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Specific Timing for Colposcopy

Is it Worthwhile?

From the ¹Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, the Coombe Women's Hospital, Dublin, Ireland; ²Service de Gynécologie Obstétrique, Hôpital Nord, Chemin des Bourrely, Marseille, France; and the ³Department of Epidemiology and Preventive Medicine, Royal College of Surgeons in Ireland, St. Stephens Green's, Dublin, Ireland.

OBJECTIVE: To estimate if the time of the menstrual cycle would improve the chance of seeing the squamocolumnar junction at colposcopy.

METHODS: A retrospective study was conducted on 1,248 patients with normal menstrual cycles who attended our colposcopy clinic between 2003 and 2007. Timing of colposcopy, parity, contraception, smoking status, and visibility of the transformation zone were recorded for analysis. The transformation zone was classified as type 1 when completely ectocervical and fully visible, type 2 when it was partially endocervical but fully visible, and type 3 when not fully visible.

RESULTS: No significant difference was found between the rate of types 1, 2, or 3 transformation zone observed in patients who were examined during the second week of their menstrual cycles and the others (P=.581). Compared with women in the first week of their menstrual cycle, those on the 22nd day or later were significantly more likely to have a type 1 transformation zone at colposcopic examination (odds ratio [OR]=1.6, P=.029, logistic regression using day 1 to 7 as baseline). The probability for a patient to have a type 1 transformation zone declined with age (OR=0.59, P<.001), parity (OR=0.47, P<.001), and smoking status (OR=0.55, P<.001), whereas it increased with the use of combined oral contraception (OR=2.7, P<.001). Adjusting for these factors, we found no statistically significant effect of the time of cycle on the visibility of the transformation zone.

CONCLUSION: Timing colposcopy during the menstrual cycle does not improve the visibility of the transformation zone and is not recommended.

LEVEL OF EVIDENCE: III