Effect Of Reproductive Factors On Cervical Intraepithelial Neoplasia:a Population-based Cohort Study

Objective:Human Papillomavirus(HPV)infection is known to be not the only factor in the development of cervical cancer.And cervix,as part of female reproductive tract,is regulated by estrogen.Reproductive factors are related to the change of hormone level in female.At present,the relationship between reproductive factors affected by estrogen level such as age of menarche and menopause and the risk of cervical intraepithelial neoplasia(CIN)is unclear.Methods:Firstly,demographic characteristics,CIN and cervical cancer related factors and cervical cancer screening were investigated of eligible participants in Shanxi.And then colposcopy and cervical histopathology were further performed for the atypical squamous cells of undetermined significance(ASCUS)and above ASCUS participants.A CIN cohort of 3504 patients was established based on the final pathological findings.Clinical data were obtained through questionnaires,physical examinations,laboratory tests,and collection of biological specimens.We evaluated the age at menarche,menopause status,first intercourse age and squamous-columnar junction(SCJ)visibility of CIN2+ in this 3504 cohort study in baseline and examine these factors associated with regression of CIN1 patients in the follow up.Results:After adjusting for multiple confounders,we observed that first intercourse age,age of menarche,menopause status and squamous-columnar junction visibility were associated with the risk of CIN2+.Age at menarche ≤12 years was a risk factor among post-menopausal women compared with age at menarche ≥17 years(OR=2.04,95%CI1.04-3.97).Premenopausal women had higher risk of CIN2+ than postmenopausal women(OR=1.91,95%CI 1.39-2.65).Menopausal status was correlated with the outcome of CIN1 and post menopause was a significant predictor of CIN1 regression.Conclusion:Early age at menarche and menopause status are associated with risk of CIN2+.And menopause status might be an important tool to predict the clinical regression of patients,suggesting that post menopause could be helpful in monitoring CIN1.Ascertaining menarche and menopause history may help to identify women predisposed to increased risk of CIN development and regression.