Moderate cervical dysplasia: degrees and how to treat

Moderate dysplasia of the cervix refers to a variety of intraepithelial neoplasia. This is a very common gynecological disease, which is characterized by the appearance of atypical cells in the deep cellular structures of the uterine neck. The main danger of this pathology lies in the high probability of developing cancer with the progression of the disease and the absence of treatment. According to statistics, the development of dysplasia is most often experienced by women of childbearing age (from the age of 25).

According to the WHO classification (1995), three degrees of cervical intraepithelial neoplasia (CIN) are distinguished in medicine, which differ depending on the growth of atypical cells and have the corresponding designations:

• CIN I (weak);
• CIN II (moderate);
• CIN III (expressed) is the most dangerous degree of severity.

"Moderate" is considered to be grade II dysplasia, when it is detected, lesions up to 2/3 of the thickness of the flat epithelium are observed. At the same time, the cell nuclei increase in size, the cell disposition is disturbed, the nuclear-cytoplasmic ratio significantly changes, pathological mitosis arises. In about 40% of cases, the disease regresses, but under certain adverse conditions and reduced immunity the disease passes into the last (ІІІ) stage. Progression of the process is characterized by extensive damage to the multilayer epithelium of the cervical canal, which indicates the development of intraepithelial cancer. According to medical statistics, the probability of diagnosing intraepithelial cancer in patients with severe dysplasia of the cervix is about 20 times higher than in women with a healthy (undamaged) cervix.

Moderate dysplasia of the cervix is a fairly serious, but quite curable disease, if detected in time. This pathology is expressed in the rapid multiplication of mutated cells located in the epithelial layers of the cervix. Today in medicine, any stage between the healthy state of the female body and cancer is commonly called the term "cervical intraepithelial neoplasia."

The diagnosis of "Moderate dysplasia of the cervix" has a code of mb 10 N87.1 and belongs to class 14 - "Diseases of the genitourinary system" in the International Classification of Diseases of the 10th revision.

The degree of dysplasia is determined on the basis of the complexity of the disease, i.e., depending on the pathological changes on each of the layers: surface, intermediate, basal. When the pathology is transferred to the basal layer, the patient gets the most dangerous diagnosis - "cervical cancer". Because of untimely diagnosis of cervical cancer in the world, about 4-5 thousand per 100 thousand women die each year.

The concept of precancerous diseases of the cervix first appeared in 1947 and combined pathologies that are characterized by atypism of the epithelium of the uterine neck without invasion. Studying the effect of dysplasia of any severity on the development of cervical cancer, Richart first introduced into medical practice the term "cervical intraepithelial neoplasia" (in "cervical intraepithelial neoplasia"). In the research work of the scientist it was pointed out that with mild degree of dysplasia it is completely reversible and does not require intensive therapy. However, in modern medicine, "dysplasia of any degree of severity" is considered to be a "precancerous condition".

[1], [2], [3], [4], [5], [6]

Causes of the moderate cervical dysplasia

Moderate dysplasia of the cervix is a lesion of the structure of the second degree mucosa, which is "intermediate" between the first and third. Therefore, for positive results of treatment, pathological changes in the cervix should be detected as early as possible. Therapy will be aimed at suppressing papillomavirus, and hence preventing carcinoma, a malignant tumor that can develop in a woman with grade II dysplasia within 3 years.

What are the main causes of mild cervical dysplasia? It is considered that the following factors can provoke this pathology:

• exogenous (external) - infection of the female body with various viruses (herpes, chlamydia, papilloma, HIV), as well as the development of gonorrhea, trichomoniasis, urea- or mycoplasmosis;
• endogenous (internal) - immunodeficiency and various hormonal disorders;
• bacterial vaginosis;
• too early onset of sexual activity and frequent change of sexual partners;
• hereditary predisposition;
• inflammatory diseases of the pelvic organs (chronic);
• prolonged use of contraceptives;
• abortion and early childbirth (up to 18 years) with trauma to the cervix;
• large families;
• presence in the history of neglected erosion, vaginal / vulvar dysplasia;
• diseases of endocrine glands;
• alcohol and smoking abuse;
• deficiency of folic acid;
• regular neglect of personal hygiene.

The assumption of the direct impact of human papillomavirus (HPV) on the development of cervical cancer was put forward by Hausen in the 1970s. The main way of transmission of this virus is sexual. Oncogenic genotypes of papillomavirus are: 16, 18 (cause 2/3 of all cases of carcinoma), and 31, 33, 45, etc.

