Here's why women should still get a pap smear after menopause
“Your Pap test was irregular. We’d like you to come back in for a follow-up.”
It’s not a phone call any woman wants to get, but it’s not uncommon for women to get irregular Pap results after menopause.
Most irregular Pap results turn out to be relatively benign – maybe the doc didn’t get enough cells, or there’s some low-grade inflammation. But it’s worth remembering that rates of deaths from cervical cancer are down significantly over the past 40 years, due in large part to regular screenings, so it’s important to follow up.
Most women have had at least one Pap test, if not a couple dozen, but if you’re like us, you may not be entirely sure how necessary it is, how often we should do this (particularly as we age), or even what the doc is looking for in there.
What is a Pap test intended to look for?
Dr. Jessie: A Pap smear is a test every woman needs periodically. It is a test to look for abnormal cells of the cervix. It’s a pretty easy test, your doctor will simply place a speculum and swab your cervix with a small brush to collect a few cells. Frequently the sample from the Pap is also tested for HPV. HPV is a sexually transmitted virus that causes most abnormal Paps. A Pap is actually just a screening test, it gives your doctor information about whether or not you are at risk for abnormal cervical cells.
How often should a post-menopausal woman get a Pap test?
Dr. Jessie: How frequently a woman should get a Pap after menopause depends on her age and the results of her recent Pap tests. If a woman has had all normal Paps, she can stop getting Pap tests after the age of 65. Between the ages of 30 and 65 the frequency of Paps depends on the result of her Pap and HPV testing. If the HPV test is negative and the Pap is normal, screening every 3 years is completely appropriate.
What qualifies as “irregular”? What is my doc seeing?
Dr. Jessie: An irregular Pap is actually something a pathologist finds when she looks at the cells from the Pap. It is not something your doctor finds during the exam. When the pathologist looks at the cells, they are looking for anything that could be a sign of abnormal cells of the cervix.
What could be happening in my body that would result in an irregular Pap test?
Dr. Jessie: There are a couple of possibilities as far as irregular Paps go, especially after menopause. In some cases, there is HPV that is causing actual abnormal cells in the cervix. In other cases, after menopause, thinning of the vaginal and cervical tissue or inflammation in the vagina or cervix related to thinning of those tissues can make the cells on the Pap appear to be abnormal. It will be impossible for your doctor to know which of these scenarios are the case without further testing.
I was told my Pap test was irregular. What happens next?
Dr. Jessie: If your Pap screening test winds up abnormal, it is important to schedule diagnostic testing. The diagnostic test for an abnormal Pap is called a colposcopy. During this procedure, your doctor places a speculum in order to visualize your cervix and coats your cervix in a dilute vinegar solution. Your doctor will then look through a magnifier to look for any areas highlighted by the vinegar. If any possible abnormal areas are found, your doctor will do biopsies of your cervix. This may include biopsies of the external cervix or sampling of the internal cervix. This process can be a little crampy but is generally pretty quick.
How long can I wait before scheduling a follow up?
Dr. Jessie: I usually recommend having your follow up appointment within 1-2 months after your abnormal Pap smear.
I get “false” irregular results often – when can I stop having follow-up procedures?
Dr. Jessie: Some women do get false irregular results after menopause. If this happens many times, you and your doctor may want to discuss how and when to do follow up. Depending on the findings and your risk factors, the colposcopies may be able to be performed less often than yearly.
On the other hand, it is always possible that there are actually abnormal cells there, so this needs to be a very careful discussion. In some cases, when the abnormal Pap is thought to be related to atrophy or thinning of the tissues after menopause, a woman can use vaginal estrogen for a couple of weeks prior to her annual exam and Pap, which can normalize the Pap.
I have a teenage daughter. What are your thoughts on the HPV vaccine?
Dr. Jessie: DEFINITELY do get your daughter (and son) the HPV vaccine. The vaccine is FDA-approved for girls and boys between the ages of 9 and 26. It is worth getting your daughter vaccinated to decrease her chances of needing a colposcopy or other procedures on her cervix. Men are carriers of the virus, so vaccinating your son is also a great idea!
Birth control pills don’t cause cervical cancer or HPV; why is my prescription dependent on getting a Pap test?
Ok, good question, this is a common misconception. Actually, your prescription for your pills is not dependent on your Pap, but on your coming in for your annual exam. The Pap is one small part of this yearly appointment.
When you come for your exam, your doctor gets updated by you on any health changes, surgeries and changes to your family’s health throughout the year as well as determining what cancer screening testing is appropriate. The screening that she is tracking includes the Pap smear, but she also determines if you are up-to-date on your mammogram, are you due for a colonoscopy, etc. She also does an exam, which may or may not include a Pap smear.
Getting this information is vital to your health in many cases. I have, more than once, had someone come in for their yearly and found that they were recently diagnosed with a new medical problem and shouldn’t be on birth control pills. Had I just continued to prescribe the pills without seeing the patient, she may have been at risk for complications related to the pill.
Now that many women use long-acting forms of birth control or need Paps only every 3-5 years, some women are skipping their yearly exams. I don’t recommend this. Even if a pap or a refill isn’t needed, having an annual is important so your doctor can continue to keep track of what screening is necessary and when, stay updated on any new issues and do a thorough exam to look for any changes in your body that need to be addressed.
Can menopause cause an irregular Pap result?
Dr. Jessie: Yes! After menopause a woman’s estrogen levels decrease to very low levels. The vaginal tissues are affected by estrogen. Thinning of the tissues can make the cells appear abnormal on a Pap. The colposcopy will help determine the difference between actual abnormal cells and cells that appear abnormal because of thinning of the tissues.
Beating cervical cancer before it starts
While the death rates from cervical cancer have declined, that doesn’t mean incidences of the disease are radically fewer – in fact, as the US population ages, the number of cancer diagnoses generally has actually increased. Pap tests can detect changes that could lead to cancer before the disease develops, making it a very effective preventative tool. And, as more and more young people are vaccinated against HPV, rates of cervical cancer should continue to decline.
What is your experience with Pap tests? If you’ve had an “irregular” result that caught cancer early or before it became cancer, we would very much like to share your story. You can respond to us at email@example.com, and we guarantee to protect your privacy, if you prefer. Or you can share with the community by leaving us a comment below, or talking to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.
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