01 Feb Naturopathic Management of HPV: Proactive Care For Your Cervix
Guest post by: Dr. Jennah Miller, ND
As a naturopathic doctor with a focus on women’s health, it’s my job to make sure that you are fully informed and empowered in your healthcare decisions and treatment options. In the context of cervical health, understanding the results of your most recent PAP test can be both incredibly important as well as empowering. Many of us have had a PAP test come back abnormal, but how many of us have understood what this result actually means in the context of our health? Education can be an important aspect of your healthcare in and of itself, especially when it comes to understanding your cervix. So we’re going to dive into some of these more mysterious aspects of cervical health: understanding your PAP test results and learning more about what you can do on your own to improve clearance of HPV and cervical dysplasia (because I’m all for putting the power back into the hands of the patient!).
What does my abnormal PAP mean?
The presence of an abnormal PAP test generally indicates that you are experiencing some degree of cervical dysplasia – this means that under certain conditions and stressors, the previously normal cells of your cervix have mutated and become abnormal in size, shape, and/or function. The most common cause of these abnormal cellular changes is the Human Papilloma Virus (HPV), and approximately 75% of sexually active Canadians will have at least one HPV infection in their lifetime.
However, the interesting fact is that not all individuals who have been exposed to HPV will have abnormal PAP test results in their lifetime. A variety of factors seem to play a role in progression of HPV to cervical dysplasia, such as which specific HPV strain you have contracted (low or high risk), immune system function, sexual practices and HPV status of your sexual partners, as well as factors such as diet, smoking status, and long term oral contraceptive pill use.
When your PAP test results return as “abnormal” they generally have one of the following basic terms to indicate the severity or “grade” of the cervical lesions present:
- ASCUS – atypical squamous cells of undetermined significance (some cells don’t look normal, but it’s unclear what the cell changes mean by looking at the PAP alone)
- LSIL – Low stage intraepithelial neoplasia (the cells don’t look normal, but they usually aren’t precancerous)
- HSIL – High stage intraepithelial neoplasia (the cells are abnormal or precancerous – the cells may develop into cancer if left untreated)
- SCC – Squamous cell carcinoma (there are cancerous cells present)
Wait, what is cervical dysplasia?
Cervical dysplasia is a term used to describe the abnormal cellular changes that occur to the cells of the cervix. It indicates the presence of pre-malignant or pre-cancerous changes to the cervix, and if left untreated it may progress to cervical cancer over time. High stage lesions are more likely to progress to cervical cancer, while low stage lesions are less likely. The main causative factor for cervical dysplasia is chronic HPV infection.
What is HPV?
HPV or the Human Papillomavirus is an infectious agent that is generally transmitted between sexual partners via direct sexual contact of the skin and/or mucous membranes. There are over 100 different strains of HPV, some of which can cause genital and non-genital warts, while others can cause cervical dysplasia that can progress to cervical cancer. Low-risk strains of HPV (like 6 and 11) are more likely to cause external genital warts, while high-risk strains (like 16 and 18) are more often associated (approximately 70%) with cervical changes and progression to cancer. After your abnormal Pap test results, your gynecologist may assess for HPV strain using an HPV DNA test. Alternatively, you can use Eve Kit to collect your own sample at home to test for HPV DNA!
Naturopathic Management of Cervical Dysplasia and HPV
Naturopathic management of cervical dysplasia focuses mainly on addressing HPV persistence. This means treating alongside conventional recommendations (such as loop electrosurgical excision procedure (LEEP) or repeat screening measures) to increase immune system function, allowing your body to clear HPV and prevent recurrence of cervical dysplasia after treatment. Current conventional treatments such as LEEP entail surgical removal of the abnormal cells of the cervix, but generally do not address HPV eradication. Naturopathic treatment remains a great addition to conventional recommendations, since it increases immune system functioning by optimizing nutrition, along with other preventative measures which are discussed in greater detail below. These measures can help prevent persistent HPV infections from causing cervical dysplasia to recur post LEEP or other more invasive procedures.
Preliminary research on diet and cervical dysplasia indicates that a diet rich in fruits and vegetables correlates with a lower incidence of cervical intraepithelial neoplasia and progression to cervical cancer. In particular, low intake of dark green and deep yellow vegetables was associated with increased risk of cervical cancer, especially in smokers. One study in particular, by Tomita et al. (2011), found increasing intake of these types of foods was associated with nearly a 50% decreased risk of CIN3 (HSIL).