Diagnosis of mild dysplasia can be carried out only under medical conditions, under the supervision of a gynecologist, using special instruments. Early diagnosis of CM dysplasia is based on a cytological examination of smears developed by the Pap smear. This study allows you to accurately determine the location of altered areas of the mucous membrane of the cervix.

[7], [8]

Pathogenesis

Moderate dysplasia of the cervix develops due to hyperplasia (increase in size and active reproduction) of basal cells of the flat epithelium. Such a process leads to a violation of maturation and atypia - an abnormal cell structure, especially nuclei. At this stage 1 / 2-1 / 3 part of the thickness of the epithelium is affected, on which mitoses are visible. The affected part is represented by oval, elongated, modified cells (which have large nuclei with nucleoli and coarse chromatin structure).

The pathogenesis of mild dysplasia is often associated with infection with HPV (predominantly 16th or 18th strains). We can talk about the two main stages of HPV development: reproductive infection (this stage is reversible) and integrative infection (papillomavirus DNA is inserted into the genome of infected cells, and this leads to a tumor transformation). In connection with active reproduction of HPV in infected cells, an "aggressive" estrogen of 16α-hydroxyestrone is formed, and favorable conditions for the development of the tumor process are created. Reliable criteria by which you can most accurately determine the prognosis of the disease, at this time have not been studied.

[9], [10], [11], [12], [13]

Symptoms of the moderate cervical dysplasia

Moderate dysplasia of the cervix does not have a certain symptomatology, and this feature greatly aggravates the course of the pathological process. About 10% of women have an absolutely hidden course of the disease at all stages, up to its malignant degeneration. Therefore, a major role in the timely detection of pathology is given to a regular visit to a gynecologist and the planned conduct of Rahr tests.

Symptoms of moderate dysplasia of the cervix are lubricated and usually come down to the pain that occurs during sexual intercourse, the appearance of bloody discharge or whiteness after sexual intercourse. From the symptomatology, one can also note a drawing pain in the lower back and in the lower abdomen. The body temperature does not increase, except for cases of inflammation and secondary infections.

When attaching a microbial infection to a background of moderate dysplasia, the following symptoms may occur:

• itching and irritation of the mucosa;
• burning sensation in the vagina;
• bloody (sometimes - purulent) discharge with a characteristic odor;
• profuse and prolonged bleeding during menstruation;
• the occurrence of bleeding outside menstruation;
• Stretching pain in the lower abdomen.

First signs

Moderate dysplasia of the cervix is almost asymptomatic, the clinical picture is blurred. Women with dysplasia in 90% of cases do not even suspect about such health problems.

The first signs of dysplasia appear only at later stages of the disease. Most often - it's discomfort and pulling pain in the lower abdomen. When an infection is attached, symptoms may appear in the form of vaginal spotting after intercourse or the use of tampons, which is perhaps the only obvious sign of the pathological process.

Sometimes there is burning and itching (especially with a microbial infection of the vagina), similar to the symptoms of colpitis / cervicitis. The patient can have abundant discharge (whites) from the genital tracts of different colors and odors.  

With the above signs or the presence of discomfort in the abdomen, the appearance of drawing pains, burning, itching, etc., a woman should be immediately examined by a gynecologist. Timely diagnosis of dysplasia will help the doctor to apply effective therapeutic methods to treat the insidious disease and eliminate its consequences.

[14], [15]

Complications and consequences

Since moderate dysplasia of the cervix refers to a variety of precancerous conditions, the consequences of pathology are predictable: the second degree of disease can go to the third. This means that the most dangerous consequence of dysplasia will be the development of a malignant tumor.

According to medical statistics, in 43% of grade II dysplasia passes independently after the "release" of the patient's body from HPV. Approximately in 35% of cases there is a long stable course of the pathological process. In 70% of women, recovery occurs approximately 2 years after the diagnosis was established.

Timely diagnosis of dysplasia, complex treatment in combination with the exclusion of provoking factors leads to positive results. Inadequate treatment or complete absence of therapy can cause the development of formidable complications, i.e., the transformation of dysplasia into cancer. At a dysplasia of II degree the probability of development of tumoral process is equal 5-7%. Viral infections (papilloma or cytomegalovirus, herpetic, etc.), inflammatory processes of a chronic nature, as well as immunodeficient conditions (eg, HIV infection) can contribute to the degeneration of pathology into a malignant tumor.

