Pap Smears Revert to Normal with the Right Treatment

by John R. Lee, M.D.

A premenopausal woman (in her ‘40s) named Nancy wrote me three months ago to tell me she was scheduled to have a hysterectomy because of abnormal (dysplasia) Pap smears. She had been treated with birth control pills (why is a mystery) but the Pap smear was still abnormal. I referred her to our PREmenopause book and suggested that she consider three months of cyclic progesterone cream (15 mg/day of progesterone from day 12 to day 26 of the cycle), folic acid (4 to 5 mg/day), and vitamin B6 (50 mg/day), and then get another Pap smear. I asked her to let me know the results.

Last week Nancy wrote to report that her repeat Pap smears were entirely normal. She said that her doctor did a cervical biopsy and it, too, was entirely normal. Her doctor called it a spontaneous remission and reluctantly cancelled their intended surgery. I suggested she get another repeat Pap smear in six months to mollify her doctor. I get mail like Nancy’s every week: this approach is certainly preferable to a hysterectomy, by any measure.

In my experience, the great majority of abnormal Pap smears (that are not due to obvious inflammation) are due to deficiencies of folic acid and progesterone, and they all routinely revert to normal cells when the deficiencies are corrected.

This article was originally published in the John R. Lee, M.D. Medical Letter.