Additional research looking at the intake of diindolymethane (DIM), a compound rich in cruciferous vegetables like broccoli and Brussels sprouts, indicated that increased intake over a 12 week period can decrease the grade and severity of cervical dysplasia on PAP smear and colposcopic assessment. I generally recommend that my patients add 1-2 servings of cruciferous vegetables to their daily intake to mimic this. It’s important to take these studies with a grain of salt, and combine dietary measures appropriately with conventional treatment recommendations. The bottom line is that you should focus on bright, colourful fruits and vegetables, incorporating them into your diet as often as possible.
Barrier usage (e.g., condoms or dental dams) is the biggest factors that I like to touch on for my patients with cervical dysplasia. While there are many lifestyle factors we can’t necessarily control for that increase our risk for cervical dysplasia (i.e. family history of cervical cancer, low socioeconomic status), barrier use is one that we can take into our own hands. Sinc e HPV is sexually transmitted, and often passed between sexual partners, usage of barrier devices until cervical dysplasia has resolved is ideal. This prevents recurrent transmission of HPV between partners, and has also been linked to increased regression of cervical dysplasia in general. This means using condoms 100% of the time until your Pap test comes back as normal.
Screening and Continued Care
After your first abnormal Pap test, you will generally undergo a number of repeat screening procedures before progressing to conventional treatment options such as the LEEP procedure (where the abnormal tissue is removed from the cervix using an electro-cautery tool). Depending on the grade of your cervical dysplasia, your family doctor/gynecologist may recommend either a repeat PAP test in 6 months, or added assessment via colposcopy (visualization of the cervix using a microscopic tool) and biopsy of the cervical tissue. For more information about what to expect your follow-up timeline to be, check out this handy tool regarding Ontario Screening Guidelines for abnormal Pap test results. Once your Pap tests begin to display as normal again, you return to regular screening Pap tests every 3 years or every 1 year, depending on HPV status.
Adhering to conventional screening guidelines and recommended LEEP procedures is an important contributing factor in decreased death rates from cervical cancer in Canada. You should never avoid these conventional care options to pursue solely naturopathic care – instead I like to view the care I provide my patients as adjunctive to conventional treatment options. On top of the few recommendations I noted, there are many other evidence-based herbal and supplemental options to explore with your naturopathic doctor for improving HPV eradication and decreasing persistence. Your healthcare plan should be as unique as you are, and your local naturopathic doctor will consider this as they recommend an adjunctive treatment plan for your cervical dysplasia.
De Vet, H. C. W., & Sturmans, F. (1994). Risk factors for cervical dysplasia: Implications for prevention. Public Health, 108(4), 241-249.
González, C. A., Travier, N., Luján‐Barroso, L., Castellsagué, X., Bosch, F. X., Roura, E., … & Sacerdote, C. (2011). Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study. International journal of cancer, 129(2), 449-459.
Institute for Natural Medicine and the American Association of Naturopathic Physicians. Naturopathic Medicine FAQs. Accessed from: https://www.naturopathic.org/files/INM%20AANP%20FAQ13%20Cervical%20Dysplasia%20PDF%20version.pdf
Munk, A. C., Gudlaugsson, E., Malpica, A., Fiane, B., Løvslett, K. I., Kruse, A. J., … & Baak, J. P. (2012). Consistent condom use increases the regression rate of cervical intraepithelial neoplasia 2–3. PloS one, 7(9), e45114.
National Cancer Institute. HPVand Cancer. Accessed from: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet#q2
The Society of Obstetricians and Gynaecologists of Canada. Accessed from: https://www.sexandu.ca/stis/hpv/
Tomita, L. Y., Roteli-Martins, C. M., Villa, L. L., Franco, E. L., & Cardoso, M. A. (2011). Associations of dietary dark-green and deep-yellow vegetables and fruits with cervical
intraepithelial neoplasia: modification by smoking. British journal of nutrition, 105(6), 928-937.
Jennah Miller is a Toronto based Naturopathic Doctor who believes that the strongest step a woman can take towards empowerment, is in taking care of her health. She works with weird, wild, and badass women in co-creating their own unique brilliance. Dr. Jennah understands that women are not just small men, and she thinks it’s high time your health care took that into account. Don’t you?
Dr. Jennah graduated from the Canadian College of Naturopathic Medicine with a special interest in fertility and reproductive health, as well as a passion for teaching women how to love their periods and connect with the shifting tides of their own bodies. With an undergraduate degree in Nutrition, she has an in depth knowledge of how to fuel the female body. She believes above all, that you are important and worth your own time. You can find out more about her and her naturopathic practice at www.jennahmiller.com.
From time to time, we invite guest experts to share their professional opinions and thoughts on our blog. Views, opinions and positions expressed within these posts are those of the author alone, and do not represent those of Eve Medical.