How frequent should Pap smears be after menopause?

Reaching menopause is a defining moment in a woman’s life.  She is done having monthly menstrual cycles with her reproductive days behind her.  Does this also mean she is done having regular Pap smears by her gynecologist?  The answer to this can vary depending on who you ask but generally, pap smears are still recommended even for postmenopausal women.

Pap test screening guidelines

Pap test screening is designed to look for changes in the cells of the cervix indicating if there are any changes to the cervix or if it may show cervical cancer.  This test is the best tool for detecting pre-cancerous cells or conditions that can lead to cervical cancer.  The earlier cervical cancer is caught, the greater chance of a woman being cured.

According to the American College of Obstetricians and Gynecologists, here are the guidelines for cervical cancer screening or the Pap test:

·      If a woman is younger than 21 years of age she does not need screening

·      Women between the ages of 21-29 years should have a Pap test every 3 years

·      Women between the ages of 30-65 years should have a Pap test plus an HPV test every 5 years or a Pap test alone every 3 years

·      Women age 65 and older do not need screening if they have no history of cervical changes and either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the pat 5 years.

What about after menopause?

The average age of menopause is age 51.  With the average life expectancy for women in the United States at age 81, this is a long time to not be screened for cervical changes or cancer with the Pap test.  Therefore it is still recommended even after a woman has gone a full year without a menstrual cycle to continue to have Pap tests. 

There are some exceptions to this however.  Women who have had a total hysterectomy for a noncancerous condition with no prior history of precancerous Pap tests may be able to discontinue the test.  Also if a woman is not at a high risk for contracting human papilloma virus (HPV) and depending on her previous medical history, this can be a determining factor at play.  But ultimately, she needs to discuss this with either her primary care physician or her gynecologist to seek their professional opinion advising her in making the best decision.

Women between the ages of 65-70 may no longer need to be screened as long as they have had at least three normal Pap tests in a row and no abnormal Pap tests in the previous 10 years.

The basic recommendation for after menopause is a woman can get a Pap test every three years if the following are true for her:

·      Women who have had normal Pap test results for three years in a row

·      A woman has no prior history of precancerous Pap test result, no HIV infection, no weakened immune system, and no history of in utero exposure to diethylstilbestrol.

·      Women who have a higher risk of cancer may need a Pap test more frequently.

·      Pap tests can be discontinued if a woman has had a total hysterectomy unless the surgery was performed for cervical pre-invasive or invasive cancer or other uterine cancers.

Even if a postmenopausal woman meets the recommendations for only having Pap tests every three years, she should still be aware of symptoms that could indicate cancerous conditions of the cervix which include:

·      Abnormal bleeding after sexual intercourse or after menstrual cycles have stopped

·      Abnormal vaginal discharge

If any of the above symptoms are noticed, a woman needs to see her healthcare provider right away to get an accurate diagnosis. 

Dr. David B. Samadi is a Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY – 212-365-5000.  Follow Dr. Samadi at www.samadimd.com,  www.prostatecancer911.com, and www.roboticoncology.com.