Concerns Surrounding ASCUS Pap After History of Complex Hyperplasia with Atypia
I am a 43-year-old woman, standing at 5 feet 8 inches tall and weighing 245 pounds. I have concerns regarding my health, particularly after receiving news about a recent pap smear. My race is Caucasian, and I live in the USA. In 2017, I was diagnosed with complex hyperplasia with atypical cells, leading to a dilation and curettage (D&C) procedure that revealed no additional abnormalities. Subsequently, I started a conservative treatment regimen involving a combination of birth control pills. In 2020, a diagnosis of CIN II was made following an HPV infection, which led to a loop electrosurgical excisional procedure (LEEP) that showed clear margins. I received the HPV vaccine in 2022 and had normal pap smear results until recently. Now it's 2025, and I've been notified of an ASCUS (Atypical Squamous Cells of Undetermined Significance) pap result, which was HPV negative. The result arrived via email at 5:30 PM, and I am currently in a state of panic. I struggle with anxiety related to cancer, especially concerning women’s health issues given my previous medical history and the discomfort from estrogen-related symptoms. While I understand that ASCUS itself is often not a cause for immediate concern, I've been experiencing pelvic pain localized to the lower left side, near my ovary, for approximately three months. During my last pap examination, my doctor mentioned scheduling an ultrasound, which raises a few questions. Could the ASCUS result indicate changes in my endometrial cells? I had been taking Slynd, a progesterone-only pill, resulting in suppressed menstrual cycles for about two years, but I switched to Nikki due to some associated androgenic effects. Now, my periods have returned with light spotting and one particularly heavy episode about a month ago. It’s been around 3 or 4 years since my last endometrial biopsy. Should I consider requesting one now? Additionally, my most recent ultrasound was two years back, which showed a thin endometrium. Is it advisable for me to seek a second opinion from an oncologist, someone I’ve never consulted before? Alternatively, would proceeding with a hysterectomy be the right move to alleviate my fears? I am genuinely worried that my treatment approach has been too cautious, leaving me with potential risks. I would appreciate any guidance or advice on how to move forward with my situation.
Answers (1)
6/25/2025, 6:10:56 AM
OpenHealth AI
It's completely understandable to feel anxious about your health, especially with your complex history and recent ASCUS pap result. Let's break down your situation to offer some clarity and actionable steps moving forward.
Main Points:
- ASCUS (Atypical Squamous Cells of Undetermined Significance) pap results are often not immediately alarming, especially if HPV negative.
- Your pelvic pain and history may warrant further investigation, including potential imaging or biopsy.
- It's reasonable to discuss your concerns and options with your healthcare provider, including a second opinion or further diagnostic procedures.
Explanation:
ASCUS Pap Result: This result means that some cells on your cervix appear abnormal, but the cause isn't clear. Most of the time, ASCUS doesn't indicate cancer or serious problems, especially if you're HPV negative. However, given your previous medical history, it's understandable to want more answers.
Pelvic Pain: The pain you’re experiencing could be related to various issues, which might not necessarily stem from your cervical cells. Conditions like ovarian cysts or endometriosis are possibilities. Your history of hyperplasia and CIN II does warrant careful attention to any new symptoms, such as pain or changes in menstrual cycles.
Endometrial Concerns: Given your history, an endometrial biopsy is a reasonable consideration, especially since it has been some time since your last one, and if you have ongoing irregularities or pain. It can help rule out abnormal changes in the endometrium.
Next Steps:
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Contact Your Healthcare Provider: Schedule an appointment to discuss your ASCUS result in detail and your symptoms. Prepare specific questions about the significance of the ASCUS result, your pelvic pain, and potential next steps (including biopsy).
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Request Imaging or a Biopsy: Discuss the possibility of an ultrasound if not already scheduled, and consider whether an endometrial biopsy is appropriate based on your current symptoms and medical history.
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Monitor Symptoms: Keep track of your pelvic pain and any other symptoms—note the intensity, duration, and any changes in your menstrual cycles. This information can be helpful for your healthcare provider.
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Consider a Second Opinion: If after your discussion with your provider you still feel unclear or uneasy, seeking a second opinion from a gynecologic oncologist can provide you with reassurance and further insight into your health.
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Address Anxiety: Given your feelings of anxiety, consider discussing mental health support options. This can include therapy or support groups to help manage concerns about your health.
Taking these steps can help you feel more empowered and informed about your health decisions. Remember, it's okay to seek clarity and advocate for your health needs—you're not alone in this journey. Let me know if you need more information or additional support!
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