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DESCRIPTION
Dysplasia is abnormal growth and development of the cells of the lining of the cervix. It can range from mild to moderate or severe depending on the spread of the abnormal cells. The degree of abnormality is considered a precancerous condition, but does not represent cancer of the cervix. The diagnosis may be medically classified as CIN I, II, or III; or low-grade SIL or high-grade SIL. These classifications help define the extent of the abnormal growth and to determine the appropriate treatment. Dysplasia occurs in females age 15 and over, and most often in those age 25 to 35.
FREQUENT SIGNS & SYMPTOMS
Usually no signs or symptoms occur. The suspected diagnosis results from a routine Pap smear evaluation.
Occasional signs and symptoms of the condition can include:
- Genital warts.
- Abnormal bleeding.
- Spotting after intercourse.
- Vaginal discharge.
- Low back pain.
It is important to note that these symptoms are not unique to cervical dysplasia and they may indicate a different problem. If you are experiencing any of these signs or symptoms, you should see your health care provider for an accurate diagnosis.
CAUSES
The precise cause of cervical dysplasia is not known. Studies have found a strong association between cervical dysplasia and infection with human papilloma virus (HPV), but additional factors (still unknown) must also be at play in order for cervical cells to change and become precancerous.
There is an association with human papilloma viruses (genital warts) or similar viruses. See links below for more information.
MoonDragon's Obgyn Information: Genital Warts
There are concerns about the estrogen found in hormonal contraceptives causing cervical dysplasia. If you are taking hormonal contraceptives containing estrogen, you may want to consider another form of birth control method that is hormone-free.
Pregnancy: Cases of cervical dysplasia may advance during pregnancy, but treatment can generally be deferred until after delivery. A biopsy to diagnose cervical dysplasia is safe to perform during pregnancy. Treatment with cervical conization may adversely affect fertility.
RISK INCREASES WITH
Repeated infections. Human papilloma virus (HPV) and genital warts have a strong association with cervical dysplasia.
Smoking.
Immunosuppression. Having suppressed immune function from, for example, HIV or the use of chemotherapeutic medications to treat cancer.
Multiple pregnancies and pregnancy before age 20.
Multiple sexual partners. Early onset of sexual activity (younger that 18 years old).
Having a partner whose former partner had cervical cancer.
History of one or more sexually transmitted diseases, such as genital herpes or HIV.
Being born to a mother who took diethylstilbestrol (DES) to become pregnant or to sustain pregnancy (this drug was used many years ago to promote pregnancy but is no longer used for these purposes).
Low levels of folate (Vitamin B-9) in red blood cells.
Dietary deficiencies in vitamin A, beta-carotene, selenium, vitamin E, and vitamin C.
Long-term oral contraceptive use (5 years or more).
PREVENTIVE MEASURES
While there is no established strategy for preventing cervical dysplasia, regular Pap smears are the most effective and reliable method of identifying the condition in its early stages. Such early detection is key to preventing the condition from progressing to cervical cancer. Women should begin receiving annual Pap smears as soon as they become sexually active or no later than age 21. Women whose mothers took DES during pregnancy are advised to begin regular Pap smears at age 14, at the onset of their first menstrual period, or as soon as they become sexually active, whichever comes first.
Sexual monogamy of both partners. Practicing safe sex. Using condoms helps to prevent the transmission of HPV, a contributing factor in 90 percent of cervical dysplasia cases. Use of a diaphragm by the female or a condom by the male for sexual intercourse may offer some protection from cervical dysplasia. See MoonDragon's Contraception Index for information about Barrier Contraception Methods.
Yearly Pap smears (will not prevent dysplasia, but will aid in early diagnosis).
Stop smoking.
Drink lots of water! Try to drink at least 1/3 of your body weight in ounces of pure water each day. Keep in mind that you need even more water if you are breastfeeding or if you live in a dry climate.
