Cervical cancer is the fourth most common cancer and accounts for 2% of all new female cancer cases in the UK, with over 3000 people being diagnosed each year.
The majority of cervical cancer cases are caused by the Human Papilloma Virus (HPV) but 99.8% of cases are preventable and it is highly curable if caught early.
The main ways to prevent cervical cancer are having the HPV vaccination (introduced in 2008 and typically given to girls aged 12-13) and attending routine cervical screenings.
Cervical screenings (previously known as smear tests) are estimated to prevent up to 3900 cases of cervical cancer and save 4500 lives each year but despite this, only 68.7% of eligible people have them.
With cases of cervical cancer estimated to rise by 60% in the next two decades in women over 50, cervical smear tests are an important component of looking after your health in menopause and beyond.
What is a cervical screening?
Cervical Screening (previously known as a cervical smear test) is a routine screening procedure designed to detect for the HPV virus and early signs of abnormalities in the cells of the cervix and help prevent cervical cancer. The cervix is the opening of the womb that connects to the vagina.
Why is it important?
The purpose of cervical screening is to identify the presence of high-risk human papillomavirus (HPV), which in some cases, can cause abnormal changes in the cells of the cervix that could lead to cervical cancer. Early detection allows for timely intervention and treatment, reducing the risk of developing cervical cancer.
When should I have a cervical smear test?
Cervical smear tests are recommended for women aged between 25 and 64. It is advised every three years for women aged 25 to 49 and every five years for women aged 50 to 64. Everyone in this age range should go for cervical screening.
Women who have had a total hysterectomy, including the removal of their cervix, do not require cervical smear tests. Some women undergo a subtotal hysterectomy, where the cervix is left in place. These women should continue to have routine smear tests.
Smear tests are not used to investigate abnormal bleeding. If this occurs (for example bleeding in between periods or after sex, you should see your GP to be investigated further.
What happens during the test?
During the test, a healthcare professional will gently collect a sample of cells from your cervix using a small brush or spatula. The procedure is usually quick and may cause mild discomfort but is not usually painful.
The entire process of a cervical smear test usually only takes a few minutes and involves the following:
- You’ll be asked to undress from the waist down. A sheet or cover will be provided for modesty.
- You’ll lie on an examination table and with your feet together, flat on the bed, you’ll be asked to let your knees fall apart. This helps the nurse access the cervix easily.
- The nurse will gently insert a speculum into your vagina. This device helps to hold the vaginal walls open, allowing a clear view of the cervix. You may feel some pressure but shouldn’t feel pain.
- A small, soft brush or spatula is used to gently collect cells from the cervix. This usually takes a few seconds and may feel a little ticklish or uncomfortable but not painful.
- The speculum is removed carefully, and you can get dressed.
- The nurse will explain when you are likely to get your results.
If possible, you should arrange the test for when you are not menstruating and avoid using vaginal creams, foams or medications for at least 48 hours before the test.
If previous smear tests have been painful, you might want to take vaginal oestrogen nightly for two weeks prior to your smear.
What happens after the test?
You may experience light spotting or mild discomfort after the test, but this is normal and usually resolves quickly. Your sample will be sent to a laboratory for analysis, and you will be informed of the results.
If your test is negative for HPV, nothing further will happen. You’ll be invited back for your next screening in three or five years.
The laboratory will test your sample for cell changes if positive for HPV. If there are cell changes, you’ll be invited for a colposcopy, where your cervix is examined closely. If there are no cell changes, you’ll be invited for your next cervical smear test after one year instead of three or five years.
Occasionally the results come back saying the sample is ‘inadequate’ meaning that it needs to be repeated as they have not got enough samples.
Smear tests and menopause
The decline in hormones that occurs during menopause can result in vaginal changes. Low levels of oestrogen (and testosterone) can make vaginal tissue thinner, drier, less elastic and more fragile. This can make having any sort of vaginal examination uncomfortable or even painful.
However, you shouldn’t let the worry of a cervical smear test being painful prevent you from having it done. Instead, there are some steps you can take to make the process more comfortable.
Learn more about vaginal changes during menopause.
Do I need a smear test after menopause?
After menopause, women should continue to have regular cervical smear tests, as and when they are invited to do so by the NHS screening programme. Although the likelihood of cervical cancer is highest in women aged 30-34, it can occur at any age. Between 2017 and 2019, there were over 1000 cases per 100,000 people aged 45 to 64 and around a tenth of new cases were in females aged 75 and over.
How often you have a smear test will depend on your age and medical history:
- Up to the age of 49, you’ll be invited for a screening every three years.
- Between the ages of 50 and 64, screenings will take place every five years.
- After 65, you'll only be asked to have a screening if a recent test was abnormal.
Painful smear tests after menopause
If after menopause, you find smear tests uncomfortable, painful or even unbearable, it might feel like the easiest option to just not have them. However, this can increase your risk of cervical cancer as should you have any abnormal cells in the cervix, they’ll go undetected.
