[NP-Clinical] contraceptives with abnormal PAPs

[Rick/Laurel Webb]

Thanks- as always I appreciate your thoughtful replies. Sometimes abnormal
paps don't make sense at all to me either ie I had a 50 year old woman who
was monogamous for 30 years, same partner and had an ascus hpv high risk
positive pap. Never abnormal pap before. No sense at all. Thanks again. 

Laurel

 

  _____  

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Kimberly Spering
Sent: Wednesday, February 14, 2007 8:23 PM
To: NP Clinical
Subject: Re: [NP-Clinical] contraceptives with abnormal PAPs

 

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 <mailto:webb at ohiohills.com>  

To: 'NP Clinical' <mailto:np-clinical at nurse.net>  

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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