The present study was conducted among the oral contraceptive users to see any impact of their socialfactors on the morphological changes in the en- docervix. These changes were seen more prominantly in the advancing age, low socio-economic group multiparous and having their marital life more than 5 years period. The oral contraceptives were taken by 53.33 percent ofwomen for 7-18 months duration. The prevalence and severity of the mor­phological change increased significantly with the increase in duration 'of use of contraceptives. However no relationship was observed with the religion and nativity of the users as well as the types of oral contraceptives used.
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Ganguli, Gauri

Saxena, Meena

Saxena, S C

Singh, G

Singh, Mamta

Srivastava, J P

English

Indian Journal of Community Health

• IIndian Journal of Community Health, 1995, Vol 8, NO.2 -'3 : 15 -18A SOCIO-MEDICAL STUDY OFMORPHOLOGICAL C.HANGES IN ENDOCERVIXWITH' THE USE OF ORAL CONTRACEPTIVESS C Saxena*, Meena Saxena**, G Singh***, Mamta Singh ****Gauri Ganguli*****, andJ P Srivastava****** .The present study was conducted among the oral contraceptive users to see any impact of their social factors on the morphological changes in the en-docervix. These changes were seen more prominantly in the advancing age, low socio-economic group multiparous and having t~ir marital life morethan 5years period. The oral contraceptives were taken by 53.33percent of women for 7-18months duration. The prevalence and severity of the mar-phological change increased significantly with the increase in duration 'of use of contraceptives. However nq relationship was observed with thereligion and nativity of the users as well as the types of oral contraceptives used.I.INTRODUCTIONAccording to the present estimates, over 80 millionwomen around the world use "the pill' (WHO)l. Likeany drug, these contraceptives can not be made free ofadverse potentials. It was observed that women usingoral contraceptives have cervical displasia andneoplasia more than the general population. Stem etal2, Kline3 and Ory et al4 rep~rted the relative risk ofcervical carcinoma in situ for oral contraceptive usersas compared to non users to be increased with durationof their use. .The present study was under taken to see therelationship of morphological changes with socialfactors like age, socio- economic status, parity, maritalstatus and duration of use of oral contraceptives ..*Asstt. ProfDepartmentofS.P.M., G.S. V}I. Medical College, Kan-pur**Ex-RegistrarDeptt. ofObst. & Gynaecology, M.LN. Medical College,Allahabad***Prof & HeadDepartment of S.P.M., M.LN. Medical College, Al-lahabad****ProfessorDepartment of Pathology, M.LN. Medical College, Al-lahabad*****ProfessorDeptt. ofObst. & Gynaecology, M.LN. Medical College,Allahabad******Assoc. ProfDepartmentofS.P.M., G.S. V.M. Medical College, Kan-pur15MATERIAL AND METHODSThe present study was conducted in S.R.N. and KamlaNehru Hospital of MLN. Medical College,Allahabad. A total of 120 women were studied whowere taking oral contraceptives regularly. A detailedhistory was taken with special. reference to the name,age, parity, socio-econonllc status, marital status,.menstural history and duration of oral contraceptivesused and any complaints before or during the use. Afterdoing the proper general and systemic examination perspeculum and per vaginal examination was done to seeany discharge, cervical erosion and inflammation ofcervix. Cervical scrape smears were taken by means ofa wooden spatula and stained by standardPapanicolaou's technique5. The cases were grouped inseven groups (Singh et al)6' - normal, chroniccervicities, disp1asia - mild, m.oderate and severe,carcinoma in situ and invasive carcinoma.RESULTS AND DISCUSSIONNormal histology of cervix was found in 40 cases(33.33 percent), Chronic cervicitis in 50 cases (41.67percent). mild displasia in 14 (11.6 percent), moderatedisplasia in 10 (8.53 percent) and severe displasia in 4cases (3.3~ percent) and carcinoma in situ in 2 