The main danger of the transition of dysplasia into cancer is the inconspicuous, almost asymptomatic course of this process. Emerging from atypical, cancer cells begin to divide many times and spread into the deep layers of the mucous neck, as well as to nearby tissue sites. Progression of the tumor process leads to the spread of cancer cells through the systemic bloodstream into bone tissue and internal organs. In this process, there is an appearance of distant metastases throughout the body.

Moderate dysplasia of the cervix is an insidious disease that requires effective therapy, up to the use of the most radical methods, including surgical (in the last stages - removal of the uterus because of the high risk of malignant cells).

The complications of this pathology are associated, first of all, with the possibility of the second stage of the disease becoming a third stage, which is fraught with oncological processes. As a result of non-elimination of provoking factors, relapse is possible - that is, the repeated development of dysplasia, which most often occurs against the background of secondary pathologies. In this case, therapy should be more active than in the primary treatment of dysplasia.

Infectious complications occur in the surgical treatment of dysplasia, as a result of which the local protective properties of the mucosa decrease. To prevent infections, a woman must carefully observe the rules of personal hygiene, and also refrain from having sexual intercourse for at least a month after the course of treatment.

After surgery, there is a complication in the form of bleeding. It is necessary to note the possibility of scar formation and subsequent complications during childbirth as a result of poor stretchability of scar tissue. Due to the obstruction of the cervical canal on the background of an ascending infection (endometritis or chronic salpingitis), hormonal problems (in particular, menstrual cycle disorders) and infertility development can be observed.

Complications occur when untimely detection of dysplasia, the lack of comprehensive treatment and annual preventive examinations, as well as the genetic predisposition of the female body to oncology, a combination of STDs, severe immunodeficiency.

Modern gynecology has effective methods of diagnosing and treating dysplasia of the 2nd degree of severity, thanks to which it is possible to detect pathology in time and prevent the degeneration of the disease into the third degree and cancer.

[16], [17], [18]

Diagnostics of the moderate cervical dysplasia

Moderate dysplasia of the cervix is diagnosed annually in 10 million women worldwide. With a traditional gynecological examination using mirrors, grade II dysplasia can only be diagnosed in advance: visually it manifests itself in the form of changes in the color of the mucosa and peculiar white spots on it.

Accurate diagnosis of moderate dysplasia of the cervix is carried out on the basis of a gynecological sampling of smears for the PAP test and special cell analysis for oncocytology. Such diagnostic methods allow one hundred percent to identify the so-called. "Atypical" cells are multi-core, large and without a clear shape.

From other methods of diagnosing dysplasia, we can distinguish:

• colposcopy (allows better visualization of the cervical tissue to detect abnormal areas);
• taking a smear to determine the presence and typing of HPV;
• a biopsy with carrying out of histological research (it is considered the most effective method of diagnosing dysplasia).

The most informative is histological examination of tissue samples as a result of conization and biopsy of CM with scraping of the cervical canal.

[19], [20], [21], [22]

Analyzes

To establish the diagnosis of "moderate dysplasia of the cervix" can only be based on the results of the tests. It is important to note that with dysplasia, there are no significant changes in blood and urine tests. Therefore, other types of analyzes, in particular, studies aimed at detecting HPV, will be more effective.

Analyzes for diagnosing moderate dysplasia:

• PAP test (cytological Pap smear) - is considered a "gold" standard for diagnosing dysplasia; the reliability of this test reaches 80%;
• analysis from the surface layer of the cervix of the uterus on HPV;
• enzyme immunoassay (allows to determine the oncoprotein E7);
• additional bacteriological studies.

If a tumor is suspected, a woman can be prescribed immunohistochemistry with oncomarkers.

According to the results of the Pare test, cytological material reveals intraepithelial changes. Latin letters indicate obvious deviations from the norm: for example, the abbreviation LSIL means that epithelial lesions are insignificant, and the HSIL index indicates a moderate degree of CIN II and the development of carcinoma in the initial stage.

More revealing medical research on histology (the so-called "cervical tissue biopsy") and conization (biopsy cone).

The doctor can prescribe the patient's tests to determine the concentration of different hormones in the blood (hormonal homeostasis), because one of the key factors that provoke the development of CM dysplasia is the long-term use of birth control pills. Some of the oral contraceptives cause hormonal disorders and thus are a prerequisite for the development of precancerous pathology. Evaluation of hormonal imbalance is carried out on the basis of a blood test to determine the concentration of progesterone, estrogen and free testosterone. The analysis of excretion (excretion of hormones through urine) allows more specifically to assess hormonal failures in the body.