Eating a diet rich in beta-carotene, vitamin C, and folate (vitamin B-9) from fruits and vegetables. Eat your protein. Protein is a major building block for the immune system and healthy tissue. Organic fruits and vegetables contain carotenoid and flavonoid compounds that support a healthy immune system (antioxidants help to prevent and repair damage to cells). Organic is preferable since pesticides, fertilizers, and herbicides may be carcinogenic and may alter the body's hormonal balance.
Take your nutritional supplements. A good multivitamin adds important nutrients that may be missing in the diet and can counteract the effects of stress on the body.
Sleep well and make sure you get plenty of rest. Sleep is the body's time to rest and repair itself and is important for a healthy immune system and healthy body tissues.
Exercise is important. It aids promoting healthy circulation, oxygenation of tissues, and detoxification.
EXPECTED OUTCOME
With early diagnosis and treatment, when necessary, the outlook is excellent.
Spontaneous regression (reversal) occurs in a significant number of patients.
Pap smears are essential to detecting precancerous lesions as well as early stages of cervical cancer. The regular use of Pap smears as a screening test has prevented millions of cases of cervical cancer and has saved a similar number of lives. Despite their value, they are not always 100% accurate. Up to 2% of women with normal Pap smear results actually have high-grade cervical dysplasia at the time of evaluation. In some rare cases, Pap smears may produce "false positive" results, meaning that a healthy woman may be falsely diagnosed with cervical dysplasia. Despite these errors, Pap smears are the most effective and reliable method of identifying cervical dysplasia.
Cervical cancer, a major complication of cervical dysplasia, is the leading cause of death in many developing and poorer countries and accounts for 4,800 deaths in the United States every year. Most cervical cancer deaths occur in women who have not had a Pap smear. Cervical cancer constitutes more than 10% of cancers worldwide and it is the second leading cause of death in women between the ages of 15 and 34.
With early identification, treatment, and consistent follow-up, nearly all cases of cervical dysplasia can be cured. Without treatment, many cervical dysplasia cases progress to cancer. Women who have been treated for cervical dysplasia have a lifetime risk for recurrence and malignancy. Fortunately, while the incidence of cervical dysplasia has been on the rise, the incidence of cervical cancer has declined dramatically. This may be due to improved screening techniques, which identify cases of cervical dysplasia in the early stages, before they have progressed to cancer.
POSSIBLE COMPLICATIONS
Some severe dysplasia may progress to cancer of the cervix.
Recurrence is possible, especially in the first two years following treatment. If a woman has completed childbearing, recurrent dysplasia can be treated with a hysterectomy.
Complications can result from the treatment, such as excessive bleeding or infection.
TREATMENT
GENERAL MEASURES
Women routinely visit a health care provider or midwife if for no other reason than to have pap smear every few years. A pap smear is a test for cancerous or precancerous cells of the cervix that involves scraping some tissue from the opening of the cervix, putting it on a slide, and sending it to a laboratory. The pap smear will come back rated as a Class I through Class V. Class I is normal (benign), Class II is usually an irritation or inflammation, Class III is a true cervical dysplasia that can range from mild to serious, Class IV may be one of a variety of pre-cancers or cancers, and Class V is a seriously invasive cancer. The problem with pap smears is that they have a very high rate (as much as 70 percent) of false positives, giving a more serious class rating than really exists, and a very high rate of false negatives, giving a less serious rating when there really is trouble. There is a new type of test available called the ThinPrep system that gives a significantly more accurate reading, but you're still subject to a lot of uncertainty if the test comes back "positive".
