Risk factors of human papillomavirus-related cervical lesions in postmenopausal women: a cross-sectional study

The incidence of cervical cancer is increasing in postmenopausal women globally, particularly in less-developed nations, including China. However, research on cervical cancer screening methods and related factors in China is limited. In the present study, we aimed to identify the independent risk factors associated with cervical lesions in postmenopausal women. Additionally, we compared the clinical characteristics and demographic information between women diagnosed with low-grade squamous intraepithelial lesions (LSIL) and those with high-grade squamous intraepithelial lesions+ (HSIL+).

We conducted a cross-sectional study using qualitative human papillomavirus (HPV) DNA testing for cervical cancer screening among postmenopausal women across 23 districts and counties in Chengdu, China. Multivariate logistic analysis was employed to analyze demographic information, clinical history, and auxiliary examinations to identify independent risk factors for cervical lesions in postmenopausal women.

A total of 917 patients participated in the study and were categorized as: 624 patients with LSIL (68.0%) and 293 patients with HSIL+ (32.0%). Multivariate analysis revealed that factors showing significant differences between two categories included co-infection with types 16 and 18 (adjusted odds ratio [aOR] = 0.348, 95% confidence interval [CI] = 0.138-0.881, p = 0.026), mixed infections involving other types, HPV 16/18 (aOR = 0.514, 95% CI = 0.336-0.785, p = 0.002), transformation zone (TZ) 3 (aOR = 1.604, 95% CI = 1.018-2.528, p = 0.041), and colposcopy impressions indicating high-grade features and worse (aOR = 11.846, 95% CI = 2.132-65.807, p = 0.005).

Co-infection with HPV types 16 and 18, as well as mixed infections involving HPV 16/18 and other types, TZ 3, and colposcopic features indicative of high-grade lesions and cancer, were identified as independent risk factors for HPV-related cervical lesions in postmenopausal women. Therefore, postmenopausal women with these high-risk factors need to undergo frequent cervical screening, and histopathological examination, if necessary.