[23], [24], [25], [26]

Instrumental diagnostics

To diagnose "moderate dysplasia of the cervix" (CIN II), it is necessary to conduct studies that would confirm the spread of the pathological process at 2/3 of the depth of the epithelial layer, ie, help establish a second severity of the disease.

In addition to collecting anamnesis, instrumental diagnosis is one of the primary ways to determine the disease. General examination of the patient (screening method) consists in a cytological examination of the cervix using gynecological mirrors (Pap test).

If the patient is suspected of pathological changes in the structure of the cervix, the doctor prescribes further observation (in-depth diagnosis). A further stage of the survey involves colposcopy together with a targeted biopsy of the cervix and a biopsy of the endocervix.

Colposcopy is a visual method, which in 80-90% of cases accurately determines the pathology. From the "pluses" of this type of study can be noted ease of use, from the "minuses" - low specificity, because of what can not predict the development of the process and thereby reduce the mortality rate from invasive forms of cervical cancer.

It should be noted that it is also impossible to predict the progression of the dysplasia of the uterine neck by the histological method of the study. The most informative method is the histology of the drug, carried out as a result of conization with scraping of the cervical canal.

Differential diagnosis

Moderate dysplasia of the cervix requires the behavior of differential diagnosis with other pathologies and female diseases.

Differential diagnosis of dysplasia, in particular, is carried out with true erosion of the cervix and a cancerous tumor. So, with erosion, the mucosal layer is destroyed under the influence of certain factors. The growth of a cancerous tumor is associated with the growth of atypical cells in tissues.

Differential diagnosis of dysplasia is also performed with cervicitis, dystrophic processes, leukoplakia without atypia, decidual tissue during pregnancy. In this regard, the establishment of an accurate diagnosis requires the consultation of other medical specialists, such as gynecologist-endocrinologist, oncogynecologist, immunologist, so that the doctor can determine the best treatment tactics.

Differential diagnosis of dysplasia is carried out with various diseases and pathological processes, such as:

• herpes cervicitis;
• syphilis;
• tuberculosis of the genital organs;
• protozoal and parasitic infections;
• venereal lymphogranuloma;
• sarcoidosis;
• cervical (cervical) ectopia;
• cervical polyps;
• micro-glandular hyperplasia;
• hyperkeratosis and parakeratosis;
• squamous cell papilloma;
• leiomyoma;
• cervical atrophy;
• papillary adenofibroma;
• endometriosis of the cervix, etc.

Pathological changes in the flat epithelium can cause various pathogens: the virus of the papilloma, the second type of herpes simplex, the causative agent of syphilis, etc. The isolation of the culture is considered the most effective method of diagnosing the pathological process and determining the type of pathogen.

Each type of pathogen specifically affects the cervical epithelium. For example, the causative agents of chlamydia or gonorrhea affect exclusively the cylindrical epithelium. Other pathogens can cause tumors (condylomas) and ulceration of different sizes on the surface of the uterine neck.

Symptomatic dysplasia is similar to the signs of trichomonas and herpes virus, in which there is abundant secretion of turbid mucus, and also the presence of atypical cells in the cytological smear.

Treatment of the moderate cervical dysplasia

Moderate dysplasia of the cervix requires a specific treatment strategy, which is determined by the severity of the disease. After setting the diagnosis, the doctor will choose the optimal treatment regimen aimed at maximizing the positive result.

Treatment of moderate dysplasia of the cervix is based on the achievements of world medicine in recent years. Patients under the age of 40 years are prescribed laser treatment, radio wave conization, and electroconisation. Women after forty are more preferable to conduct radio wave conies and electroconisation. For patients under the age of 23, treatment is not usually prescribed, especially if the pathology does not cover the cervical canal, or only pinpoint areas of cervical dysplasia are identified.

Often, the gynecologist is forced to choose expectant management to determine the most effective method of therapy. Sometimes with dysplasia of moderate severity, it is possible to do with restorative drugs, since in 70% of ill women pathology is cured independently. Mandatory treatment is necessary if the patient is diagnosed with HPV.

At a dysplasia of the second degree or a recurring pathology conservative preparations can be appointed or nominated:

• antibiotics and anti-inflammatory drugs;
• immunomodulators and interferon preparations;
• drugs (most often candles) to restore the structure of the epithelium of the cervix and the microflora of the vagina;
• vitamin complex preparations.