Physical exam: If any of the symptoms mentioned earlier are present, your health care provider will perform a physical including an abdominal, back, and pelvic examination. As part of the pelvic exam, a Pap smear will be performed to detect precancerous or cancerous cells in the cervix. A Pap smear is also performed annually for screening purposes even when no symptoms are present. This test may be performed more or less often than once a year, depending on your individual medical history and risk factors for cervical cancer. For example, an individual who has had abnormal Pap smears in the past may require more tests than an individual who has always had normal Pap smears. But, if you have had normal pap smears 3 years in a row and you are over age 30, your doctor may perform a pap smear test only every 2 to 3 years. If there are any questionable or unclear results from the Pap smear, one of the following tests will be performed:
To confirm a diagnosis, a colposcopy (examination of the cervix with a colposcope, a slender optical instrument with a lighted tip) with a magnifying lens to examine the abnormal cell growth in the cervix. It is usually performed and combined with a biopsy. A biopsy is a small sample of tissue that is removed from the cervix and examined under a microscope for any signs of cancer.
Treatment measures will vary depending on the degree and extent of the cervical dysplasia. Possibilities include cryotherapy (freezing), laser therapy, loop resection, conization of the cervix or cone biopsy. Be sure you understand the treatment options and any risk factors involved.
Follow-up care will depend on the treatment method used.
Follow-up Pap smears every 3 to 6 months for a year may be recommended to verify the success of treatment and to detect an recurrence.
SURGERY AND OTHER PROCEDURES
Surgical removal of abnormal tissue is the most common method of treating cervical dysplasia. Ninety percent of these procedures can be done in an outpatient setting. These procedures include:
- Cryocauterization – extreme cold destroys abnormal cervical tissue; this is the simplest and safest procedure and it usually destroys 99% of the abnormal tissue; frequently performed without anesthesia.
- Laser therapy – lasers destroy abnormal cervical tissue with less scarring than cryocauterization; more costly than cryocauterization; performed with local anesthesia; 90% cure rate.
- Loop electrosurgical excision (LEEP) – thin loop wire excises visible patches of abnormal cervical tissue; performed with local anesthesia; 90% cure rate.
- Cervical conization – small cone-shaped sample of abnormal tissue is removed from the cervix; requires general anesthesia; 70% to 98% cure rate, depending on whether cancer cells have spread beyond the cervix.
MEDICATION
Medications are not used to treat cervical dysplasia.
Prescription medication may be given for 2 to 7 days following the procedure.
You may use non-prescription medication, such as acetaminophen, for minor pain.
ACTIVITY
Delay sexual relations until a follow-up medical examination determines that healing is complete.
To help recovery and aid your well-being, resume daily activity, including work, as soon as you are able.
DIET
No special diet, however for nutritional information see MoonDragon's Obgyn Information: Genital Warts for more information and nutritional recommendations.
Eating a diet rich in beta-carotene, vitamin C, and folate (vitamin B9) from fruits and vegetables is highly recommended. See Holistic Recommendations below for more information about nutritional and alternative therapies.
Nutrition and Dietary Supplements: Several population-based studies have suggested that eating a diet rich in the following nutrients from fruits and vegetables may protect against the development of cervical cancer:
- Beta-carotene - Some research suggests that individuals deficient in beta-carotene may be more likely to develop cancerous or precancerous cervical lesions, but this relationship remains inconclusive. Other studies indicate that oral supplementation with beta-carotene may promote a regression, or decline in the signs of cervical dysplasia.
- Folate (Vitamin B-9) - Like beta-carotene, some evidence suggests that folate (also known as vitamin B-9) deficiencies may contribute to the development of cancerous or precancerous lesions in the cervix. Researchers also theorize that folate consumed in the diet may improve the cellular changes seen in cervical dysplasia by lowering homocysteine (a substance believed to contribute to the severity of cervical dysplasia) levels. The benefit of using dietary folate to prevent or treat cervical dysplasia has not been sufficiently proven.
