An Abnormal Smear and Colposcopy – What does it mean?

In Ireland, women aged between 25 and 60 are invited to obtain a cervical smear once every three years. This screening process, run by Cervical Check from the HSE, was put in place to combat the number of women diagnosed with cervical cancer. I’ve written recently about the importance of getting a regular smear test to ensure you’re healthy. However, what happens if it doesn’t come back with a clean bill of health? What if your cervical smear comes back showing abnormalities? What does a referral for a colposcopy mean? It can be easy to panic and assume “Oh god, it’s cancer, it’s definitely cancer”, but that’s not the case. Here’s a look at what those abnormal results can indicate, and how they’re treated afterwards.

If your cervical smear test comes back showing abnormalities, it will depend on their severity as to how the health professionals proceed.

In some cases, smear tests show changes in the cells of the cervix. These changes are common and most are caused by a virus called the human papillomavirus (HPV).  HPV is a common virus usually spread by skin to skin contact during sexual activity. Any person who has ever engaged in sexual activity is likely to have been exposed to HPV. Most HPV infections clear up on their own but can persist without symptoms for many years. It is thought that over 75% of Irish women have contracted it at any time in their lives, but as it may dormant they may not know until a test like this is done.

If changes in the cells of the cervix are found, they can be low grade or high grade.

Low grade changes are common and most clear up on their own. When these changes are found, your smear test sample will be tested for certain types of HPV infection.

If high grade changes are found, or low grade with evidence of HPV, these are less likely to clear up on their own and you may need a more detailed examination called a colposcopy. A colposcopy is free of charge and the doctor or nurse who took your smear test will arrange it for you.

So, what’s a Colposcopy?

A Colposcopy is basically examination under a big microscope to get a closer look at your cervix. You’ll be lying on a specially-designed chair, with legs in stirrups (think delivery room). You’ll be naked from the waist down but wearing a gown. Like the cervical smear, a speculum will be inserted and gently opens up your vagina to give a better view of your cervix. A microscope with a light (the colposcope) is used to look at your cervix – this stays about 30cm outside your vagina and allows the colposcopist to see the cells on your cervix.

Special liquids are applied to your cervix to highlight any abnormal areas. You may feel a mild tingling or burning sensation when these are applied, but generally it’s not sore. If abnormalities are found, a small sample of tissue (a biopsy) may be removed for closer examination in a lab. They may ask you to cough while they do this to relax the muscles. This shouldn’t be painful, but you may feel a slight pinch or stinging sensation.

If it’s obvious that you have abnormal cells in your cervix, you may be offered treatment to remove the cells immediately. Otherwise, you’ll need to wait until you get your biopsy result.

Something to be aware of if you’re undergoing a colposcopy AND use a mirena coil/copper coil as birth control – there is a small risk that the Mirena may become unlodged and fall out. This happened to me, and I wasn’t expecting it, so made for an unhappy surprise. In some cases, they may be able to put another one back in for you, but in my case I was advised to go back to my own GP and get it done at my own cost. I’m advised that it is a rare occurrence, but with all things, the more information you have going in, the better!

After having a colposcopy, you’ll be able to go home as soon as you feel ready, usually straight afterwards.  You’re safe to work, drive and do anything else you like afterwards generally, though you may feel like taking it easy. You may have a brownish vaginal discharge, or light bleeding if you had a biopsy – this is normal and should stop after three to five days. For me, it was a bit of a heavier bleed which I put down to the dislodgement of the Mirena. As Mirena had pretty much stopped my periods, this wasn’t a very welcome development, but thems the breaks! The general advice is to wait until any bleeding stops before having sex or using tampons, vaginal medications, lubricants or creams.

How Long Until I Get Results? 

The clinic generally advises that results are returned to you by post within four weeks. In my experience, my colposcopy was carried out on the 18th of January, and results sent out in a letter postmarked 31st January – just less than two weeks. It will depend on the amount of results going through the lab, so any change in speed does not necessarily indicate the result.

Okay, I’ve got my results. What now? 

When your results come back from the Colposcopy clinic, they will detail exactly what the next move will be.

About 40% of women who have a colposcopy have a normal result. This means no abnormal cells were found in your cervix during the colposcopy and/or biopsy and you don’t need any immediate treatment. You’ll be advised to continue with cervical screening as usual, in case abnormal cells develop later on. It means no further action is needed for the next 3 years.

About 60% of women have abnormal cells in their cervix. These are known as cervical intra-epithelial neoplasia (CIN) or cervical glandular intra-epithelial neoplasia (CGIN). This does not mean that 60% of women have cervical cancer, so it’s not necessarily anything to worry about. However, it does show changes that MAY turn into cancer if left untreated, so it’s important to follow up. If a biopsy hasn’t already been carried out during your colposcopy, it may be carried out at this stage.

The different types of abnormal biopsy result and what they mean are as follows:

  • CIN 1 – it’s unlikely the cells will become cancerous and they may go away on their own; no treatment is needed and you’ll be invited for a cervical screening test in 12 months to check they’ve gone
  • CIN 2 – there’s a moderate chance the cells will become cancerous and treatment to remove them is usually recommended
  • CIN 3 – there’s a high chance the cells will become cancerous and treatment to remove them is recommended
  • CGIN – there’s a high chance the cells will become cancerous and treatment to remove them is recommended

For me, I was very relieved to find that my result came back as CIN 1. This means no further treatment is required at this time. I’ve got an appointment at the end of the year to ensure everything is hunky dory. It had been very easy to allow panic to set in. Now, at least, I am armed with the facts and know where I stand. To me, it cemented just how important getting a cervical smear test is. Left unmanaged, it could have developed into something more sinister and had a bigger impact on my health.

If you need treatment for abnormal cells, your GP will give you more info on what’s involved.

This publication from the HSE may also help.

Hopefully this will have helped to de-mystify the process of what happens when you’ve got an abnormal smear test result. While it’s natural to worry, most of the time it is simply a sign that you’ve caught something early. As we all now know, the earlier these abnormalities are caught, the easier they are to clear up and the less likely to become anything more sinister they are.

If you’ve been holding off on getting your Cervical Smear done, just head over to Cervical Check and get registered, or make that appointment with your GP – it’s twenty minutes that could save your life.

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2 comments / Add your comment below

  1. Hi Lisa,

    Great article, really worthwhile!

    First things first, the free smear tests that we are offered here in Ireland are brilliant and we should all attend. They save lives, and I’m very grateful. So I just want to warn anybody that has to attend the Colposcopy Clinic to take some painkillers, either with you or just before you go.

    I think to be fair that its a free service and painkillers cost money, so I get it!

    Last year, I had to have a polyp removed, when the leaflet arrived it clearly stated that pain relief would be offered, but there was no mentioned on the day, I was asked however, if I would like to look on the screen as the doctor removed the polyp; how absolutely thrilling, needless to say I declined! The whole procedure hurt; from inserting the speculum, to the removal of the polyp, although the doctor did a neat job, and worked quickly, I did experience some pain, it was bearable. Then they chemically cauterised the wound, and that really, really stung badly.

    The nurse, held my hand, she knew just how painful the procedure was, she was an absolutely brilliant human being. She told me to go home and take my usual painkillers.

    It stung so badly, my husband wanted to run an errand but I couldn’t stand the pain, and had to go straight home to my painkillers. I told my doctor about it, and she said ‘that was harsh’!

    My advise to any woman facing the Colposcopy Department, take two Paracetamol before hand!

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