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Do You Need A Smear Test After The Menopause

How Is Menopause Diagnosed

Do Women Need Pap Smears after Menopause?

There are several ways your healthcare provider can diagnose menopause. The first is discussing your menstrual cycle over the last year. If you have gone a full year without a period, you may be postmenopausal. Another way your provider can check if you are going through menopause is a blood test that checks your follicle stimulating hormone level. FSH is a hormone produced by the pituitary gland this gland is located at the base of your brain. However, this test can be misleading during the beginning of menopause when your body is transitioning and your hormone levels are fluctuating up and down. Hormone testing always need to be interpreted in the context of what is happening with the menstrual period.

For many women, a blood test is not necessary. If you are having the symptoms of menopause and your periods have been irregular, talk to your healthcare provider. Your provider may be able to diagnose menopause after your conversation.

General Recommendations For Ht

Current guidelines support the use of HT for the treatment of severe hot flashes that do not respond to non-hormonal therapies. General recommendations include:

  • HT may be started in women who have recently entered menopause.
  • HT should not be used in women who have started menopause many years ago.
  • Women should not take HT if they have risks for stroke, heart disease, blood clots, and breast cancer.
  • Currently, there is no consensus on how long HT should be used or at what age it should be discontinued. Treatment should be individualized for a woman√Ęs specific health profile.
  • HT should be used only for menopause symptom management, not for chronic disease prevention.

Initiating Therapy

Before starting HT, your doctor should give you a comprehensive physical exam and take your medical history to evaluate your risks for:

  • Heart disease
  • Osteoporosis
  • Breast cancer

While taking HT, you should have regular mammograms and pelvic exams and Pap smears. Current guidelines recommend that if HT is needed, it should be initiated around the time of menopause. Studies indicate that the risk of serious side effects is lower for women who use HT while in their 50s. Women who start HT past the age of 60 appear to have a higher risk for side effects such as heart attack, stroke, blood clots, or breast cancer. HT should be used with care in this age group.

Discontinuing Therapy

How Does Menopause Affect Bone Health

The older a person is, the greater their risk of osteoporosis. A persons risk becomes even greater when they go through menopause. When your estrogen level decreases during menopause, you lose more bone than your body can replace. This makes your bones weaker and more likely to break. To keep your bones strong, its important to get enough calcium and vitamin D in your diet. These help your body absorb calcium. Your doctor can suggest ways to get more calcium through food, drink, and, possibly, a calcium supplement. They may also suggest that you take a vitamin D supplement to help your body process calcium. Ask your doctor what amount of daily calcium and vitamin D is right for you.

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Can I Get A Pap Or Hpv Test If Ive Been Sexually Assaulted In The Past

Yes. If you were sexually assaulted or abused in the past, and this experience makes medical exams difficult for you, talk to your doctor or nurse first.

Before the test, while you are still fully clothed, tell your doctor or nurse that youve been assaulted in the past and that you have concerns about the test. It may be difficult to lie on an exam table with your legs in footrests or to have a doctor or nurse put a speculum into your vagina. Your doctor or nurse will talk with you about ways to make the Pap or HPV test easier.

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I Was Told My Pap Test Was Irregular What Happens Next

Pap Smears after Hysterectomy for Cancer

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.

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How Much Does The Test Cost

The cost of a Pap smear depends on where the test is taken and if you have insurance coverage. Costs of testing may include the office visit, the fee for the healthcare professional to conduct the Pap smear, and the actual laboratory analysis.

If your doctor recommends a Pap smear, these costs are typically covered by insurance, but, depending on your plan, you may be responsible for copays or a deductible. Your doctor and insurance plan can provide more specific information about your costs for a Pap smear. Local and federal health departments may offer financial assistance programs for Pap smears for people who dont have insurance.

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When Does Menopause Usually Happen

Menopause happens when you have gone 12 months in a row without a period. The average age of menopause in the United States is 52. The range for women is usually between 45 and 58. One way to tell when you might go through menopause is the age your mother went through it.

Menopause may happen earlier if you:

  • Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.
  • Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who dont smoke.

can also cause you to start menopause earlier.

Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries. Learn more about early menopause on our page.

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Do Women Need A Pap Smear After Menopause

Menopausal women, especially postmenopausal women often ask the question of their doctor or gynecologist, do I still need a pap need a pap smear after menopause? Its a question that can only be answered according to each individual womans prior medical history. The short answer is yes, menopausal women and postmenopausal women should continue to have a pap smear but their regularity must be advised by their doctor or gynecologist.

Pap screen testing should begin at age 21. Routine screening is recommended every two years for women 21-29 years old and every 2 to 3 years 30 years old and up. It is your best tool to detect pre-cancerous conditions that may lead to cervical cancer. If detected early, cervical cancer can be cured.

