Spectrum of PAP Smear Cytology According to the Bethesda System 2014 in Perimenopausal Women Presenting in a Tertiary Care Centre in North India

Abstract

Background: Perimenopausal women, owing to fluctuating hormonal status, are prone to bleeding disorders and cervical epithelial changes, making Papanicolaou smear screening clinically important in this age group. This study aimed to evaluate the demographic profile, presenting complaints, specimen adequacy, and spectrum of cervical cytological findings, using the Bethesda System 2014, in perimenopausal women over a two-year period.
Methods: This retrospective-prospective observational study was conducted in the Department of Pathology, Government Medical College, Kathua, from January 2024 to December 2025. A total of 490 perimenopausal women aged 40–55 years who underwent cervical screening were included. Cytological findings were categorized according to the Bethesda System 2014, and specimen adequacy was assessed.
Results: A total of 960 cervical Pap smear samples were examined, of which 490 (51.0%) were from perimenopausal women and constituted the study population, the majority belonged to the 40–44 years age group (60.0%). Abnormal uterine bleeding was the most common presenting complaint (62.0%). Of the cervical cytology samples, 445 (90.8%) were satisfactory for evaluation. Negative for intraepithelial lesion or malignancy (NILM) was observed in 418 (93.9%) cases, with inflammatory changes constituting the predominant finding. Epithelial cell abnormalities were identified in 27 (6.1%) cases, including ASC-US in 11 (2.5%), LSIL in 6 (1.3%), HSIL in 4 (0.9%), squamous cell carcinoma in 3 (0.7%), ASC-H in 2 (0.4%), and AGC in 1 (0.2%) case.
Conclusions: Cervical cytology remains a valuable screening tool in perimenopausal women, detecting a clinically significant burden of epithelial abnormalities alongside predominantly reactive findings, and supports continued screening throughout this transition irrespective of age or symptom severity.