Cervical Ectropion
Cervical ectropion is a benign gynaecological finding characterised by the presence of glandular columnar epithelium on the ectocervix, where it is normally covered by non-glandular stratified squamous epithelium.
This updated UKMLA guide to cervical ectropion covers causes and risk factors, symptoms, diagnosis and management of cervical ectropion.
Histology
Normal cervical histology:
| Region | Normal epithelium |
|---|---|
| Endocervix (endocervical canal) | Glandular columnar epithelium |
| Ectocervix | Non-keratinised stratified squamous epithelium |
In cervical ectropion:
- Glandular columnar epithelium (normally lines the endocervix), becomes visible on the ectocervix (which is normally squamous)
Causes and Risk Factors
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
Clinical Features
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
Red Flags and Referral Criteria
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.
Investigation and Diagnosis
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
Other investigations to exclude other causes:
- If there is purulent vaginal discharge → vaginal swabs
- NAAT to test for chlamydia and gonorrhoea
- If CIN cannot be ruled out on macroscopic visualisation → consider pap smear, colposcopy, biopsy
Management
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
References