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  • Title: Cervical cytology associated with levonorgestrel contraception.
    Author: Misra JS, Engineer AD, Tandon P.
    Journal: Acta Cytol; 1995; 39(1):45-9. PubMed ID: 7847008.
    Abstract:
    Cytologic monitoring of cervical smears was carried out in 686 women receiving two modes of levonorgestrel contraception, one in the form of a subdermal implant and the other as an intrauterine device. The period of contraception with both delivery systems ranged from six months to five years. No case of malignant neoplasia was seen in any of the 44 subjects even after five years of continued levonorgestrel contraception. Preinsertion cytology revealed eight dysplastic smears (seven mild and one moderate); the lesions reverted to normal six months later and remained normal after one to four years of hormone use. A total of 19 dysplastic smears (18 mild and 1 moderate) were detected in the postinsertion smears collected after one to five years of contraception, giving an incidence of 2.8%, which was nonsignificant when compared with the control figure of 1.3%. Regression of the lesion to normal was observed in all 19 dysplasias on follow-up and in none did the dysplasia progress to a higher grade or frank malignancy. The incidence of dysplasia was more than twice as high with the intrauterine device as with the implant (4.9% vs. 2.1%). Hence, the implant appeared to be safe during five years of contraceptive use in terms of cervical pathology. However, longer follow-up of a large number of women is needed to reach a definitive conclusion. Physicians performed cervical smears before insertion and every 6 or 12 months thereafter on 686 fertile women who had received either a subdermal levonorgestrel implant (524) or a levonorgestrel-releasing IUD (162) since October 1983 at eight human reproduction centers of the Indian Council of Medical Research throughout India. There were a total of 1503 smears among implant users and 359 smears for IUD users. Researchers aimed to determine the oncogenic potential of levonorgestrel in long-term users of these contraceptives. The period of contraceptive use ranged from 6 months to 5 years. 21.5% of the women had inflammatory smears at preinsertion. 5.6% of them had trichomonal infection. The incidence of inflammation increased with duration of contraceptive use among women with initially normal smears (e.g., IUD, 12.1-40%), while it fluctuated among those with initially inflammatory smears. Physicians should conduct early cytologic monitoring 1-2 months after treatment for infection, since inflammation can lead to cytopathologic changes in epithelial cells. There were 19 new cases (1 moderate and 18 mild cases) of squamous intraepithelial lesions (SIL) (dysplasia). 4 of the 19 women had inflammatory smears. The postinsertion incidence of SIL was more than twice that of the preinsertion incidence (2.8% vs. 1.3%), but the increase was not significant. The postinsertion SIL incidence was more than two times as high for IUD users than implant users (4.9% vs. 2.1%). Neither incidence was significantly greater than the preinsertion incidence. The dysplasia did not advance to a higher grade or malignant neoplasia on subsequent follow-up. In fact, in all 19 cases, the lesion regressed to normal on subsequent follow-up. These findings suggest that the levonorgestrel implant can be used safely for as long as 5 years. A long-term follow-up study with a large sample size is needed to confirm that levonorgestrel contraceptives do not induce cervical cancer.
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