Guidelines for Women with a Hysterectomy

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Guidelines for women with a hysterectomy SITUATION GUIDELINE Sub-total hysterectomy Routine screening as per NCSP guidelines (uterus removed but all or part of the cervix remains) Total hysterectomy for Further screening (i.e. a vaginal vault smear) is not required benign reasons + previous negative smear history Total hysterectomy for One baseline vaginal vault smear required: benign reasons + Unknown If result normal no further vaginal vault smears smear history required If result abnormal screen as per NCSP guidelines Total hysterectomy + Either of the following approaches could be used: previous CIN1 1. The NCSP recommends that women with histological evidence of CIN1 at any time in the past should have 3-yearly vault smears until age 70 years1. 2. The RANZCOG provides the advice that women with previous smear or cervical biopsy with a low-grade lesion that had reverted to normal cervical cytology prior to hysterectomy do not need vaginal vault smears unless they are symptomatic2. Total hysterectomy + Guidelines for a high-grade abnormality apply, that is annual previous CIN2 or CIN3 vaginal vault smears until age 70 years. Test of Cure pathway However, subsequent to two consecutive vaginal vault smears and HPV tests 12 months apart, and both are negative, vault smears are required every 3 years until age 70 years3. Total hysterectomy for If the woman has had a total hysterectomy (i.e. there is no benign reasons + remaining cervical tissue), and where there has been no previous immunocompromised abnormality, continue with 3-yearly vaginal vault smears until age 70 years. If the woman has had any previous abnormality, annual vault smears are required. Total hysterectomy for The NCSP guidelines no longer apply as these women are under genital malignancy ongoing surveillance by an oncologist who will be providing advice on appropriate surveillance and care. 1 Ministry of Health, 2008. Guidelines for Cervical Screening in New Zealand, page 40 2 RANZCOG, 2007. Pap Smears after Hysterectomy, as cited in Ministry of Health, 2008. Guidelines for Cervical Screening in New Zealand, page 40. 3 Ministry of Health, 2008. NCSP Best Practice Guidance on HPV Testing, as cited in Ministry of Health, 2008. Guidelines for Cervical Screening in New Zealand, page 41. February 2015 .

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