|dc.description.abstract||This study examines the effect of progesterone-only injectable
contraceptives, and medroxyprogesterone acetate (Depo-Provera) in
particular, on the cells of the uterine cervix.
Cervical and vaginal smears were taken before commencement of therapy
and at 3 and 6 month intervals thereafter on 79 asymptomatic women
attending a family planning clinic. Results of hormonal and cellular
measurements before and after therapy were compared.
menstrual cycling was also studied.
The effect on
Methods used were hormonal maturation indices, image analysis
measurements and microscopic observation of cellular . features. The
latter included anisocytosis, anisokaryosis, karyomegaly , plaque
formation, cytoplasmic wrinkling, nuclear grooving, hypertrophy,
atrophy, cytoplasmic moulding and density, retarded maturation and
nuclear protrusions. Squamous, endocervical and metaplastic cells were
Analysis of the results showed that progesterone-only contraceptives
produce all of the above to a greater or lesser degree resulting in an
increased relative nuclear area which may be confused with
intraepithelial neoplasia. This is due to the production of a folate
deficiency at target organ level which interferes with cell division and
slows the maturation process. This effect enabled further observations
to be made leading to the establishment of the origin and content of the
nipple-like protrusions which occur in endocervical cells in response to
Physiological effects included amenorrhoea and irregular menstrual
cycling. Most women showed evidence of interference with normal cycling
to a varying degree.
The documented cellular changes were shown to modify the expression of
common inflammatory and neoplastic conditions of the uterine cervix.
These included trichomoniasis, herpesvirus cervicitis, human
papillomavirus infection, folate deficiency, cervical intraepithelial
neoplasia and invasive carcinoma as well as multiple pathologies. The
potential for diagnostic error was examined.
New diagnostic criteria were formulated based on the comparison of
cellular features found in the presence of the contraceptive with those
found under normal conditions. It is anticipated that these criteria
will facilitate the cytological diagnosis of pathological conditions of
the uterine cervix in users of depo-medroxyprogesterone acetate (DMPA),
leading to increased accuracy and improved and better directed patient