Cervical Dysplasia, HPV and Your Fertility - 5 Natural Treatment Options For Your Abnormal PAP Test Result - Dr Jennah Miller ND

If you’re an adult female, you’ve probably been getting a regular screening PAP test completed every three years since your early 20’s. You book that often-dreaded appointment with your gynecologist or family doctor, and bring yourself in for a quick sample of cervical cells to be collected and sent off to the lab. Most of the time, this is the last you hear about your cervical health, until you’re reminded three years later to do it all again. 
For women who have abnormal cervical cells, however, this process tends to look a lot different. You are usually contacted by your gynecologists’ office, and informed that you will need to have a repeat PAP test much sooner than expected, usually in 3-6 months time. Depending on the extent of cellular abnormalities, you may also be referred for a colposcopy and biopsy of your cervix (fancy words for fancy imaging procedures). 
But how does all of this impact your fertility and future conception? Does the health of your cervix play a role in subfertility and pregnancy outcomes? With rates of HPV and cervical dysplasia on the rise, it’s important to be informed and empowered about how your cervical health can impact your fertility, even if conception is not your immediate goal. Today I break it all down, and chat about one of my favourite women’s health topics; cervical dysplasia!  


What does my abnormal PAP mean?
Let’s start with the basics! My patient’s come in all the time, knowing nothing more than their PAP test result was “abnormal” – while this knowledge is important, it doesn’t tell us enough about how severe the cellular changes are, or how concerned we need to be about progression to cervical cancer. 
The presence of an abnormal PAP test generally indicates that you are experiencing some degree of cervical dysplasia – this means that under certain conditions and stressors, the previously normal cells of your cervix have mutated and become abnormal in size, shape, and/or function. The most common cause of these abnormal cellular changes is the Human Papilloma Virus (HPV), which has been estimated to be present in 80-90% of the North American Population at current. However, the interesting fact is that not all individuals who have been exposed to HPV will have abnormal PAP test results in their lifetime. A variety of factors seem to play a role in progression of HPV to cervical dysplasia, such as which specific HPV strain you have contracted (low or high risk), immune system function, sexual practices and HPV status of your sexual partners, as well as factors such as diet, smoking status, and long term oral contraceptive pill use.
When your PAP test results return as “abnormal” they generally have one of the following basic terms to indicate the severity or “grade” of the cervical lesions present:

• ASCUS – atypical squamous cells of undetermined significance (some cells don’t look normal, but it’s unclear what the cell changes mean by looking at the PAP alone)
• LSIL – Low stage intraepithelial neoplasia (the cells don’t look normal, but they usually aren’t precancerous)
• HSIL – High stage intraepithelial neoplasia (the cells are abnormal or precancerous – the cells may develop into cancer if left untreated)
• SCC – Squamous cell carcinoma (there are cancerous cells present)

Huh? What is cervical dysplasia?
Cervical dysplasia is a term used to describe the abnormal cellular changes that occur to the cells of the cervix. It indicates the presence of pre-malignant or pre-cancerous changes to the cervix, and if left untreated it may progress to cervical cancer over time. High stage lesions are more likely to progress to cervical cancer, while low stage lesions are less likely. The main causative factor is currently chronic HPV infection.


What is HPV?
HPV or the Human Papillomavirus is an infectious agent that is generally transmitted between sexual partners via direct sexual contact of the skin and/or mucous membranes. It is considered the main causative factor of cervical cancer worldwide. There are over 100 different strains of HPV, some of which can cause genital and non-genital warts, while others can cause cervical dysplasia and progress to cervical cancer. Low-risk strains of HPV (like 6 and 11) are more likely to cause external genital warts, while high-risk strains (like 16 and 18) are more often associated with cervical changes and progression to cancer. After your abnormal Pap test results, your gynecologist may assess for HPV strain using an HPV DNA test.


How does this impact my fertility? 
Now for the fertility talk! Presence of cervical dysplasia on it’s own has not yet been linked to any changes to fertility status, but the use of recommended conventional treatment options is a different story. The most common conventional treatment of cervical dysplasia is a surgical procedure called LEEP, where the abnormal tissue is removed from the cervix using an electro-cautery tool. Research indicates that those who undergo surgical treatment of cervical intraepithelial neoplasia are at in increased risk of subfertility, with prolonged time to pregnancy. Time to conception was prolonged in 16.4% of women treated via surgical removal of the cervical tissue, versus 8.4% in untreated women, and 8.6% of women who underwent colposcopy alone. 
The LEEP procedure may also impact the production of cervical mucous, which is an extremely important aspect of how the sperm is able to travel unimpeded to meet and fertilise the egg during your fertile window. The procedure has also been linked to stenosis (or narrowing) of the opening to the cervix, which may impact fertility and pregnancy outcomes – most common of which include increased risk of premature rupture of membranes, low birth weight, and pre-term delivery. Incompetence of the cervix, which can be caused by surgical trauma to the area, may also increase the risk for miscarriage. 
The good news, is that LEEP is not your only option when it comes to treatment of cervical dysplasia. Luckily, the clearance rate of HPV and cervical dysplasia is naturally quite high – about 60% of individuals with low grade cervical dysplasia will regress to normal within two years, with 33% of those with high grade changes following suit. The main issue that arises is HPV persistence – conventional treatment options only focus on removing the abnormal cells from the cervix, and do not focus on clearing the virus itself. As a result, the return of cervical dysplasia post LEEP procedure can be as high as 30%. Naturopathic treatment options that improve clearance of HPV as well as promote regression of dysplasia fill in the gaps of conventional care, while also being mindful of impacts to future fertility and pregnancy outcomes. 