With prolonged detection of dysplasia after conducting multiple PAP tests, a woman is prescribed surgical treatment. The choice of the method of operation will depend on the severity of the disease. Young, nulliparous patients are most often prescribed surgery using a radio-knife or laser, as well as low-traumatic techniques in the form of multiple cryodestruction (the use of liquid nitrogen in the form of extreme cold for cauterization of altered cervical tissues) and electrocoagulation. Each of these treatments has its advantages and disadvantages, but it helps in more than 90% of cases.

Laser therapy and radio wave moxibustion are suitable for the treatment of dysplasia of all degrees and guarantee the absence of scars in 94-95% of cases.

Medications

Moderate dysplasia of the cervix requires treatment with medication. However, this disease can not be cured by some medications, - more radical measures, in particular, surgical intervention, will be needed here.

Medications are used before and after the manipulation to remove the altered areas during dysplasia. At the same time, it is necessary to carry out therapy aimed at excluding pathological conditions, due to which the disease developed. This, above all, concerns the papillomavirus infection, so the patient is prescribed a specific treatment for confirmation of the diagnosis. The same tactics are needed when determining the woman's other infections - Trichomonas, Chlamydia, etc.

The following medicines are used in the treatment of grade 2 dysplasia:

• Biologically active additives (Indinol) - contribute to the recovery of estrogens and the suppression of hyperplastic processes.
• Immunomodulators (Genferon, Viferon, Isoprinosin) - have antibacterial and immunomodulating action, promote rapid tissue healing, have analgesic effect, and also destroy papillomavirus and cytomegalovirus infection, genital herpes and other viruses.
• Vitamin Complexes.
• Antibiotics (with concomitant infectious diseases): Ceftriaxone, Azithromycin, Doxycycline.
• Terzhinan (eliminates the symptoms of vaginosis).
• Malavit (eliminates unpleasant symptoms in the form of itching, etc.).

Vaginal suppository is prescribed to normalize the microflora of the vagina, the destruction of bacteria, pathogenic microorganisms (Betadin, sea buckthorn candles, Livarol, Hexicon).

Alternative treatment

Moderate dysplasia of the cervix is not treated only by medication or alternative medicine. Complex therapy should be used, the primary role in which is the operation to remove atypical sites of the mucous neck.

Alternative treatment is only an auxiliary method and is used only after consulting with a gynecologist.

The patient is recommended rational nutrition, which includes the use of the following products: cabbage of all kinds, carrots, citrus fruits, tomatoes, legumes, peppers, dairy food. In addition, you should drink green tea more often, which helps restore epithelial cells.

You can use syringing (green tea + calendula - 1 spoon, brew 1 liter of boiling water) for a month. In the inflammatory process accompanying dysplasia, the baths with decoction of pine (5 tablespoons per 1 liter of boiling water) will help. Extract of the rhizome of badana, which has an astringent effect, can be purchased at the pharmacy and also used for syringing according to the instructions to the drug.

Tampons with propolis or sea-buckthorn oil accelerate the healing processes and have a general strengthening effect. The course of treatment is usually 10-20 days.

[27], [28], [29]

Herbal Treatment

Moderate dysplasia of the cervix requires a special approach to treatment. With regard to the use of herbs, this issue must be discussed with the attending physician, in no case avoiding self-medication.

Herbal treatment is not a basic therapy, but only additional measures that include the use of herbs with anti-inflammatory, astringent and wound-healing action.

Tamponing is one of the main techniques used in alternative therapy. You can use aloe juice by moistening the tampon and inserting it deeper into the vagina. This procedure is carried out twice a day for a month.

After surgical manipulations (cryodestruction, cauterization, conization), pine buds that are rich in ether compounds and have a good antibacterial effect can be used. A few tablespoons of raw materials must be poured into 1 liter of cold water and boiled for 5 minutes. After cooling, the broth is used for washing and syringing (2 rivers a day for 2 weeks).

Effective action has a decoction of the rod (Vitexagnus castus), which has a hemostatic property and normalizes the state of the hormonal system.

Decoction of the milk thistle and burdock root cleans the blood and promotes the activation of blood supply to the epithelial tissue. Raw materials in equal proportions (1 tbsp.) Should be poured with boiling water (250 g) and insist for 30 minutes. After this, drain and use in a warm form for irrigation twice a day.

