PLOS ONE Medicine&Health

Impact of menopausal status on human papillomavirus detection and cervical neoplasia in middle-aged Senegalese women

by Emily R. Spencer, Rachel L. Winer, Selly Ba, Marie Pierre Sy, John Lin, Qinghua Feng, Geoffrey S. Gottlieb, Papa Salif Sow, Nancy B. Kiviat, Stephen E. Hawes

Hormonal and immunologic changes related to menopause may play a role in human papillomavirus (HPV) and cervical neoplasia detection, yet this relationship has not been examined in West African populations, where cervical cancer remains a leading cause of cancer-related death. The purpose of this study was to assess whether menopausal status is associated with HPV and cervical neoplasia detection in Senegalese women aged 40–60. We conducted a secondary analysis of three prospective cervical cancer studies in Dakar, Senegal (1998–2011). Participants with known menopausal status and a satisfactory HPV test (N = 3,118) and/or Pap smear (N = 2,907) were included, excluding those with cervical cancer or pregnancy; participants without known HIV status were additionally excluded from the cervical neoplasia analysis. Multivariable logistic regression and generalized estimating equations were used to estimate adjusted odds ratios and 95% confidence intervals, adjusting for age, gravidity, and HIV status. Compared with premenopausal women, postmenopausal women had significantly higher odds of HPV detection (OR = 1.48; 95% CI: 1.18, 1.85), including both high-risk (OR = 1.55; 95% CI: 1.25, 1.93) and low-risk types (OR = 1.64; 95% CI: 1.30, 2.08). Odds of cervical neoplasia were elevated, but non-significant, among postmenopausal women (OR = 1.36; 95% CI: 0.97, 1.90), with increased odds for both high-grade (OR = 1.43; 95% CI: 0.90, 2.28) and low-grade lesions (OR = 1.30; 95% CI: 0.84, 2.02). However, in a sensitivity analysis restricted to participants with known HIV status, these cervical neoplasia odds were attenuated, suggesting caution in interpreting the magnitude of these findings. These findings suggest menopause may contribute to HPV persistence or reactivation, and development of cervical neoplasia. Our results highlight the importance of continued surveillance for HPV and cervical neoplasia among older women, particularly in low-resource settings with disproportionately high cervical cancer burden.