To Your Health

After my last Pap test, which came out mildly abnormal, I "spotted" for several days. My doctor's nurse told me not to worry and I finally did have a normal menstrual period. Why would that happen, and is it worrisome?

Q. After my last Pap test, which came out mildly abnormal, I "spotted" for several days. My doctor's nurse told me not to worry and I finally did have a normal menstrual period. Why would that happen, and is it worrisome?

A. There are several possible explanations, and you should mention your experience to your physician at your next visit. As his nurse indicated to you, it probably does not warrant immediate action. You should certainly continue to have the Pap test regularly. This test, named for its inventor, Dr. George Papanicolaou, has saved thousands of lives in the 50 years it has been in use.

From this limited information, the best explanation for all that you describe would be vitamin C deficiency. Notions of vitamin C requirements have changed a lot in the past decade or so, and it appears that we need a lot more than what is required simply to prevent the symptoms of scurvy. Estimates of the minimum daily vitamin C requirement have risen from about 15 milligrams (mg) per day to over 100 mg per day, with some recommending a minimum of 500 mg per day. These amounts are not easily obtained from the typical American diet.

There are a couple of reasons for suspecting vitamin C deficiency, and your positive Pap test is one of them. Several years ago the plasma vitamin C level of women with an abnormal Pap test was found to be, on average, only about half that of women with a normal test. Also, the spotting could easily be due to poor wound healing at the site of the biopsy. A very recent study of patients with bleeding problems following surgery found that a vitamin C supplement (between 250 and 1,000 mg per day) stopped the bleeding within 24 hours. The condition of some of these patients was so serious that they were requiring blood transfusions, so it is impressive when something as simple as a vitamin C supplement can eliminate a risky procedure such as a blood transfusion.

Even patients who were not judged to be deficient in vitamin C have experienced improvement in wound healing when supplemented with vitamin C using amounts as high as 3,000 mg per day. Ulcers and surgical wounds are also found to heal better and even genetically impaired collagen synthesis improves with vitamin C supplements in this range. Vitamin C supplements can provoke diarrhea, abdominal gas, bloating, or cramping in about 15% of people taking such a high dose, but a change from an ascorbic acid form of vitamin C to a mineral ascorbate form such as calcium ascorbate will usually solve this problem. These "buffered" forms of vitamin C are less acidic and less likely to cause gastric irritation.

A second vitamin to consider supplementing is folic acid. Deficiency is closely associated with a positive Pap test and to a lesser extent with poor wound healing. Folic acid deficiency is common among American women, possibly because we as a nation are faulty about consumption of fresh raw foods, which are our richest sources of folic acid. Because of the relationship of folic acid deficiency to some birth defects, a folic acid supplement is now recommended for all women of childbearing age.

Vitamin E deficiency is also capable of producing the problems you describe, a positive Pap test and slow wound healing, although it is statistically about half as likely as vitamin C or folic acid deficiency to be the root of the problem. Still, this possibility should not be ignored.

The good news is that there is easy and safe nutritional relief for both the problems you have experienced, remedies that may have additional benefits besides those you would expect.

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