Top 5 Naturopathic Management Options for Cervical Dysplasia and HPV 
So, what can you do to help prevent persistence of HPV and improve clearance of dysplasia without impacting fertility? Ongoing PAP tests in accordance with screening guidelines are particularly important – whether you decide to move forward with conventional and/or naturopathic treatment, continued cervical screening is crucial in monitoring potential progression to cancer. Repeat PAP testing may also be linked to increased rate of regression of cervical dysplasia, so keep up to date on those PAP tests, especially if they’ve been abnormal! ​

1. Up the intake of cruciferous vegetables - Research looking at the intake of DIM (a compound rich in cruciferous vegetables like broccoli and Brussels sprouts) indicates that increased intake over a 12 week period can decrease the grade and severity of cervical dysplasia on PAP smear and colposcopic assessment. I generally recommend that my patients add 1-2 servings of cruciferous vegetables to their daily intake to mimic this.
2. Drop some ‘shrooms – No, not the psychedelic kind! Intake of Coriolus or Reishi mushrooms has been shown to boost the immune system and improve clearance of high risk HPV strains. Dosing is important here though, so talk to your naturopathic doctor about whether you’re taking the right amount.
3. Munch on even more veggies - Low intake of dark green and deep yellow vegetables was associated with increased risk of cervical cancer, especially in smokers. One study in particular found increasing intake of these types of foods was associated with nearly a 50% decreased risk of CIN3 (HSIL).
4. Sip on green tea regularly – Green tea contains an active compound called EGCG. While the research is still a bit mixed, increasing your intake of green tea throughout the day seems to be a potential adjunctive treatment option due to it’s anti-viral effects on HPV and immune stimulating properties. 
5. Consider a topical cervical escharotic treatment - This treatment is generally considered less invasive that the conventional alternative (LEEP), as it causes an “eschar” or scab to form on the top most layers of the cervix, which will slough off in between treatments (as opposed to surgical removal of dysplastic sections of the cervix). Many of the herbal components of the topical also provide anti-viral activity, which helps to improve clearance of HPV, and regression of cervical dysplasia, when applied locally to the area of abnormal cellular changes. This treatment is provided in-office by trained naturopathic doctors (like myself!), which eliminates the possibility of self-application error.

Have more questions about this topic? Meet with us!
We offer a free 30 minute consultation to all new patients. Come in and meet with one of our Naturopathic Doctors to discuss your options for promoting cervical health, while also preserving your fertility. Click the button below to book with us today!

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About the Author

Dr Jennah Miller is a Naturopathic Doctor at the Toronto Reproductive Acupuncture Clinic. Read her full bio.

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References 


De Vet, H. C. W., & Sturmans, F. (1994). Risk factors for cervical dysplasia: Implications for prevention.Public Health,108(4), 241-249.
Tomita, L. Y., Roteli-Martins, C. M., Villa, L. L., Franco, E. L., & Cardoso, M. A. (2011). Associations of dietary dark-green and deep-yellow vegetables and fruits with cervical intraepithelial neoplasia: modification by smoking.British journal of nutrition,105(6), 928-937.
González, C. A., Travier, N., Luján‐Barroso, L., Castellsagué, X., Bosch, F. X., Roura, E., ... & Sacerdote, C. (2011). Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study.International journal of cancer,129(2), 449-459.
Kyrgiou, M., Athanasiou, A., Paraskevaidi, M., Mitra, A., Kalliala, I., Martin-Hirsch, P., ... & Paraskevaidis, E. (2016). Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. Bmj, 354, i3633.
Ciavattini, A., Clemente, N., Carpini, G. D., Gentili, C., Di Giuseppe, J., Barbadoro, P., ... & Liverani, C. A. (2015). Loop electrosurgical excision procedure and risk of miscarriage. Fertility and sterility, 103(4), 1043-1048.
Acharya, G., Kjeldberg, I., Hansen, S. M., Sørheim, N., Jacobsen, B. K., & Maltau, J. M. (2005). Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia. Archives of gynecology and obstetrics, 272(2), 109-112.
Bogdanova, J. (2008) Coriolus versicolor–innovation in prevention of oncogynecological diseases, especially HPV. Akush Ginekol (Sofiia). 2008;47 Suppl 3:51-3.
Ali, N., Roshdy, E., Sabry, M., & Al-Hendy, A. (2013). Green tea: varieties, production and health benefits. Food and beverage consumption and health (Eds. Wu, W.), Nova Biochemical, USA, 33-74.
Hudson, T., & Northrup, C. (2008). Women's Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness. McGraw-Hill.
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet#q2