Abnormal Pap Smear

Also indexed as:

Cervical Dysplasia, Cervical Smear Test

What you need to know

A routine cervical smear test is a must for most women. If you are sexually active, then caring for your cervix is especially important. According to research or other evidence, the following self-care steps may be helpful:

• Check out folic acid
• Ask your doctor if taking 10 mg a day can help reverse severe cervical dysplasia

• Fill up on fruits and veggies
• Help keep your cervix healthy by getting the nutrients you need from fruits and vegetables, especially tomatoes and dark yellow or orange vegetables, such as carrots and squash

• Practice safe sex
• Reduce your risk for cervical dysplasia by postponing sexual activity until you're older, limiting sexual partners, and using barrier methods of contraception

• Steer clear of cigarette smoke
• Kick the habit and avoid secondhand smoke to reduce the risk of severe dysplasia

• Plan a follow-up
• If your pap smear detects an abnormality, see your healthcare provider for a repeat exam to determine whether additional tests or treatments are needed

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full abnormal pap smear article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About abnormal pap smear

Sexually active teenagers and women 20 to 65 years old are advised to have periodic Pap smears, where a small amount of tissue is swabbed from the cervix and examined for evidence of precancerous or cancerous changes. A pap smear is considered abnormal when abnormal cervical cells are found. Cervical dysplasia is a term used to describe abnormal cervical cells taken during the pap smear. Cervical dysplasia is usually graded according to its severity, which can range from mild inflammation to precancerous changes to localized cancer.

If an abnormality is detected early, the doctor can prescribe effective treatment before the problem becomes more serious. Cervical cancer is a common, sometimes fatal disease. It is now known that human papilloma virus (HPV), also the cause of genital warts, is the major cause of cervical dysplasia.

Product ratings for a Pap smear

Rating	Nutritional Supplements	Herbs
	Folic acid (for women using oral contraceptives)
		Green tea extracts (poly E or (-)-epigallocatechin-3-gallate)
	Selenium Vitamin A Vitamin E	Echinacea, Goldenseal, Marshmallow, Myrrh, Usnea, Yarrow (suppository; in various combinations)
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms?

There are no symptoms of cervical dysplasia until the disease has progressed into advanced cancer. Therefore, it is crucial that sexually active women, or women over age 20, have yearly Pap smears until the age of 65. Women who experience bleeding between menstrual periods, bleeding after intercourse, abnormal vaginal discharge, abdominal pain or swelling, urinary symptoms, or pelvic pain should be evaluated by a healthcare provider, even if it is not the regular time for a Pap test.

Dietary changes that may be helpful

Most dietary studies have found that women consuming high amounts of nutrients from fruits and vegetables have less risk of cervical dysplasia.^{1, 2} Protective effects may be especially strong from diets high in dark yellow/orange vegetables (carrots, winter squash, etc.)³ and tomatoes.^{4, 5}

Lifestyle changes that may be helpful

Cigarette smoking increases the risk of cervical dysplasia,^{6, 7, 8} and increases the likelihood that mild forms of dysplasia will progress to more severe forms.^{9, 10} Quitting smoking and avoiding exposure to secondhand smoke are essential for this and many other health reasons.

Certain sexual behaviors are consistently associated with cervical dysplasia, such as becoming sexually active at an early age and having multiple sexual partners.^{11, 12} Avoiding these behaviors may reduce the risk of cervical dysplasia. For those who are sexually active, using barrier methods of contraception, such as a condom or diaphragm, is associated with reduced risk of cervical dysplasia.^{13, 14, 15}

Vitamins that may be helpful

Large amounts of folic acid-10 mg per day-have been shown to improve the abnormal Pap smears of women who are taking birth control pills.¹⁶ Folic acid does not improve the Pap smears of women who are not taking oral contraceptives.^{17, 18} High blood levels of folate (the food form of folic acid) have been linked to protection against the development of cervical dysplasia¹⁹ but these folate levels may only be a marker for eating more fruit and vegetables.

Women with cervical dysplasia may have lower blood levels of beta-carotene and vitamin E^{20, 21} compared to healthy women. Low levels of selenium²² and low dietary intake of vitamin C^{23, 24} have also been observed in women with cervical dysplasia. Women with a low intake of vitamin A have an increased risk of cervical dysplasia.²⁵ However, there is little research on the use of vitamin A as a treatment for cervical dysplasia.

In a double-blind trial, when women with cervical abnormalities were given either 500 mg of vitamin C or 50,000 IU beta-carotene per day for two years, no significant evidence of improvement was seen in either group, and those assigned to both supplements experienced a statistically insignificant worsening of their condition.²⁶ Given that the apparent association between these supplements and deterioration of the condition of the cervix appears to have been due to chance, there is currently no sound evidence supporting the use of vitamin C or beta-carotene supplements for women with cervical dysplasia.

Are there any side effects or interactions?

Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

In a preliminary study, women with cervical dysplasia were randomly assigned to receive either (1) 200 mg per day of (-)-epigallocatechin-3-gallate (a flavonoid found in green tea), (2) 200 mg per day of poly E (a green tea extract), or (3) no treatment (control group) for 8 to 12 weeks. Approximately two-thirds of the women receiving (-)-epigallocatechin-3-gallate or poly E had an improvement in their Pap smear, compared with only 10% of the women in the control group.²⁷

Several other herbs have been used as part of an approach for women with mild cervical dysplasia, including myrrh, echinacea, usnea, goldenseal, marshmallow, and yarrow.²⁸ These herbs are used for their antiviral actions as well as to stimulate tissue healing; they are generally administered in a suppository preparation. No clinical trials have proven their effectiveness in treating cervical dysplasia. A doctor should be consulted to discuss the use and availability of these herbs.

