[NP-Clinical] contraceptives with abnormal PAPs

[Kimberly Spering]

Hi, Laurel~

I have never read or heard that contraceptives were contraindicated with LSIL or higher lesions.  There was a small study I read years ago that suggested that some people using OCPs (and who smoked) had a higher chance of cell changes from HPV.  Sorry...I have no recollection of what study it was, however.

I would be curious, however, as to what age this woman is.  Certainly research suggests that younger women with HPV are more likely to clear the virus and the cells will revert to normal.  However, in our practice, we would do a colposcopy, which of course, is the DIAGNOSTIC tool for actual changes (not screening, as a PAP).  We'd make financial arrangements for her, especially given the "possibly high-grade lesion" part of the diagnosis.

I am still shaking my head at a 30 year old patient in the practice...completely normal PAPs for the past 4 years, monogamous for years...until this year's PAP--suddenly, she has a high-grade lesion...colpo was diagnostic for cervical CA.  After a cold cone, the doc had to give her the horrible news that the margins weren't clear, and she needs a hysterectomy, node dissection, and probably chemo, once staging is complete.

Just my two cents, but I'd consider getting her to another GYN for a second opinion.  At the very least, I'd repeat the PAP in 4 - 6 months.

Kim Spering
OB-GYN
  ----- Original Message ----- 
  From: Rick/Laurel Webb 
  To: 'NP Clinical' 
  Sent: Wednesday, February 14, 2007 6:58 PM
  Subject: [NP-Clinical] (no subject)


  Hi all

  Fast question because I haven't been able to find answer online or in Contraceptive Technology.

  Is it contraindicated to give oral contraceptives or ortho evra to female with abnormal pap LSIL possibly high grade lesion.. She will not be having colpo or biopsy or hpv testing for about 6 months or more because of insurance issues. 

  FYI: I have already counseled her about earlier treatment for abnormal pap etc but when I sent her to a gynecologist he told her treatment could wait for many years and refused to do it since she didn't have insurance, so I am really more interested in concerns about use of birth control with the possibility that this abnormal pap.

  Laurel FNP

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