- Other dietary nutrients that may protect against the development of cervical cancer include:
- Vitamin C: Vitamin C 1000 w/Rosehips, 100% Natural, Nature's Way, 1000 mg, 250 Caps
- Selenium: Selenium, 100% Natural, Nature's Way, 200 mcg, 100 Caps
- Vitamin E: Vitamin E, d-alpha tocopherol, Nature's Way, 400 IU, 100 Softgels
- Vitamin A: Vitamin A, 100% Natural, Nature's Way, 10,000 IU, 100 Softgels
- Vitamin B-12: Ultra B-12, NOW Foods, 4 oz Liquid, 5,000 mcg
- Vitamin B-6: Vitamin B-6 (Pyridoxine), 100% Natural, Nature's Way, 100 mg, 100 Caps
In addition, some of the risk factors for cervical dysplasia may cause certain nutritional deficiencies. For example, smoking may contribute to a deficiency in vitamin C and long-term use of birth control pills may diminish folate levels. Research has yet to prove whether taking vitamin C and folate supplements can help prevent or treat cervical dysplasia or cervical cancer. At the same time, it seems prudent to eat a diet rich in fruits and vegetables which contain vitamin C, folate, and beta-carotene, as these nutrients have been shown to have many health benefits.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
If any of the following occurs:
- Pain, swelling, redness, drainage or bleeding increases in the surgical area.
- You develop signs of infection: headache, muscle aches, dizziness, or a general ill feeling and fever.
- Vaginal discharge increases or begins to have an unpleasant odor.
HOLISTIC SUGGESTIONS
Cervical dysplasia occurs when cells form irregularly on a woman's cervix, which is located at the mouth of the uterus. Since this unusual growth is considered a precondition to cancer, health care providers generally suggest burning, freezing or cutting off the problem cells. However, the condition progresses so slowly that your health care provider will probably wait a month or two, then retest you. Take advantage of this time to try an herbal-nutritional therapy program.
During the time when you are diagnosed with cervical dysplasia and before you actually have medical treatment for the problem. Commit yourself to healing yourself so you don't have to go through with the medical invasive procedures recommended by your health care provider. Even with medical treatment, your dysplasia can return and further, more invasive methods may be recommended by your health care provider. If you can avoid these procedures using relatively simple holistic approaches, all the better.
A woman with stage 3 cervical dysplasia (stage 4 is cancerous) was able to do just this by using these methods. With only one month to turn around her dysplasia before she was to have surgery done (freezing had been tried previously and the dysplasia returned), she was committed to healing herself. She placed castor oil packs over her abdomen, sat in sitz baths filled with a strong tea of sage, eucalyptus and comfrey leaf tea and used a tampon soaked in a strong solution of calendula tea. She faithfully did each of these treatments at least once a day, more often when she could manage it. Her next test showed far fewer signs of dysplasia and, although her health care provider was apprehensive about discussing herbs, sent her home to "continue doing whatever you are doing." The next three times she was tested, she came up completely clean; so she stopped taking the herbs. That was years ago, and following her health care provider's advice, she continues to get tested regularly—at least twice a year. She also follows her herbalist's advice to keep estrogen down to normal levels and her immunity up. She does not expect the dysplasia to return, but if it ever does, she knows what she will do.
Cervical dysplasia can be caused, or at least promoted, by the same virus responsible for genital warts (human papillomavirus) and possibly by those viruses that cause herpes (herpes simplex types 1 and 2), although not all women with warts or herpes necessarily develop dysplasia. Another contributing factor is excessive amounts of the more carcinogenic form of estrogen that is manufactured by the body. In addition, women whose mothers took a synthetic estrogen called diethylstilbestrol (DES) in the 1940s and 1950s to prevent miscarriage were overexposed to estrogen and often develop dysplasia. (Unfortunately, until 1979, much of the meat sold in the United States also contained small amounts of DES.) The American Cancer Society also lists estrogen-based birth control pills, multiple sexual partner and smoking as risk factors for dysplasia. Researchers have reported that smoking even two or three cigarettes a day seems to concentrate carcinogens in the cervix.
