Abnormal Pap Smear Tests: Implications and Recommended Next Steps

An abnormal Pap smear test result can reveal many things about your reproductive health. Practically speaking, it sheds light on changes in the cells collected from your cervix that could be from infections, inflammation, or exposure to certain strains of human papillomavirus (HPV). 

With its unique advantages, a Pap smear test is one of today’s pillars in women’s healthcare. It is a powerful tool an OBGYN uses to guide women toward better reproductive health. While not all abnormal Pap smear test results point to cancer, understanding what abnormal test results mean will help you find the answers and take confident steps toward your health.

READ ALSO: Regular Pap Smears: A Key Preventive Measure for Women’s Health

Let’s discuss all of that in more detail in this article.

Specific Factors Causing Abnormal Pap Smear Test Results

Various factors, including infections, hormonal changes, and medical procedures, can lead to abnormal Pap smear results. These findings do not always cause alarm but indicate the need for further evaluation or monitoring. Below, we explain how these factors can affect your Pap smear result and what a pathologist might observe under the microscope.

1. Human Papillomavirus. HPV is the most common cause of abnormal cervical changes. HPV infections often resolve independently and shouldn’t cause you to worry. However, when they persist, they can cause cellular abnormalities, also detected by Pap smear tests. It is also important to note that certain strains of HPV put you at higher risk for developing cervical cancer if left undetected and untreated. Because of this, routine Pap smear tests must not be taken for granted.
2. Bacterial Vaginosis. Bacterial vaginosis (BV) occurs when the natural balance of bacteria in the vagina is disrupted, leading to an overgrowth of harmful bacteria. This imbalance causes cervix inflammation, which may result in abnormal cellular changes. When inspecting the sample, a pathologist might observe epithelial cells covered with bacteria, known as “clue cells,” and signs of inflammation, such as swollen cells and excessive white blood cells. While BV is not dangerous, it can interfere with Pap smear results and requires treatment to restore bacterial balance.
3. Yeast Infections. A yeast infection caused by an overgrowth of Candida fungi can cause inflammation of the cervix and surrounding tissues. This inflammation can trigger changes in cervical cells that may appear abnormal during a Pap smear. In the lab, a pathologist might detect budding yeast, fungal filaments (hyphae), and increased white blood cells in the sample. These findings can mimic precancerous changes, making it essential to distinguish infection-related abnormalities from more severe conditions.
4. Hormonal Fluctuations. Hormonal shifts, such as those occurring during perimenopause, menopause, or the use of contraceptives, can affect the health and appearance of cervical cells. Estrogen deficiency, for example, may cause thinning of the cervical lining (atrophy), resulting in cells that look irregular under the microscope. A pathologist might observe smaller cells with altered shapes or irregular nuclei, often accompanied by minimal mucus production. These changes are usually benign and reversible with proper hormonal management.
5. Pregnancy. Pregnancy brings significant hormonal changes that can alter the cervix’s appearance and cellular composition. Increased blood flow to the cervix can lead to heightened sensitivity and inflammation, sometimes causing atypical results in a Pap smear.  A pathologist examining the sample may note cells with increased size (decidual cells) and a higher number of inflammatory cells, which reflect the body’s adaptive response to pregnancy. These findings are usually harmless but might warrant follow-up to rule out any underlying concerns.
6. Cervical Procedures. Previous cervical procedures, such as biopsies, cryotherapy, or LEEP (Loop Electrosurgical Excision Procedure), can leave scar tissue or cause inflammation, which may affect Pap smear results. A pathologist may observe irregular cell formations or fibrotic tissue that can appear similar to precancerous changes. Additionally, the healing process from these procedures may introduce atypical cells that look abnormal temporarily. In such cases, your OB-GYN may recommend follow-up testing to monitor healing and ensure no lasting issues remain.

Types of Abnormal Findings on a Pap Test

Various abnormal findings on a Pap test can indicate succeeding steps like monitoring or additional diagnostic tests. Below are the most common types of abnormal findings and their entails.