cases(1.67 percent).The maximum number of oral contraceptive users(68.93 percent) were between 21-30 years of age. Theprevalence of displasia was found to increasesignificantly with age among oral contraceptive users.The higher prevalence of chronic cervicitis was found. in 20-30 years of age (72.0 percent) while displasia(64.28 percent). was found In 30-40 years of age(Table-I).Singh and Baveja7 reported 47.5 percent of displasia inthe age group of 21-30 years whild Worth & Goyes8reported no effect of age on endocervical displasia afterthe use of oral contraceptives. Rotkin9 stated that theprevalence of invasive cervical cancer increases withage until the menopause and then afterwards declines.The prevalence of chronic cervicitis and displasia wasfound significantly higher in low socio-economicgroup (Prasad classification) 10 and might be related tosexual freedom after the use of pills, early age ofmarriage, multiparity and vaginal infections (Table-2).Rao & Krishnall, Singh & Baveja6 and Engineer eta112had also reported the similar findings.A Socw.medit:al Study o/Morphological Changes in Endocervix81.67 percent of cases had 1-4 children while 18.33percent were multiparous. The prevalence and severityTABLE.! .RELATIONSHIP OFMORPHOLOGICA~ CHANGES WITH AGE AMONGORAL CONTRACEPTIVE USERS.Age Normal Chronic Dvsplasia Carcinema Invasive Totalin Years Cervicitis Mild Moderate Severe insitu carcinoma16-20 12 4 - - - - - 16(75.0) (25.0) (13.33)21 - 25 16 14 4 2 - - - 36(44.44) (38.89) (11.11) (5.56) (30.0)26-30 10 22 6 6 2 - - 46(21.75) (47.83) (13.04) (4.34) - - - (38.33)31-35 2 10 4 2 - 2 20(10.0) (50.0) (20.0) (10.0) - (10.0) (16.67)36-40 - - - - 2 2(100.0) (1.67)40+ - - - - - - - -of inflammation and displasia was found significantlyto increase with parity. The severe displasia was seen(16.66 percent) in multiparous (Table- 3). Thesechange might be due to traumatic effect to the cervicalepethelium by repeated deliveries and higher levels ofovarian hormones first during the pregnancy and thenby taking oral contraceptives. The findings weresimilar to those reported by Wahi et al 13 and Rao II .The chronic cervicitis and displasia was found to beincreased with the duration of marital life among theoral contraceptive users. The highest prevalence ofchronic cervicitis were reported 3.years after. The mild& moderate displasia between 6-10 years and severedisplasia and carcinoma in situ was observed only afterTABLE-2RELATIONSHIP OF MORPHOLOGICAL CHANGES WITHSOCIO-ECONOMICSTATUS AMONG ORAL CONTRACEPTIVE USERS.Social- Normal Chronic Dvsolasia Carcinema Invasive TotalClass* Cervicitis Mild Moderate Severe in situ carcinomaI 10 4 2 - - - - 16(62.50) . (25.0) (12.5) (13.34)II-III 18 14 4 4 2 - - 42(42.85) (33.33) (9.52) (9.52) (4.76) (35.0)IV-V 12 32 8 6 2 2 - 62(19.35) (51.62) (12.90) (9.67) (3.23) (3.23) (51.66)Total 40 50 14 10 4 2 - 120133.33) 41.67) 11.67) . 8.33) 3.33) 1.67) 1(00)TestofSignificanceX2 - 5.43, df- 2, P< .05Note: Figures in parentheses demote percentage.16Indian JournalojCommunity Health, 1995, Vol 8,No. 2.3: 15- 18TABLE-3RELATIONSHIP OF MORPHOLOGICAL CHANGES WITH PARITYAMONG ORAL CONTRACEPTIVE USERS.Parity Normal Chronic '1 DvsDlasia Carcinema Invasive TotalCervicitis Mild Moderate Severe carcinomamSltuNil 14 8 - - - - - 22(63.63) (36.67) (18.33)1-2 20 28 6 4 - - - 58(34.49) (48.28) (10.34) (6.89) (48.34)3-4 6 12 4 4 2 - - 28(21.42) (42.85) (14.29) (14.29) (7.15) (23.33)5-6 - 2 4 2 2 2 - 12(16.66) (33.33) (16.66) (16.66) 16.66) (10.00)Total 40 50 14 10 4 2 - 1201(33.33) 1(41.67) 101.67) 1(8.33) (3.33) (1.67) . InDO)Test of Significance X2 - 9.15, df- 2, P< .01Note: Figures in parentheses demote percentage.10 years of marriage (Table-4).Raol1, Baveja Singh6 had also reported the similarobservations. The, factor responsibile for these changescarcinoma in situ was mainly found after 18 months ofuse.Ory 4 observed that the relative risk of cervicalTABLE.4RELATIONSHIP OF MORPHOLOGICAL CHANGES WITH DURATION OFMARITAL LIFE AMONT ORAL CONTRACEPTIVE USERS.Fufation of . Normal Chronic DvsDlasia Carcinema Invasive TotalMarital Cervicitis Mild Moderate Severe insitu carcinomaLife (in Years)0-2 24 12 2 - - - - 38(63.16) (31.58) (5.26) (31.66)3-6 14 32 6 4 - - - 56(25.01) (57.14) (10.71) (7.14) (46.66)7 -10 2 6 6 . 