EFFECTS OF PROGESTERONE ONLY CONTRACEPTION ON CERVICAL CYTOLOGY AMONG WOMEN IN ILE IFE
Cervical cancer is the third most common female cancer and also the commonest gynaecological malignancy in Nigeria. One of the major risk factors associated with cervical cancer is the persistence of high risk Human Papilloma Virus. Co-factors such as smoking of cigarette, immunosuppressive state and use of hormonal contraception have also been identified. The contraceptive prevalence rate is improving globally; among these contraceptive users are hormonal contraceptive acceptors. Most hormonal contraception contain a combination of oestrogen and progesterone but progesterone only formulation exists in forms such as pills, injectable, implants and intrauterine contraceptive systems. Prolonged usage of combined Oral contraceptive pill has been linked to the development of cervical cancer especially the adenocarcinoma variant. Concern has been raised as regards safety of progesterone only contraception as a cofactor in cervical cancer development.Objective: The study aim was to determine the effect of progesterone only contraception on cervical cytology among women in Ife-Ijesha area.
Method: This was a cross sectional analytical study, in which 85 women who were on progesterone only contraception at the family planning clinic were recruited, while another 85 women who were not on progesterone only contraception were recruited from gynaecological-oncology clinic. Relevant socio-demographic information and risk factors were obtained from the patients and entered into a Proforma designed for that purpose. From each woman, Pap smear was taken using Ayre’s spatula and cyto-brush and transferred into glass slides. The specimen was fixed immediately before being sent to Morbid Anatomy and Histopathology Department for cytological examination.
Result: The results were presented in tables and charts. Student t test was used for continuous variables while chi square was used for categorical variables. P value of <0.05 was taken to be statistically significant. Eighty- five women on progesterone only contraception were matched with eighty-five women who were not on progesterone only contraception for age, parity, retroviral status and smoking status. The prevalence of abnormal Pap smear was 4.7% among non-users of progesterone only contraception, while those who used progesterone only contraception had prevalence of 17.6% p value was 0.037. Significant difference exists between age at coitache among users and non-users of progesterone only contraception 21.9 ±4.4 Versus 23.5 ± 4.2 p value 0.014. Progesterone only contraception usage was associated significantly with abnormal Pap smear. (p= 0.007, Odd ratio 4.33, confidence interval of 1.37-13.68). Age, parity, duration of progesterone only contraception use, previous history of pelvic inflammatory disease, and history of multiple sexual partner(s) were not significant predictors of abnormal Pap smear.
Conclusion: Prevalence of abnormal Pap smear was commoner among progesterone only contraception users.
Recommendation: More frequent screening using Pap smear among women on progesterone only contraception is recommended.