Instead, there are several steps you can take to make the experience a more positive one:
Use vaginal oestrogen cream or pessaries
This form of hormone replacement therapy (HRT) can help improve vaginal tissue elasticity and reduce dryness by replenishing oestrogen locally. However, you should avoid using any in the 48 hours before your appointment.
Ask about a smaller speculum
Some people find the speculum being inserted the most uncomfortable part of a cervical smear test. A smaller speculum can reduce pressure and discomfort, particularly if vaginal tissues are thinner.
Use a lubricant
A water-based lubricant can ease the insertion of the speculum without affecting the quality of the cell sample. Talk to the nurse beforehand and ask if more can be applied to the speculum.
Empty your bladder
A full bladder can increase pressure in the pelvic area, making your smear test more uncomfortable so going to the toilet beforehand may help.
Relax your muscles
This may be easier said than done when you’re apprehensive but tensing your muscles can make inserting the speculum harder. Take slow, deep breaths and try to consciously relax your thighs and hips during the test.
Talk to the nurse
Healthcare professionals have experience in providing care to people with a variety of needs and concerns. Before your cervical smear test, talk to your nurse and explain you’re feeling anxious and have found previous tests painful. They can adapt the process to make it more comfortable for you.
Take pain relief beforehand
Over-the-counter painkillers like ibuprofen can reduce discomfort and inflammation. Take a dose about 30-60 minutes before your appointment.
Try a different position
You may find it more comfortable to lie on your side to have your screening done. Ask the nurse if this is possible.
Consider vaginal moisturisers
These are different from local oestrogens and don’t contain hormones. They aim to restore moisture in the vagina and alleviate dryness over time. Using them as part of your regular routine in the weeks leading up to your cervical smear test may make the process more comfortable.
Can menopause cause abnormal smear test results?
The changes that occur during menopause can make it harder to interpret cell changes leading to an abnormal cervical smear test result. Your cervical cells can experience changes that mimic precancerous conditions, even though they are not cancerous. Further testing can help determine whether an abnormal result is accurate. Whilst around 1 in 20 women will have a smear test result which is abnormal, only about 1 in 2000 will have cervical cancer.
What is a colposcopy?
A colposcopy is often recommended after an abnormal cervical smear result where changes to the cervical cells may be found secondary to high risk human papillomavirus (HPV), or after several inadequate cervical smear tests. It can also be used to investigate unusual vaginal bleeding.
This is a medical procedure used to closely examine the cervix for any abnormalities or signs of disease.
What to expect during a colposcopy
We suggest you schedule the procedure for when you are not menstruating. Avoid having sexual intercourse or using vaginal creams or pessaries in the 24 hours before your colposcopy.
You will lie on an examination table with your legs on a padded support. A speculum is inserted to open the vaginal walls, allowing the cervix to be visible. The colposcope is a microscope with a light attached which is used to examine the cervix. The doctor or nurse carrying out the procedure will put liquids on the cervix which will enable them to see any abnormal cervical cells. If any abnormal areas are identified, a small tissue sample known as a biopsy may be removed for further examination.
The procedure typically takes 15-20 minutes. You may feel slight pressure or discomfort, but don’t worry, a colposcopy is generally well-tolerated.
If abnormal cells are found during the procedure, you may be advised to have them removed to reduce your risk of cervical cancer. This can be done in two ways:
Large Loop Excision of the Transformation Zone (LLETZ): An injection of local anaesthetic is given to numb the cervix and a heated loop of wire is used to remove the tissue. The procedure takes about 15 minutes and is often carried out at the same time as the colposcopy.
Cone biopsy: If a larger area of tissue needs to be removed, a cone biopsy may be recommended. This is usually carried out under general anaesthetic and therefore involves a further appointment. A cone shaped section of tissue from the cervix is removed.
Following a colposcopy, you can expect the following:
- Your doctor or nurse will discuss the findings with you and how the results of any biopsy will be communicated to you. The results may take several weeks.
- You can resume normal activities after a colposcopy. If you have had a LLETZ or cone biopsy, you may be given some specific instructions
- You may have some mild pain for a few days and simple painkillers such as paracetamol can help with this.
- Your provider will recommend follow-up care based on the results.
- Complications are rare and you will be given information about these during your consultation. If you start to experience heavy bleeding, unpleasant smelly vaginal discharge or worsening pelvic pain you should seek medical advice.
Menopause is a natural life stage but that doesn’t mean that it won’t feel overwhelming or that you have to go through it alone. At Menopause Care, we have a team of specialists here to support you through it with evidence-based advice and tailored treatment plans that can help alleviate symptoms and empower you to make positive changes for your health and well-being. To discuss your unique experience of menopause, book a consultation with a menopause doctor.
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