Pap smears, also called pap tests, will likely remain a necessary part of your healthcare routine after menopause.
Pap smears help track the overall health of your cervix. If cells with an abnormal growth pattern are detected, it could be an early sign of cervical cancer.
Most (not all) forms of cervical cancer are caused by the human papillomavirus (HPV). HPV can lie dormant in the body for weeks, months, or even years before it’s detected.
That means you could be at risk for cervical cancer well after the initial date of infection, even postmenopause.
Everyone with a cervix should get routine pap smears and/or HPV tests until age 65.
Your specific screening schedule after menopause will depend on whether you:
- were vaccinated against HPV as an adolescent or young adult
- use condoms or other barrier methods during partnered sexual activity
- take immunosuppressant medications
- have ever vaped nicotine, smoked cigarettes, or used other tobacco products
- have a family history of cervical cancer, or have a weakened immune system
After menopause, your clinician may recommend extending the time between pap smears or stopping them entirely if you meet two conditions.
- don’t have a personal or family history of cervical cancer OR
- were vaccinated against HPV as an adolescent or young adult OR
- have had a hysterectomy
And have had at least:
- 3 consecutive negative pap smear results
- 2 consecutive negative co-test results
- 2 consecutive negative HPV test results
If you have a personal history of precancerous cells or cervical cancer, you may be able to discontinue screening after 20 years have passed since surgery to remove abnormal cells or growths.
A typical screening schedule is as follows:
- pap smear every 3 years OR
- pap smear and HPV test (called a co-test) every 5 years OR
- HPV test every 5 years
Although these guidelines start to relax after age 65, they don’t go away entirely.
Many doctors and other healthcare professionals recommend getting pap smears and/or HPV tests every 5 years until you consistently receive a negative result.
Screening is especially important for folks who have more than one sexual partner and do not consistently use condoms or other barrier methods.
As the hormones estrogen and progesterone gradually decrease, the vaginal canal may become drier and less elastic.
This can make a speculum feel more like the jaws of life than a standard medical tool — but pain or discomfort shouldn’t be the new standard.
Here are a few things you can do to make your exam more comfortable:
- Choose your clothes wisely: Wearing easily accessible clothing, like a loose dress, so you don’t have to undress all the way may help alleviate stress and anxiety.
- Use a vaginal moisturizer: Not lubricant, a vaginal moisturizer. The main difference is that moisturizers are meant to be used regularly, and lubes should only be used during sexual activity. Vaginal moisturizers can be purchased over the counter, but prescription versions are available and can be requested from a primary care physician.
- Request additional lubricant on the speculum: This will make insertion more comfortable. You can never have too much lube! Be mindful of your own allergies and request the best type of lube for your body.
- Request a smaller speculum: Yep, you heard it here. Larger than larger isn’t the only size option. Ask your clinician to use a smaller speculum until you find one that feels the most comfortable to you. You can also try lying in a different position, or request to insert the speculum yourself.
Remember, this is your appointment. Your health and comfort are always the priority.
If you haven’t already, you may consider starting hormone replacement therapy (HRT). HRT helps boost estrogen and progesterone in the body with a daily pill, patch, gel, or cream, which can lessen the symptoms of menopause.
HRT isn’t a quick, day-of solution to manage pelvic discomfort, but it can be beneficial in the long run. You may find that future pelvic exams or pap smears are more comfortable due to hormone levels remaining balanced.
Some strains of HPV can produce warts on the skin. This includes:
Most HPV strains do not cause symptoms. Abnormal cells quietly spread to healthy tissue, which can become cancerous if left untreated.
Symptoms commonly linked to cervical cancer include:
- persistent pelvic, abdominal, or back pain
- unusual vaginal discharge
- pain during or after vaginal penetration
- bleeding after vaginal penetration
If you experience any of these symptoms, consult with a doctor or other healthcare professional as soon as possible.
They can determine if your symptoms are the result of HPV or another STI, an early sign of cervical cancer, or due to another underlying condition.
Early detection and treatment of any health condition are key to preventing further complications.
HPV is transmitted through intimate skin-to-skin contact. Although using condoms and other can help reduce the risk of transmission, they don’t eliminate it entirely.
That’s why it’s so important to talk with your partner(s) about STI status — yours, theirs, and that of any other sexual partners you each have.
If you have a sexual partner with a penis, and they have or have had other sexual partners with a vagina, be sure to ask about their past partners’ HPV status.
There currently isn’t a way to test for HPV in people with penises, so knowing the status of their past partners can help you make informed decisions about sexual activity and safer sex practices.
If you have a current or past HPV diagnosis, it’s possible to contract other HPV strains. Practicing safer sex can help reduce your risk of contracting a new strain or transmitting the strain you have to others.
Limit or avoid vaping, smoking, or ingesting nicotine and tobacco products. This can help reduce your risk of developing several different cancers, including cervical cancer.
If you have a family history of cervical cancer, you may benefit from more frequent screening. Talk with a doctor or other healthcare professional to develop a screening schedule that fits your needs.
You could be at risk of developing cervical cancer, even after menopause.
Regular screenings allow your clinician to keep a catalog of the cells on the cervix. If a change is detected, they can act swiftly before any abnormal cells spread to healthy tissue.
Pap smears are the best way to monitor for these changes. You should continue to get pap smears after menopause unless a doctor or other healthcare professional has advised you to stop.
Catasha Gordon is a sexuality educator from Spencer, Oklahoma. She’s the owner and founder of Expression Over Repression, a company built around sexual expression and knowledge. You can typically find her creating sex education materials or building some kinky hardware in a fresh set of coffin nails. She enjoys catfish (tail on), gardening, eating off her husband’s plate, and Beyoncé. Follow her everywhere.