title: Cervical changes associated with progestagen-only contraceptives: a team approach.
abstract: OBJECTIVE
  To report clinical, cytologic and colposcopic findings among women using progestagen-only contraceptives for more than 3 years as compared to nonhormonal contraceptives; and to assess the role of nursing in increasing the women's knowledge about Pap test and risk factors for cervical cancer in a developing country set-up.
  
  
  METHODS
  A prospective cross-sectional comparative study.
  
  
  METHODS
  Family-planning clinic of a tertiary care university hospital.
  
  
  METHODS
  A total of 325 current users of contraceptive methods for more than 3 years.
  
  
  METHODS
  Patients were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. While group B comprised 125 patients wearing intrauterine devices. In both groups, the patient was asked about the risk factors and her knowledge about cancer cervix. Clinical and cytologic evaluations of the cervix were done. For each patient, two cervical smears were taken using Ayre's spatula and the endocervical brush.
  
  
  METHODS
  Clinical, cytologic and histopathologic cervical abnormalities after prolonged use, and the effect of health education or counseling on the patient's knowledge about preinvasive or invasive cervical cancer.
  
  
  RESULTS
  Initial naked eye assessment of the cervix revealed statistically significant difference between both groups (p < 0.000). However, cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions (SIL) in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. Women's knowledge was compared in the first and last interviews by the nursing staff involved in health education or counseling. It increased in the counseling group; however, the difference was statistically insignificant.
  
  
  CONCLUSIONS
  Prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings. There was a marked lack of women's knowledge as regards Pap test and cervical cancer with some statistically insignificant improvement after interview and counseling. Extended training of the nursing staff on the procedure of Pap smear would help establish screening programs in the developing countries.
authors.affiliation: Departments of Obstetrics and Gynecology, Assiut University, 71111 Assiut, Egypt. a_darwish@mailcity.com
authors.forename: A
authors.initials: A
authors.lastname: Darwish
authors.forename: S
authors.initials: S
authors.lastname: Labeeb
authors.forename: M
authors.initials: M
authors.lastname: Galal
authors.forename: H
authors.initials: H
authors.lastname: Rashad
authors.forename: S
authors.initials: S
authors.lastname: Hassan
mesh_terms: D016022:Case-Control Studies; D002584:Cervix Uteri / Q000187:drug effects / Q000473:pathology*; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D024802:Nurse's Role; D065006:Papanicolaou Test; D010353:Patient Education as Topic; D010808:Physical Examination; D011372:Progestins / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013048:Specimen Handling; D002578:Uterine Cervical Dysplasia / Q000139:chemically induced* / Q000175:diagnosis; D014626:Vaginal Smears
chemical_list: D003271:Contraceptive Agents, Female; D011372:Progestins