You can treat the problem cells and at the same time stimulate your immune system with a tea or tincture of echinacea, calendula and false indigo, an immune system herb with properties similar to echinacea. While most people may not think of calendula (known as pot marigold) is not only just a pretty garden flower, it is also a potent immunity builder that seems to have a special affinity for healing the cervix.
Among the most important herbs for treating gynecological problems are the berries from vitex, an attractive tree from the Mediterranean. Vitex is one of the few herbs known to balance a woman's hormones, and so has become invaluable for many different formulas. To help keep excessive estrogen in line, you should also take herbs that are good for the liver, such as burdock.
You can also put herbs directly on your cervix by using vaginal suppositories or a tampon soak of goldenseal, calendula and tea tree. Tea tree suppositories are also available in natural food stores.
Many women have conquered cervical dysplasia using herbal teas, tinctures and suppositories alone, but you can speed along the process by also taking herbal sitz baths and applying castor oil packs. These treatments require a little extra time, but the end results are worth it.
Folic acid, which is not an herb but a necessary nutrient found in green, leafy vegetables, can also play a role in treating cervical dysplasia. Many women with cervical dysplasia have a folic acid deficiency, especially if they take birth control pills. According to one study of women on the Pill, three weeks of folic acid supplements reversed the risk of cervical cancer for a significant number of women. The recommended dosage for women who have cervical dysplasia take 2 milligrams of folic acid a day for three months, then reduce the dose to 0.5 milligram a day. Along with your herbal therapy, vitamins A, C and the B-complex can be extremely helpful. If you smoke cigarettes, consider quitting.
Buffered Vitamin C: (antioxidant) 3000 mg in divided doses throughout day.
B complex: 1-2 per day with meals (divided doses) or sublingual as directed.
Colostrum: (Immune Support) work up to 1 scoop a day or 12 capsules (divided doses)
Samento: (Antiviral, Antibacterial, Antiparasitical Herb) Dilute in water. Start with 1 drop 3 times/day, stay at this dose for one week. Add an extra drop every few days until you are taking 5 drops 3 times/day for a total of 15 drops. If you notice a Hexheimer reaction (detoxification), stop taking for a few days and then resume at a lower dose.
Do not get discouraged with the herbal and supplement methods if you do not experience success right away. They work with your body in a positive way and may take some time, unlike chemical medications with dangerous side effects. Herbs sometimes work quickly, sometimes not. EVen if you don't see improvement before you next test and you end up having a medical procedure done, at least you know you did what you could in the time you were given. Even after the procedure, you can continue with your herbal program to prevent the dysplasia from returning by following the herbal program once a day for one week every month.
CERVICAL DYSPLASIA TEA BLEND2 teaspoons vitex berries
1 teaspoon each burdock root and false indigo root
1/2 teaspoon each calendula flowers and echinacea root
5 cups water
Bring herbs and water to a boil in an uncovered pot, then simmer gently for 5 minutes. Remove from heat, cover pot and let steep for 20 minutes. Strain out herbs. This can also be taken as a tincture or in pill form.
HERBAL TAMPON SOAK BLEND1 heaping teaspoon dried calendula flowers
1/2 teaspoon goldenseal root powder
1 cup water
5 drops tea tree essential oil
Put herbs and water in a pot, place on stove and bring to a boil. Turn off heat and let steep for about 30 minutes. Strain and add essential oil. Soak tampon in mixture, stirring well to distribute the oil. (Be sure to use a tampon that comes enclosed in a cylinder inserter or the soaking will expand it too much.)
Herbs and oils can be purchased in bulk from Mountain Rose Herbs or Herbal-Remedies-USA. See links to both resources below. Both have quality items available to assist you in your health program.
For a woman with a Class II pap smear, use aloe vera or acidophilus douche or suppositories for a few weeks, along with taking folic acid (5 to 10 mg daily), vitamin A (10,000 IU daily), vitamin B-6 (25 to 50 mg daily) and vitamin B-12, 800 to 1,000 mcg. She also recommends vitamin A oil put directly onto the cervix five out of seven nights per week for four weeks, two weeks off and then for four more weeks. You can buy vitamin A suppositories, break open the capsules, or use a liquid vitamin A with a dropper. It is recommended that with the high doses of folic acid used in this type of treatment (a normal dose is 400 mcg), women should work in partnership with a health care professional familiar with alternative therapies, such as a Naturopathic physician.
