Impact of Menopausal Status on HPV Detection and Cervical Neoplasia in Senegalese Women

Hormonal and immunologic changes related to menopause may play a role in the detection of human papillomavirus (HPV) and cervical neoplasia, yet this relationship has not been examined in populations in West Africa, 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 detection and cervical neoplasia detection in Senegalese women aged 40 to 60. We conducted a secondary analysis of pooled data from three prospective cervical cancer studies conducted in Dakar, Senegal, between 1998 and 2011. Participants had known menopausal status and a satisfactory HPV test (N = 3,118) and/or Pap smear (N = 2,907). Participants with invasive cervical cancer or who were pregnant were excluded. Multivariable logistic regression and generalized estimating equations were used to estimate adjusted odds ratios and 95% confidence intervals, adjusting for age and number of prior pregnancies. Postmenopausal women had significantly higher odds of HPV detection (OR = 1.68; 95% CI: 1.36, 2.08), including both high-risk (OR = 2.06; 95% CI: 1.60, 2.19) and low-risk types (OR = 1.83; 95% CI: 1.40, 2.38). Odds of cervical neoplasia were also elevated among postmenopausal women (OR = 1.65; 95% CI: 1.19, 2.27), with increased odds for both high-grade (OR = 1.72; 95% CI: 1.09, 2.71) and low-grade lesions (OR = 1.59; 95% CI: 1.03, 2.45). These findings suggest menopause may contribute to HPV persistence or reactivation and the development of cervical neoplasia, independent of age. Given that HPV screening and vaccination coverage remain limited in Senegal, expanding screening to include postmenopausal women could improve detection and prevention of cervical cancer in this group. Our results highlight the importance of continued surveillance for HPV and cervical neoplasia among older women, particularly in low-resource settings where cervical cancer burden remains disproportionately high.