Cervical Screening in Menopausal Women: What You Need to Know

Cervical screening, also known as a smear test in the UK, is a vital part of women’s health care, helping to prevent cervical cancer by identifying abnormal cells in the cervix. However, for women going through menopause, there are often questions about whether screening is still necessary, how menopause affects the process, and whether their risk of cervical cancer increases.

This article provides a comprehensive guide to cervical screening during and after menopause, offering clarity and addressing common concerns.

Does Cervical Screening Stop After Menopause?

In the UK, cervical screening is routinely offered to women aged 25 to 64. The frequency depends on age:

• Ages 25 to 49: Every 3 years

• Ages 50 to 64: Every 5 years

Once you turn 65, screening is usually no longer required unless you have had recent abnormal test results or were not screened when invited previously. Post-menopausal women who have never been screened should consider having a test even if they are over 65.

For women who have undergone a total hysterectomy (removal of the uterus and cervix), screening may no longer be necessary, though your doctor will advise based on your medical history.

Does Menopause Increase the Risk of Cervical Cancer?

Menopause itself does not directly increase the risk of cervical cancer. However, the risks associated with cervical cancer are influenced by:

• Persistent Human Papillomavirus (HPV) Infection: HPV is the leading cause of cervical cancer. Women who have had HPV in the past are still at risk, as the virus can remain dormant for years.

• Weakened Immune Response: Ageing can reduce immune function, making it harder for the body to clear HPV.

• Hormonal Changes: While the link is unclear, oestrogen reduction during menopause might contribute to changes in the cervical and vaginal tissues, potentially affecting the body’s response to abnormal cells.

Challenges of Cervical Screening After Menopause

Menopause can make cervical screening more uncomfortable for some women. Common issues include:

Vaginal Dryness: Reduced oestrogen levels can lead to thinning and dryness of the vaginal walls, making the insertion of the speculum uncomfortable.

Solution: Using vaginal oestrogen creams or lubricants before the test can help.

Atrophic Changes: The cervix may shrink slightly after menopause, which can make it harder to collect adequate cells. This is why it is essential for healthcare providers to use smaller speculums or adapt their technique for menopausal women.

Fear or Anxiety: Many women feel embarrassed or anxious about the procedure, especially if they’ve experienced discomfort during previous screenings. Openly discussing these concerns with your healthcare provider can help ensure a more comfortable experience.

The Importance of Continuing Screening

Cervical cancer is often slow-growing, and many cases are preventable with early detection. Continuing regular screening during menopause ensures that:

• Precancerous Changes Are Detected Early: Abnormal cells can be treated before they develop into cancer.

• You Stay Aware of HPV Risks: Even if you are no longer sexually active, HPV can persist for years and still pose a risk.

When Should You Speak to Your GP?

You should speak to your doctor if:

• You’ve experienced unusual bleeding (e.g., postmenopausal bleeding, spotting, or blood-stained discharge).

• You’ve missed a cervical screening appointment or are overdue for one.

• You have symptoms such as pelvic pain, pain during intercourse, or unusual vaginal discharge.

HPV Vaccination and Menopause

The introduction of the HPV vaccine has significantly reduced cervical cancer rates in younger generations. However, most women over 40 were not eligible for the vaccine during their youth. If you were not vaccinated, regular cervical screening remains your primary protection against cervical cancer.

Key Takeaways

• Screening Doesn’t Stop at Menopause: Women should continue attending cervical screening until age 65 unless advised otherwise.

• Menopause Can Affect the Process: Vaginal dryness and atrophic changes can make the test more challenging but not impossible. Please check out our recommended intimate oils if you suffer.

• Cervical Cancer Risk: While menopause itself doesn’t increase cervical cancer risk, age-related factors such as persistent HPV infection can.

• Regular Screenings Save Lives: Ensuring you attend all your appointments is the best way to detect any issues early.

If you are concerned about cervical screening during menopause, don’t hesitate to contact your GP for advice. With the right support and preparation, the procedure can be straightforward and stress-free.

References

NHS UK. Cervical Screening Overview.

Cancer Research UK. Cervical Cancer Risks and Prevention.

Menopause Matters. Vaginal Health and Menopause.

If you’d like further information or support, organisations like Jo’s Cervical Cancer Trust and Menopause Matters provide tailored advice for women navigating both menopause and cervical screening.