False-Positive Cervical Dysplasia as One of the Earliest Manifestations of Genitourinary Syndrome of Menopause [ID 974]

INTRODUCTION: False-positive cervical dysplasia is a frequent yet underrecognized consequence of the genitourinary syndrome of menopause (GSM). Hypoestrogenic changes in the vaginal and cervical epithelium can mimic cytological features of dysplasia, leading to unnecessary procedures and patient anxiety. This study investigates whether local vaginal estrogen therapy can reverse abnormal cytology and reduce false-positive diagnoses. METHODS: A retrospective review was conducted on clinical data from over 800 women aged 40 and above with abnormal Pap smear results, collected over 12 years. All patients received local vaginal estrogen therapy and underwent serial cytological follow-up over time. The primary outcome was cytologic normalization following treatment. Institutional approval was obtained, and no protected health information was used. RESULTS: Over 90% of participants experienced cytologic normalization within 4–6 months of initiating estrogen therapy. In approximately 50% of women, improvement persisted 6–12 months after discontinuation. Retrospective analysis revealed that more than 80% of abnormal Pap smears were attributable to early manifestations of GSM rather than true dysplastic lesions. Cytologic regression was strongly associated with the resolution of epithelial atrophy and inflammatory changes. CONCLUSIONS/IMPLICATIONS: In perimenopausal and postmenopausal women, abnormal Pap results often reflect hypoestrogenic changes rather than true dysplasia. Local estrogen therapy is a safe and effective approach to reduce false-positive results and prevent unnecessary colposcopies, biopsies, and even hysterectomies. Integrating hormone therapy before confirming cytologic abnormalities may improve diagnostic accuracy, reduce health care costs, and spare patients from overtreatment.