• Atypical Squamous Cells of Undetermined Significance (ASC-US). ASC-US refers to slight changes in the squamous cells, which are the flat cells lining the surface of the cervix. These mild changes often result from temporary causes like an HPV infection, inflammation, or hormonal shifts.While ASC-US doesn’t indicate cancer, follow-up is required to ensure the changes don’t progress. Most women with ASC-US will not need treatment, as the abnormalities often resolve on their own.
• Low-Grade Squamous Intraepithelial Lesion (LSIL). LSIL describes early, mild changes in the cervical cells, typically linked to an HPV infection. These changes reflect the beginning stages of abnormal cell growth but are unlikely to develop into cancer in the short term.In many cases, LSIL resolves without treatment, particularly in younger women with robust immune systems. However, follow-up testing is essential to monitor the cells and ensure the abnormalities don’t progress over time.
• High-Grade Squamous Intraepithelial Lesion (HSIL). HSIL indicates more pronounced abnormalities in the squamous cells, suggesting that the changes may progress toward cancer if left untreated. HSIL requires prompt attention and further diagnostic tests, such as a colposcopy and biopsy, to assess the extent of the abnormality. While HSIL does not mean cancer is present, it reflects a higher likelihood that cancer could develop if the abnormal cells are not removed or treated.
• Atypical Squamous Cells Cannot Exclude HSIL (ASC-H). ASC-H results suggest that atypical cells are present, but their appearance raises concerns that they could represent high-grade lesions. This result means that while the abnormality is not confirmed as HSIL, the possibility cannot be ruled out. Additional diagnostic tests, such as a colposcopy, are needed to investigate further and determine whether high-grade lesions are present.
• Atypical Glandular Cells (AGC). AGC refers to abnormal cells found in the glandular tissue that lines the cervix and the upper reproductive tract. These cells can sometimes indicate precancerous changes or other underlying health concerns, such as endometrial or cervical cancer. Further testing, including colposcopy and endometrial sampling, may be recommended to identify the source of the abnormality and guide treatment decisions.
• Squamous Cell Cancer or Adenocarcinoma Cells. The presence of squamous cell carcinoma or adenocarcinoma cells is a rare but severe finding. It suggests that cancerous cells exist in the cervix or upper reproductive tract. Immediate follow-up is essential to confirm the diagnosis and begin appropriate treatment to ensure optimal outcomes and recovery.

Next Steps After Receiving Abnormal Results

Receiving an abnormal Pap smear result can be unsettling, but prompt follow-up with your healthcare provider ensures you get the proper care. Depending on the findings, your OB-GYN may recommend additional tests, provide instructions for monitoring, or suggest treatments to address the abnormality.

• Repeat Pap Smear.  If the initial result indicates mild changes, your doctor may recommend a follow-up Pap smear in six to twelve months to monitor for further abnormalities.
• HPV Testing. An HPV test may be performed to determine if a high-risk virus strain is present. This test helps guide the course of follow-up care and management.
• Colposcopy. A colposcopy allows your doctor to closely examine the cervix under magnification if more serious abnormalities are suspected. During this procedure, a biopsy may also be taken for further analysis.
• Biopsy. A biopsy involves collecting a small tissue sample from the cervix for laboratory analysis to confirm or rule out serious conditions, such as high-grade lesions or cancer.
• Monitoring and Observation. In some cases, no immediate treatment is necessary. If the abnormality is mild and likely to resolve naturally, your OB-GYN may recommend periodic monitoring. Regular follow-up appointments ensure that changes are tracked closely, allowing your healthcare team to intervene if needed.
• Medical and Surgical Interventions. Medical or surgical interventions may be required when more significant abnormalities are detected.
• Cryotherapy. This procedure freezes abnormal cells, preventing them from developing into more severe lesions.
• LEEP (Loop Electrosurgical Excision Procedure). LEEP removes abnormal tissue using a thin wire loop heated with an electric current. This method is commonly used for treating high-grade lesions.
• Laser Therapy. Laser therapy uses focused light to remove abnormal cells and promote healthy tissue growth. Your healthcare provider will determine the best treatment based on your specific diagnosis.

Final Thoughts

Abnormal Pap smear results are not uncommon; in most cases, they can be managed effectively with the proper follow-up care. Understanding the possible causes and the recommended next steps empowers you to take proactive measures for your health. Whether monitoring minor abnormalities or addressing more serious findings, working closely with your OB-GYN ensures you receive the necessary care and support.

Routine Pap smears are essential in preventing cervical cancer and maintaining reproductive health. If you have received abnormal results or have questions about your next steps, contact your healthcare provider. At Northside/Northpoint OBGYN, our specialists are here to guide you through every step of the process with care, clarity, and expertise. Schedule a consultation today to discuss your Pap smear results and plan the best action for your health.