Megaloblastic Changes in the Cervical Epithelium

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Abstract
"Megaloblastic" abnormalities of cervicovaginal cells similar to those seen in severe folate and vitamin B12deficiency were found in 22 (19%) of 115 women taking oral contraceptive agents (combined estrogen-progestogen or progestogens only). Similar changes were not observed in any of 51 controls not taking these medications. The cytologic abnormalities could not be related to hematologic findings or serum folate and vitamin B12concentrations. The changes reverted to normal or improved markedly in all eight patients treated with pharmacologic doses of folic acid for three weeks. It is hypothesized that oral contraceptive agents induce a localized interference with folate metabolism at the end organ level.