Homeopathy

Moderate dysplasia of the cervix and the use of homeopathic remedies is a matter that requires clarification. It should be emphasized that homeopathic remedies are allowed as an auxiliary therapy, most often for the restoration of ovarian activity and support of immunity.

Homeopathy is an additional method of treating dysplasia if a patient has a papillomavirus infection. In this case, the drug Acidum nitrikum (promotes rapid healing of ulcerous and erosive surfaces) is shown.

Suppositories of Papillocaine with thuja extract are prescribed when HPV is detected, and the effect of Ovarium Compositum is directed to the normalization of the hormonal balance.

Ginekohel is one of the most popular homeopathic medicines, which reduces swelling of tissues, fights inflammatory processes and improves the state of the nervous system.

Lycopodium - a drug that activates the blood supply in the cervix, and also affects the processes of regeneration and metabolism.

The use of a homeopathic remedy should be accompanied by the recommendation of the attending physician, who will determine the dosage and duration of the course of treatment.

Operative treatment

Moderate dysplasia of the cervix requires surgical intervention, that is, carrying out manipulations aimed at removing damaged tissue.

Operative treatment is shown to the patient in the absence of inflammatory processes and is performed in the first (6-10 day) phase of the menstrual cycle. Analyzes that need to be done before surgery: a smear to determine the degree of purity of the vagina, a cytological smear, tests for STIs.

Operational methods of treatment of dysplasia of the ІІ st. The following:

• Diathermocoagulation (moxibustion / excision of a site of damaged tissue by electric current).
• Laser-polarization (impact on the damaged area by a low-intensity laser beam to destroy pathological tissues).
• Ultrasonic destruction.
• Cryotherapy (use of liquid nitrogen to destroy the pathological focus).
• The knife electroknification (removal of the conical section of the cervix) is carried out by a diathermocoagulator loop.
• Conization using a scalpel.
• Amputation of the cervix.

Restorative postoperative period lasts from 4 to 6 weeks. Contraindications to surgical treatment are: pregnancy, vaginal infections of the cervix, the presence of adenocarcinoma, inflammatory processes in the pelvic organs.

In the first days after the operation, women can experience painful sensations, abundant mucous discharge with blood, fever, irregular menstrual cycle. If bleeding occurs, seek medical attention immediately. There are complications in the form of relapse of the disease, exacerbation of chronic inflammatory processes, cicatricial scarring, infertility.

Prevention

Moderate dysplasia of the cervix is not yet a sentence, but it is easier to prevent the disease than to treat it.

Prevention of dysplasia, first of all, consists in a regular visit to the gynecologist's office (at least 1-2 rubles per year) and the delivery of a Pap smear. Vaccination is also considered an effective method of specific prevention of HPV.

Women should follow their intimate life, avoiding promiscuous sexual intercourse and using reliable barrier methods of contraception with frequent changes of sexual partners. Both partners, both women and men, should be examined before starting sexual intercourse to identify possible viral infections, trichomoniasis, chlamydia, and HPV. An important factor is smoking cessation, normalization of nutrition with the inclusion of vitamin complexes and folic acid.

The preventive method is also the sanation of infectious foci in the body. Loss of control over the state of women's health can lead to the development of dysplasia in cancer, even after treatment, because the disease can recur.

It is necessary to timely treat infectious and inflammatory diseases of the genital area and background diseases of the cervix, as in 90% of situations dysplasia develops against the already altered epithelium.

[30], [31], [32], [33]

Forecast

Moderate dysplasia of the cervix in most situations is completely cured.

The prognosis is determined by the timing and timeliness of diagnosing the disease, as well as the adequacy of the therapy. The frequency of the reverse development of the pathological process depends on the degree of its severity and the age of the woman: in young patients the regress of cervical dysplasia is more likely. Moderate dysplasia in 40-70% of cases may develop spontaneously after the treatment.

We can talk about a favorable prognosis for dysplasia, provided the virus HPV is completely removed from the body. Otherwise, if the immune system is rather weak, and attempts to diagnose and treat the disease have not been undertaken, dysplasia of the ІІ century. Goes into dysplasia of the third stage, and then (in more than 12% of cases) into invasive cancer.

Moderate dysplasia of the cervix is a serious issue, requiring a special approach to the solution. In complex treatment, the probability of cure is very high and reaches 90-100%. Complex therapy should include destructive methods and antiviral treatment. When detecting dysplasia 2-3 st. It is recommended to immediately begin therapy of both the pathology itself and predisposing factors.

[34], [35], [36]