This study was conducted to determine whether advancing age is an independent predictor of increased risk ofhigh-grade pathologies among women referred for colposcopy after abnormal cervical cytology. Medical recordswere reviewed for women with abnormal cervical cytology who underwent colposcopy at Khon Kaen UniversityHospital. Logistic regression was used to determine the independent impact of age on the risk of high-gradepathologies. Mean age of the women was 42.8 years. Of 482 women, 97 (20.1%) were postmenopausal, and 92(19.1%) were nulliparous. The rate of high-grade pathologies included cervical intraepithelial neoplasia 2-3, 99(20.5%), adenocarcinoma in situ, 4 (0.8%), cervical cancer, 30 (6.2%), and endometrial cancer, 1 (0.2%). Theprevalence of significant lesions was 26.9% (95% CI, 23.1%-31.2%). In total, 31 women had cancers (6.4%; 95%CI, 4.4%-9.0%). When controlling for smear types and parity, age was noted to be a significant independentpredictor of high-grade histopathology. Women older than 35-40 years were approximately 2 times as likelyto have severe histopathology as the younger women. This study illustrates the substantial risk of underlyingsignificant lesions especially invasive cancer in Thai women with abnormal cervical cytology. Age was a significantindependent factor predicting the risk of high-grade pathologies.