Are there any side effects or interactions?

Refer to the individual herb for information about any side effects or interactions.

1. Kwasniewska A, Charzewska J, Tukendorf A, Semczuk M. Dietary factors in women with dysplasia colli uteri associated with human papillomavirus infection. Nutr Cancer 1998;30:39-45.
2. Romney SL, Palan PR, Basu J, Mikhail M. Nutrient antioxidants in the pathogenesis and prevention of cervical dysplasias and cancer. J Cell Biochem Suppl 1995;23:96-103 [review].
3. Ziegler RG, Jones CJ, Brinton LA, et al. Diet and the risk of in situ cervical cancer among white women in the United States. Cancer Causes Control 1991;2:17-29.
4. Kantesky PA, Gammon MD, Mandelblatt J, et al. Dietary intake and blood levels of lycopene: association with cervical dysplasia among non-Hispanic, black women. Nutr Cancer 1998;31:31-40.
5. VanEenwyk J, Davis FG, Bowen PE. Dietary and serum carotenoids and cervical intraepithelial neoplasia. Int J Cancer 1991;48:34-8.
6. de Vet HC, Sturmans F. Risk factors for cervical dysplasia: implications for prevention. Public Health 1994;108:241-9.
7. Becker TM, Wheeler CM, McGough NS, et al. Cigarette smoking and other risk factors for cervical dysplasia in southwestern Hispanic and non-Hispanic white women. Cancer Epidemiol Biomarkers Prev 1994;3:113-9.
8. Kanetsky PA, Gammon MD, Mandelblatt J, et al. Cigarette smoking and cervical dysplasia among non-Hispanic black women. Cancer Detect Prev 1998;22:109-19.
9. Daly SF, Doyle M, English J, et al. Can the number of cigarettes smoked predict high-grade cervical intraepithelial neoplasia among women with mildly abnormal cervical smears? Am J Obstet Gynecol 1998;179:399-402.
10. Cerqueira EM, Santoro CL, Donozo NF, et al. Genetic damage in exfoliated cells of the uterine cervix. Association and interaction between cigarette smoking and progression to malignant transformation? Acta Cytol 1998;42:639-49.
11. de Vet HC, Sturmans F. Risk factors for cervical dysplasia: implications for prevention. Public Health 1994;108:241-9.
12. Brinton LA. Epidemiology of cervical cancer-overview. In Munoz N, Bosch FX, Shah KV, Meheus A, eds. The epidemiology of cervical cancer and human papillomavirus. Lyon, France: IARC, 1992, 3-23.
13. Parazzini F, Negri E, La Vecchia C, Fedele L. Barrier methods of contraception and the risk of cervical neoplasia. Contraception 1989;40:519-30.
14. Coker AL, Hulka BS, McCann MF, Walton LA. Barrier methods of contraception and cervical intraepithelial neoplasia. Contraception 1992;45:1-10.
15. Becker TM, Wheeler CM, McGough NS, et al. Contraceptive and reproductive risks for cervical dysplasia in southwestern Hispanic and non-Hispanic white women. Int J Epidemiol 1994;23:913-22.
16. Butterworth CE Jr, Hatch KD, Gore H, et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82.
17. Zarcone R, Bellini P, Carfora E, et al. Folic acid and cervix dysplasia. Minerva Ginecol 1996;48:397-400.
18. Butterworth CE, Hatch KD, Soong S-J, et al. Oral folic acid supplementation for cervical dysplasia: A clinical intervention trial. Am J Obstet Gynecol 1992;166:803-9.
19. Butterworth CE Jr, Hatch KD, Macaluso M, et al. Folate deficiency and cervical dysplasia. JAMA 1992;267:528-33.
20. Palan PR, Mikhail MS, Basu J, Romney SL. Plasma levels of antioxidant beta-carotene and alpha-tocopherol in uterine cervix dysplasias and cancer. Nutr Cancer l991;15:13-20.
21. Ho GY, Palan PR, Basu J, et al. Viral characteristics of human papillomavirus infection and antioxidant levels as risk factors for cervical dysplasia. Int J Cancer 1998;78:594-9.
22. Dawson EB, Nosovitch JT, Hannigan EV. Serum vitamin and selenium changes in cervical dysplasia. Fed Proc 1984;43:612.
23. Wassertheil-Smoller S, Romney SL, Wylie-Rosett J, et al. Dietary vitamin C and uterine cervical dysplasia. Am J Epidemiol 1981;114:714-24.
24. Ho GY, Palan PR, Basu J, et al. Viral characteristics of human papillomavirus infection and antioxidant levels as risk factors for cervical dysplasia. Int J Cancer 1998;78:594-9.
25. Romney SL, Palan PR, Duttagupta C, et al. Retinoids and the prevention of cervical dysplasias. Am J Obstet Gynecol 1981;141:890-4.
26. Mackerras D, Irwig L, Simpson JM, et al. Randomized double-blind trial of beta-carotene and vitamin C in women with minor cervical abnormalities. Br J Cancer 1999;79:1448-53.
27. Ahn WS, Yoo J, Huh SW, et al. Protective effects of green tea extracts (polyphenon E and EGCG) on human cervical lesions. Eur J Cancer Prev 2003;12:383-90.
28. Hudson T. Women's Encyclopedia of Natural Medicine. Lincolnwood, IL: Keats, 1999, 54.

Last Review: 09-07-2006

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires August 2007.

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