinence from sexual intercourse for four weeks after cryotherapy while the cervix is healing.
I hope this has helped you and answered your question. I wish you well.
Brenda
