SUN-103 False Positive Cervical Dysplasia As One Of The Earliest Signs Of Genitourinary Syndrome Of Menopause

Abstract Disclosure: C. Dos Santos: None. A. Dominguez-Bali: None. C. Dominguez-Bali: None. A. Perera: None. A. Zarrinidarban: None. S. Verma: None. S. Escobar: None. An increased incidence of abnormal Papanicolaou (PAP) smears has been observed in women over 40 years of age who have no prior history of cervical abnormalities. Many of these women are in long-term monogamous relationships or report fewer than three lifetime sexual partners. Pathological studies have shown that cervical and vaginal atrophy due to hypoestrogenism can produce cellular changes that mimic dysplasia, suggesting that many of these abnormal findings may be misclassified. Despite undergoing multiple gynecologic interventions—including cryotherapy, loop electrosurgical excision procedures (LEEP), cone biopsies, and even hysterectomies—persistent abnormalities often remained unexplained. Given the potential role of declining estrogen in altering cervical and vaginal cytology, we investigated whether local vaginal estrogen therapy administered over a 4–6-month period could reverse these abnormalities and reduce false positive diagnoses associated with genitourinary syndrome of menopause (GSM).To evaluate this hypothesis, we analyzed clinical data collected over a 12-year period from more than 800 women aged 40 and older who presented with abnormal PAP smears. All participants received local vaginal estrogen therapy, and cytologic outcomes were followed longitudinally. The primary endpoint was the resolution of atypical or dysplastic PAP findings after treatment. Over 90% of participants experienced resolution of abnormal cytology within 4–6 months of initiating local estrogen therapy. These improvements were sustained only while treatment continued. Retrospective analysis revealed that more than 80% of abnormal smears in this population were ultimately linked to early manifestations of GSM rather than true cervical dysplasia.These findings suggest that in perimenopausal and postmenopausal women, many abnormal PAP smear results reflect hypoestrogenic epithelial changes rather than true dysplastic lesions. Local vaginal estrogen therapy appears to be a highly effective intervention, with the potential to prevent misdiagnosis and avoid unnecessary procedures such as colposcopies, biopsies, and hysterectomies. Incorporating this approach into clinical practice could lead to substantial cost savings and improved patient outcomes. Recognizing genitourinary syndrome of menopause as a frequent cause of false positive cervical dysplasia may enhance diagnostic accuracy and inform more appropriate management strategies. Presentation: Sunday, July 13, 2025