If it looks like an infection is present, a hydrogen peroxide douche consisting of a 1/4 cup of hydrogen peroxide and 2 cups of water for a couple of nights before bed. Another option is a golden seal douche, which will get rid of most organisms within a couple of days of use.
A Woman with a Class III pap smear needs to take a close look at her sexual relationship with her partner and to make some dietary changes, with particular attention paid to avoiding dairy foods. In addition to the supplements recommended above, 30 mg of zinc daily, 500 mg of vitamin C daily, and antioxidant mix, and a multivitamin are added.
Since Class III cervical dysplasia can be caused or aggravated by the excessive cell proliferation caused by estrogen dominance, the use of progesterone cream may be recommended to oppose the estrogen effects, along with the vitamins mentioned above. Women sometimes ask if they can put the progesterone directly on the cervix. Although it isn't necessary, it is fine to do if you're very sure it's pure progesterone that contains no carcinogenic chemical preservatives and no estrogenic herbs. To use it that way, look for a cream that contains only progesterone as its active ingredient.
Cervical dysplasia (myomas) were most often a sign of estrogen dominance. Add vitamin E in dosages of 600 IU at bedtime, supplemental magnesium (300 milligrams a day), and vitamin B-6 (50 milligrams per day). This treatment is simple, safe, inexpensive, successful, and natural.
Indole-3-carbinol (I3C) is a substance found in broccoli-family vegetables. A dose of 200 or 400 mg per day can improve the chances of cervical dysplasia returning to normal by itself. The related substance, diindolylmethane, might also offer benefit.
Green tea possesses substances shown to inhibit the growth of many types of cancers including liver, stomach, skin, lung, breast, and prostate cancer. Polyphenols are the compounds in green tea responsible for its anti-cancer effects. Epigallocatechin-3-gallate (EGCG) is the most effective of the polyphenols at inhibiting cancer growth and inducing cancer cell death. Polyphenol E (poly E) is a polyphenol mixture that contains EGCG. The new study evaluated the effect of green tea extracts on cervical lesions. Eighty-eight women with either chronic cervicitis (ongoing abnormal inflammation of the cervix) or mild to severe cervical dysplasia took part in the study. The women were assigned to receive either (1) poly E ointment applied locally to the cervix, (2) poly E ointment applied locally to the cervix plus one 200-mg capsule of poly E per day, (3) one 200-mg capsule of poly E per day, (4) one 200-mg capsule of EGCG per day, or (5) no treatment. The poly E ointment was applied two times per week for 12 weeks, and the capsules were taken for 8 to 12 weeks. Biopsies of cervical tissue were taken before and after treatment and Pap smears were taken every four weeks during the study to determine the presence and extent of abnormal cells. HPV DNA titers (an indicator of the severity of HPV infection in the body) were measured before and after treatment. Overall, 69% of the women treated with green tea extracts showed a positive response compared with 10% of the women not receiving treatment. A positive response was defined either as a decrease in or complete elimination of HPV, a decrease in the size of the cervical lesion, or the elimination of abnormal cells as detected on Pap smear or biopsy. All of the green tea preparations resulted in a similar response. The green tea extracts used in this study appear to be safe and should be considered for the treatment of precancerous lesions of the cervix, with the hope of stopping the progression to cancer. However, this therapy should be instituted only under close medical supervision; if it is unsuccessful, other measures must be taken to prevent the condition from worsening.
GENITAL WART (HPV) SUPPLEMENTAL PRODUCTS
Information, supplements and products for genital warts (HPV), one of the most common sexually transmitted diseases.
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