I hear this all the time in the clinic, patients will ask me if they still need to get PAP smears now that they have gone through

Does she need a PAP?

menopause.

Yes! It is extremely important to continue to monitor for cervical cancer, although maybe not as often as younger years.

What is one of the risk factors for any sort of cancer?

Age. As we get older, the negative forces on our bodies will wear our body systems down and eventually the immune system may not be able to suppress the causes of cancer.

In relation to the cervix, the most important cause is the HPV virus.

The HPV virus is felt to be the main cause of cervical cancer as certain strains cause inflammation and cellular damage, which can result in cellular atypia (a type of inflammation). Cellular atypia can then progress to cancer. Not all women who have the HPV virus get cervical cancer,  and not all women are aware they have ever been exposed to HPV.  The HPV virus is transmitted through sexual intercourse and can remain dormant for many years, even decades. So unless a couple has only had sexual relations with each other, exposure can happen unknowingly from past partners.

So why does this matter during menopause? Menopause is considered a period of time during which the immune system is compromised. This can allow a dormant HPV virus to become active and cause inflammation and irritation. And this is the guiding reason for continuing PAP smears after menopause.

The American College of Gynecologists (ACOG) has put forth guidelines for frequency of PAP smears. Women over 30 who have had 3 normal PAP smears in a row can decrease frequency of screening to every 3 years. Many specialists feel that one of these normal readings should include a negative HPV test.  And, if your sexual partner changes, you may need to resume yearly PAP smears for a while. Certain risk factors would dictate continuing with yearly PAP’s. These would include HIV infection, other causes of immuno-compromise (anything that decreases immunity like chemotherapy), exposure to DES in utero( DES is a hormone given to pregnant women in the past), prior treatment for CIN2 or CIN3. CIN stands for cervical intraepethelial neoplasia – (inflammatory changes in the cells of the cervix as seen on pap smear – some are pre-cancerous and some are early cancer).

When Can  I Stop  PAP Smears?

As recommended by ACOG, women can stop screening at age 65-70 if they have had 3 or more normal PAP and no abnormal test in past 10 years. HPV vaccinated women are encouraged to follow these same guidelines.

Cervical cancer rates have fallen by 50% in the last 30 years thanks to vigilant screening . Don’t treat this easy screening test casually, or think it is not important - continue with your screening!

Anne V. PAC

What questions do you have? I can’t tell you what to do but I can help you understand this information better so you can communicate with your doctor more clearly. Leave me a comment. Let me know what you think. And do sign up for the content I have prepared as part of your free membership.