If you’ve received abnormal Pap test results and are wondering what you can do to prevent progression of cervical dysplasia and in some cases to reverse dysplasia, know that there are natural options for managing cervical health that you can begin now.

Why do a Pap test?

Originally developed in the 1940s by Georgios Papanikolaou, the Pap smear or Pap test is a procedure used to screen for cervical cancer. The Pap test involves collecting cells from the cervix (which is the opening of the uterus at the top of the vagina) and examining the cells microscopically for the presence of abnormal cells (ie precancerous or cancerous cells). If the test result is negative for abnormal cells, the regular screening interval is recommended. If the test result is positive (ie abnormal or atypical cells were discovered), there may be further tests, treatment or follow up required depending on the type of abnormality found. One such further test, called a colposcopy, uses a magnifying instrument to examine the tissues of the cervix, vagina and vulva more closely. Often a sample of cervical tissue is taken at that time for diagnosing cervical abnormalities after an abnormal Pap test. The HPV (human papilloma virus) test may sometimes be used along with the Pap test. HPV testing looks for HPV DNA in cells collected from the cervix and can alert to the presence of high-risk HPV types associated with causing precancerous changes in the cervix.

There are over 150 known types of HPV – approximately 75% of these are cutaneous, causing warts on the skin. The other 25% of HPV types are considered mucosal and can affect the mouth, genital and anal areas, preferring the moist surface layers that line these parts of the body. These types may be transmitted through direct contact or sexual intercourse. These HPV types are further divided into low-risk and high-risk types. Low-risk HPVs do not cause cancer, but can cause skin warts around or on the genitals and anus. High-risk HPVs can cause cancer. There are approximately 12 high-risk HPV types identified, with HPV types 16 and 18 thought to be responsible for nearly 70% of cervical cancer cases. Nearly all cases of cervical cancer are attributed to infection with high-risk types of HPV. Although HPV infection is a factor in abnormal cervical cell development that can eventually lead to cervical cancer, most high-risk HPV infections occur without any symptoms and typically resolve within 1 to 2 years. Therefore, most women infected with HPV will not develop cervical cancer. Persistent infections with high-risk HPV types can give rise to cell changes that may progress to cancer without proper screening and treatment. Cell changes in the cervix occur very slowly, it can take more than 10 years from the time of an initial HPV infection until cell changes result in cancer.

Most recent cervical cancer screening guidelines in Alberta (May 2016) suggest for screening to begin three years after first sexual activity or at age 25, whichever is later. Subsequent screening is recommended every three years from initiation or from the time of the last normal Pap test result. These are general guidelines for women not displaying any symptoms. There are additional guidelines for when screening can be discontinued and for when observation is to be increased as well as screening in other circumstances.

What are the treatment options?

The conventional approach to cervical health is to screen and respond according to abnormal results with treatments aimed at targeting local cervical tissue abnormality. The methods most commonly used to treat precancerous changes in the cervix include:

• Cryosurgery: freezing to destroy affected tissue
• Surgical conization: removal of a cone-shaped piece of tissue using a scalpel, laser or both
• Laser vaporization conization: destroying affected cervical tissue using a laser
• Loop electrosurgical excision procedure or LEEP: removal of cervical tissue using a loop of wire through which electric current passes, so the wire loop acts like a scalpel

LEEP is the most common current treatment of moderate to severe cervical dysplasia (abnormal cells). Women are also more likely to convert to HPV-negative status within one to two years following the LEEP, which is sooner than women who do not receive any treatment. Though relatively safe and effective for eliminating cervical dysplasia and preventing progression of cervical cancer, there can be some concerns associated with the potential effects of LEEP on future fertility and pregnancy outcomes. The LEEP can reduce cervical mucus and occasionally can cause narrowing of the opening to the cervix. Large retrospective studies have shown this treatment to be associated with an increased risk for premature rupture of membranes and pre-term delivery as well as for low birth weight babies. There appears to be a dose dependent effect, whereby the larger the area of excision and proportion of the cervix removed, the larger and more consequential the effect may be from the treatment. There have also been several studies indicating the plausible risk of miscarriage in women with a shorter time interval from having a LEEP to becoming pregnant.

Naturopathic solutions for cervical dysplasia

There are naturopathic treatment options for women desiring an alternative to LEEP or other excisional treatments. And even if a LEEP is the best option for you, there are naturopathic treatment options to support healing following a LEEP.

Naturopathic medicine involves a holistic perspective which addresses then health of the entire individual, not just the cervix. After going through a woman’s health history, reviewing test results, we discuss risk factors that may contribute to the development and progression of cervical dysplasia and address those that are changeable, including diet and lifestyle. Treatment options often include supporting the whole body, with particular nutrients and herbs, as well as local or topical treatment for cervical dysplasia. Depending upon the grading of the cervical cell abnormality, local treatment of the cervix could include particular vaginal suppositories or escharotic treatment. Escharotic treatment uses the application of herbs to the cervix that are caustic, causing sloughing of the tissues and production of an eschar (scab), with the intention to eliminate abnormal growth and allow healthy cell growth to occur. We have had much success returning cervical cell health to normal using this protocol.

To determine if a natural treatment protocol is suitable for you, it is important to consult with a naturopathic doctor familiar with cervical dysplasia to assist in making an appropriate decision for you.

To find out more and to discuss your options for managing cervical health, call 587-521-3595 to schedule an appointment with Dr. Candace Haarsma.

References

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Kyrgiou, M., Mitra, A., Arbyn, M., Stasinou, S. M., Martin-Hirsch, P., Bennett, P., & Paraskevaidis, E. (2014, October 28). Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis. Retrieved May 28, 2017, from http://www.bmj.com/content/349/bmj.g6192

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