Cervical conization and high risk - HPV status changes in relation to menopause: a retrospective longitudinal study...

The relationship between high-risk human papillomavirus (HR-HPV) infection outcomes and cervical lesion recurrence after conization is well documented. However, the temporal dynamics of human papillomavirus (HPV) status post-conization, especially in postmenopausal women, remain unclear.

This retrospective cohort study consecutively enrolled 598 patients who underwent conization, all of whom had baseline HR-HPV positivity and histologically confirmed cervical intraepithelial neoplasia (CIN) 2-3. All patients had at least one follow - up HPV test after surgery. Temporal changes in HPV status following conization and their association with menopause were analyzed using Generalized Additive Mixed Models (GAMM).

Among the 598 patients, GAMM analysis revealed a significant decrease in HPV positivity risk over time. Adjusting for confounders, the overall risk of HPV positivity decreased by 59% every 4 months within the first 24 months post-conization (OR: 0.41, 95% CI: 0.35-0.47). After 24 months, the risk continued to decline by 7% every 4 months (OR: 0.93, 95% CI: 0.81-1.06). Menopause status significantly influenced these temporal changes; postmenopausal patients had a 45% increased risk of HPV positivity every 4 months after conization compared to premenopausal patients (OR: 1.45, 95% CI: 1.13-1.85), particularly within the first 24 months (p = 0.0032).

In patients undergoing conization, longitudinal HPV infection status changes were independently associated with menopause. The risk of HPV positivity decreased significantly in the first 24 months post-surgery, with a more pronounced decline in premenopausal patients, informing HPV testing strategies post-conization.