Once one of the most fatal cancers among American women, cervical cancer deaths have dropped by more than half since the mid-1970s.1
Despite the positive regression, Bonafide Chief Medical Officer, Dr. Alyssa Dweck, cautions that women should avoid complacency—preventative screenings for cervical cancer are to thank for saving lives, including for menopausal women. Additionally, implementation of vaccinations for the human papillomavirus (HPV) can help protect against the most common cervical cancers.
In this article, Dr. Dweck provides us with the facts on cervical screening guidelines for menopausal women, the risk for cervical cancer after menopause, and more.
Cervical Screening Guidelines
Cervical screening guidelines may vary according to age, family medical history, and health status, but are generally recommended to all women as a part of optimal health care.
Screenings usually consist of cervical cytology, what we know as a Pap smear, which is a procedure during which a healthcare provider collects cells from the cervix to evaluate for abnormalities, precancerous or cancerous changes..2 Often, a Pap smear test will be combined with a test for high risk human papillomavirus—HPV— which is a common sexually-transmitted virus responsible for 99% of cervical cancers.3 There is also an additional and newly recognized screening test for cervical cancer which tests for HPV only – it’s available as an in-office or newly FDA approved at home swab test.4
HPV can remain dormant in the body, sometimes up to two years or beyond before detection, which means any woman with HPV is at risk for cervical cancer well after initial exposure– including after menopause.5
That’s why, according to Dr. Dweck, cervical cancer screenings are vital for women from young adulthood to menopause, and even, beyond. Medical history past cytology results, individual risk factors and tolerance should serve as more of a screening guide than a woman’s current and actual stage, she adds.
“In general, there are no differences in screening for cervical cancer during perimenopause or menopause,” says Dr. Dweck. “Guidelines continue to evolve and change; at present screening is typically based on medical history or Pap smear and HPV results from past exams and prior treatment – screening of some sort, is typically recommended for those aged 21-65, and in some cases beyond 65.”
Current general cervical screening guidelines include:6,7
- 20s – Women ages 21-29 should have a Pap test once every three years.
- 30s - Women aged 30 and older should have a Pap test alone once every three years, with HPV co-testing every five years, or HPV only testing every 5 years. There are of course individual nuances which may dictate otherwise, as recommended by one’s physician.
- 65+ - Women over the age of 65 who haven’t had a history of cervical abnormality may be advised to end screening.
There are exceptions to the above guidelines, however. Some women who have had a hysterectomy to remove the uterus and cervix may be advised that cervical cancer screening is no longer necessary. A healthcare provider can help determine the best course of action, and women should continue with routine testing unless advised otherwise by a medical professional.
More frequent cervical cancer screening may be recommended for those with the following risk factors:8,9
- A previous cervical cancer diagnosis
- Testing showing precancerous cells also termed dysplasia
- Exposure to a hormonal drug called diethylstilbestrol (DES) in utero
- HIV infection
- Immunocompromised
- Engaging in high-risk sexual behavior
- Having a high-risk sexual partner
Risk of Cervical Cancer after Menopause
While most cervical cancers are diagnosed in women between the ages of 35 and 44, the risk of cervical cancer after menopause still exists.10 In fact, more than 20% of cervical cancers are found in women over age 65—underscoring the importance of following screening guidelines versus age or menopausal status before ending cervical screening.11
Cervical cancer screening guidelines are ever-evolving, explains Dr. Dweck, and a healthcare provider who knows your medical history is the best go-to source on if, and how often, you should be screened.
“Screenings might include a Pap smear, an HPV test, or a combination of both at variable intervals,” she says. “Currently, the standard recommendation suggests that screenings continue until age 65. This applies to those who have been screened regularly in the past, have no high-risk factors and who have had normal results in past.”
In general, women should follow the guidelines established above unless otherwise directed by a healthcare provider who knows your current and past medical history.12 For most women 30 and older this means a Pap cytology test alone, once every three years, a Pap with HPV co-testing every five years or an HPV test alone every five years – but your provider will be able to offer the most accurate cervical cancer screening guidelines based on your unique health status and risk factors.
Do Pap Smears During Menopause Hurt?
According to Dr. Dweck, Pap smears may feel a bit different after menopause compared to pre-menopause. As the hormone estrogen decreases during this transitional time, the vaginal canal may become drier and less elastic, making for a potentially less comfortable exam.13
“Menopause can affect the genital tissue anatomically, since low estrogen can cause tissues to become atrophic,” says Dr. Dweck. “The cervical opening often becomes narrow and less accessible to obtain an adequate Pap smear during menopause. An evaluation of the cervix done with a speculum might be less comfortable since the vagina becomes narrowed and more delicate during this time.”
The procedure may lead to temporary discomfort, but fortunately there are a few ways to alleviate pain, like more routinely using a vaginal moisturizer .or requesting a lubricant be used during the procedure.14“A seasoned gynecologist would typically use a smaller, narrower instrument and take care to ensure a comfortable, trauma-less experience while maintaining specimen adequacy.” adds Dr. Dweck.”
Consult Your Healthcare Provider for Advice on Cervical Screenings During Menopause
Regular cervical screenings are an important part of staying healthy, even after menopause. If you have questions about whether or not you need cervical screening, it’s important to reach out to a primary care physician, gynecologist, or qualified healthcare professional who can advise the best course of action for you.
Resources
- https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html
- https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
- https://www.mountsinai.org/care/cancer/services/gynecologic/conditions/cervical/myths-facts
- https://www.contemporaryobgyn.net/view/fda-approves-teal-wand-for-at-home-cervical-cancer-screening?
- https://www.medicalnewstoday.com/articles/can-you-get-hpv-twice
- https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
- https://www.acog.org/womens-health/faqs/cervical-cancer-screening
- https://www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841
- https://www.cancer.org/cancer/types/cervical-cancer/causes-risks-prevention/risk-factors.html
- https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html#
- https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html#
- https://www.webmd.com/menopause/menopause-pap-smear
- https://www.healthline.com/health/menopause/pap-smear-after-menopause#tips-for-comfort
- https://www.healthline.com/health/menopause/pap-smear-after-menopause#tips-for-comfort
