Cervical Ectropion

Normal cervical histology:

In cervical ectropion:

• Glandular columnar epithelium (normally lines the endocervix), becomes visible on the ectocervix (which is normally squamous)

Cervical ectropion is strongly related to increased oestrogen levels (oestrogen causes the proliferation and differentiation of cervical epithelium)

Risk factors are those associated with high oestrogen exposure:

• During years of menstruation (uncommon in post-menopausal women due to the declining oestrogen levels)
• Pregnancy
• Hormonal contraception use

Cervical ectropion is most commonly asymptomatic.

If symptomatic:

• Vaginal discharge (non-purulent, white or yellow) – most common symptom
• Post-coital bleeding – classic but only seen in 5-25% cases
• Intermenstrual bleeding
• Dyspareunia

If a >55 y/o woman presents with unexplained post-menopausal bleeding → suspected endometrial cancer pathway referral

See the Endometrial Cancer article for more information.

Since cervical ectropion is most commonly asymptomatic, most cases are diagnosed incidentally during a pelvic examination or during cervical screening (Pap smear).

Cervical ectropion is usually a clinical diagnosis made on speculum examination:

• Direct visualisation of a red, ring-like area surrounding the external cervical os (the exposed columnar epithelium on the ectocervix)
• Cervical ectropion may be associated with contact bleeding as the exposed column epithelium is relatively fragile

Cervical ectropion is benign and does NOT require routine treatment.

Only consider treatment if symptoms are affecting the patient’s quality of life:

• 1st line: discontinue any hormonal contraceptives
• Interventional treatment options
  • Cautery (electrocautery or cryotherapy)
  • Microwave tissue coagulation
  • Laser therapy