False Positive Pap Smear May Indicate Genitourinary Syndrome

Brittany Vargas

September 28, 2023


A Pap smear result indicating cervical dysplasia may actually be an early signal of genitourinary syndrome (vaginal atrophy) and can be treated effectively with local estrogen, according to a poster presented at The 2023 Menopause Meeting of the North American Menopause Society.


  • Starting in 2010, researchers in Florida and Antigua saw an increase in the number of perimenopausal women with no history of cervical abnormalities and low risk for sexually transmitted infections (STIs) presenting with abnormal Pap smears at their clinics.

  • They studied 1500 women aged 30-70 from several clinics. The women had low risk for STIs, a maximum of two sexual partners, and the presence of cervical dysplasia over a period of 12 years.


  • Nearly all (96.7%) of the women who received local estrogen treatment had a normal Pap smear following therapy.

  • A high number of patients who initially presented with cervical dysplasia underwent interventions such as colposcopies, biopsies, LEEP excisions, cryotherapy, cone biopsies, and hysterectomies because of cervical atrophy.

  • The researchers concluded that local estrogen treatment could save patients money spent on treatments for cervical atrophy.

  • Some women who underwent cone biopsies and hysterectomies and did not receive local estrogen still had vaginal dysplasia.


"In this study, we report an early sign of genitourinary syndrome of menopause: false positive cervical dysplasia caused by cervicovaginal atrophy resulting from decreased estrogen levels during perimenopause," say the investigators. "We also demonstrate how the use of local estrogen therapy can prevent a significant number of interventions and procedures, resulting in significant cost savings. This is particularly relevant as the number of Pap smears conducted in this population represents 50-60% of all Pap smears performed on women."


The data were presented at the 2023 Menopause Meeting of the North American Menopause Society on September 27. The study was led by Alberto Dominguez-Bali, MD, from the Miami Center for Obstetrics, Gynecology and Human Sexuality in Miami, Florida.


The study authors report no limitations.


The authors report no relevant financial relationships.

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