4 2 20(10.0) (30.0) (30.0) (20.0) (10.0) (16.67)11-15 - - - 2 2 - 4(50.0) (50.0) (3.33)15+ - - - - - 2 - 2(100.0) (1.66)Total 40 50 14 10 4 2 - 12-33.33) 4L(7) 101.67) 'f8.33) 3.33) In.67) 1000.0)Note: Figures in parentheses demote percentage.might be due to effect of smegma and trauma to thecervical epithelium.In the present study, the prevalence and severity of. cervical displasia was found to increase significantlywith the duration of use of oral contraceptives (P<.OOI)(Table-5). The chronic cervicitis was seen mostlywithin 6-12 months duration of use while displasia and17.carcinoma in situ for oral contraceptive users ascompared to non users was 1.3 for 1-12 months of use.2.5 for 13 to 30 months of use and 2.6 for above the 30months of use .CONCLUSIONStern et al2 reported that oral contraceptive use does<'A Socio-medical Study of Morphological Changes in EndocervixTABLE-5RELATIONSHIP OF MORPHOLOGICAL CHANGES IN ENDOCERVIX WITH THEDURA TION OF USE OF ORAL CONTRACEPTIVES.Duration of Normal Chronic Dysplasia Carcinema Invasive Totaluse (in months) Cervicitis Mild Moderate Severe insitu carcinoma0-6 18 14 0 - - - - 32(56.25) (43.75) (26.66)7 -12 14 24 4 2. - - - 44(31.82) (54.54) (9.0) (4.54) (36.67)13 - 18 8 8 4 4 - - - 24(33.33) (33.33) (16.67) (16.67) (20.0)19-24 - 4 4 2 2 - - 12(33.33) (33.33) (16.67) (16.67) ( 10.0)25 - 36 - - - 2 2 2 - 6(33.33) (33.33) (33.33)36+ - - - - 2 - - 2(100.00) ( 1.67)Total 40 50 12 10 6 2 - 120(33.33) (41.67) flO.O) 1(8.33) 13.33) 10.66) (100.0)TestX2-14.9,df-2,P<.001Note: Figures in parentheses demote percentage.not increase the subsequent prevalence of abnormalcervical cytology among women with normal smears-before the use. Extended oral contraceptive use (over 6years) appears to increase by several times the rate ofconversion of cervical dysplasia to carcinoma in situamong women with displasia at the time they beginusing oral contraceptive (WHO').Hence thorough screening of women is advised prior tostarting of the contraceptings.Since there is always a risk of change of dysplasia toneoplasia, a close follow up is advised when thewomen is taking oral contraceptives for prolongedperiod oftime.'0 .:'1. W.H.O.Report:- Steroid contraception and risk ofNeoplasia, T.R.S., 1978,619.2. Stern, E et al : Steroid contraceptive use and cervicaldysplasia, increased risk or progresion science 1977,196, 1940- 1962.3. Kline, T.S. Hoeland, M. and Wemple, D :- Am. 1. ofClinical Pathology, 1970,53,215.4. Ory, H.W. et al :- Preliminary analysis - of oralcontraceptive use and risk of developing premalignantlesions of the uterine cervix, Pharmacology of steroidcontraceptive drugs. New Yark, Raven, 1977.185. Papanicolaou, G.M. :- Am. 1. of Obst. & Gynaec.1954, 85, 458.6. Singh M., Baveja, R Singh, G. and Mehrotra, T.N. :Ind. 1. Med. Res. 1976,64, 1783.7. Singh, M., Singh, G.. Shukla, R , and Baveja. R : 8thAll India meeting of Indian Academy of Cytologists,Madra, 1978.8. Worth, A.J. and Goyes, D.A. : 1. Obst. & Gynaec. Bnt.Comm., 1972, 79, 673.9. Rotkin, I.D. Adolescent. Coitus and cervical cailcer,association of related events with increased risks,Cancer Research, 1967.10. Prasad B.G. : Changes proposed in social classificationof Indian families, Ind. Med. Asso. 1970, 55, 198.11. Rao, A : Krishna, V. and Poranderal, N : Earlydetection of cervical Cancer by Vaginal Cytology. The1. of Obst. & Gynaec. of India, 1973, 23, 315-323.12. Engineer, A.D., Misra, 1.S: and Tandon A :Cytological studies in women using different types ofharmonal contraceptives. 1. of Ind. Med. Asso. 1980,74.13. Wahi, P.N., Luthra, V.K. and Mali, S. : Cervicaldysplasia, Cytomorphological study, Ind. 1. of Med.Res., 1969,57,617-641:

A socio-medical study of morphological changes in endocervix with the use of oral contraceptives

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