Even if you are menopausal or postmenopausal, you should continue to have Pap tests. Women who have had a total hysterectomy for benign reasons and have not had a previous history of precancerous Pap tests can stop Pap smear screening. Screening may be discontinued at 70 years of age if women have had no abnormal Pap tests in the previous 10 years.

You may have a Pap test every three years if you have no past history of a precancerous Pap test result, no HIV infection, no weakened immune system, and negative HPV .

Women who have a higher risk of cancer may need a Pap test more often. Cervical cancer is NOT hereditary, so a family history does not make you higher risk for this disease. Your doctor can recommend what screening is best for you.

When Do I Need A Pap Smear


In the past, doctors recommended women undergo a Pap smear screening at every annual well-woman visit. However, new guidelines recommend individualized Pap smear screenings and/or human papillomavirus testing based on your risk of developing cervical cancer.

At Wellness for Women, the womens health experts recommend Pap smears based on age, risk factors, results of testing, and gynecological history:

  • Age 21 and younger: No Pap smear
  • Ages 21-29: Pap smear every three years and HPV testing pending results of Pap test
  • Ages 30-70: Pap smear and HPV test every 3-5 years, or Pap smear only every 3 years
  • Age 70 and over: No Pap smear needed, unless history of abnormal Pap test
  • After a hysterectomy: No Pap smear if history of negative HPV and Pap testing

However, you may need more frequent Pap smear screenings if you have a history of an abnormal Pap smear, personal or family history of cervical cancer, HIV, or a weakened immune system.

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Beating Cervical Cancer Before It Starts

While the death rates from cervical cancer have declined, that doesnt mean incidences of the disease are radically fewer in fact, as the US population ages, the number of cancer diagnoses generally has actually increased. Cervix cancer 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.

Thank you to Dr. Jessie Marrs, ob/gyn at Swedish for her input.

What is your experience with Pap tests? If youve 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 , and we guarantee to protect your privacy, if you prefer. Or you canshare with the community by leaving us a comment below, or talking to us on our or in Midlife & Menopause Solutions, our closed Facebook group.

What Is The Doctor Looking For

Almost all cases of cervical cancer are caused by HPV, varieties of the human papillomavirus.

Often, for women aged 30 and above, Pap testing is done at the same time as HPV testing.

A cytologist will examine the cells to determine if there are any precancerous or cancerous cells.

Your doctor should receive the results within a few days and hell then be able to interpret them for you.

  • Negative/Normal: This shows that the cervix is healthy and all cells are the size and shape they should be.
  • Positive/Abnormal: An abnormal result points to cells that are not of the expected shape or size.

If the results indicate any kind of abnormal finding, this does not automatically mean you have cancer.

In this case, youll require follow-up tests in order to establish firmly what the problem is.

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Cervical Screening Without A Speculum: A Future Option For Older Women

In the UK, women are invited for cervical screening between the ages of 25 and 64, and although uptake is high it has been falling for some years across all age groups . A number of studies have focused on improving uptake among younger women , but a recent BMJ article called for work to focus on the needs of older women too, given that half of all cervical cancer deaths are in women over 50 . One particular issue for older women can be that screening becomes more painful following the menopause. Lower oestrogen levels can cause thinning and dryness of the vaginal walls and its estimated that half of all post-menopausal women have these symptoms. This can mean that inserting the speculum is particularly painful for some older women. Dr Anita Lim at Kings College London has been awarded funding by Cancer Research UK to explore a different procedure for collecting samples without a speculum. Samples collected without the speculum would be tested for human papillomavirus and women would only need to have further examination if they were found to be HPV positive.

  • Screening and Immunisations team. Cervical screening programme: England, 2016-17. Health and Social Care Information Centre, 2017, p. 1 76.
  • Kitchener HC et al. A cluster randomised trial of strategies to increase cervical screening uptake at first invitation . Health Technol Assess 2016, 20:1-138.
  • Sherman SM et al. Cervical cancer is not just a young womans disease. BMJ 2015, 350:h2729.
  • Screening Guidelines: When And How Often To Get Screened For Cervical Cancer

    Pap smear: What age and how often?

    Cervical screening recommendations have been developed by several organizations, including the United States Preventive Services Task Force , the American Cancer Society , and others.

    The details of the recommendations vary, but all are based on research findings, including:

    • HPV-caused changes in cervical cells happen slowly and often go away on their own, especially in younger women
    • more effective screening tests
    • the harms of overtesting and overtreatment for cervical changes that would have gone away on their own

    Age 2129 years:USPSTF recommends that women get their first Pap test at age 21 and have Pap testing every 3 years. Even if a woman is already sexually active, Pap tests are not recommended until the age of 21.

    Age 3065 years:USPSTF recommends that women in this age group be screened for cervical cancer using one of these methods:

    • HPV test every 5 years
    • HPV/Pap cotest every 5 years
    • Pap test every 3 years

    ACS has recently published updated cervical cancer screening guidelines that recommend women start screening at age 25 with an HPV test and have HPV testing every 5 years through age 65. However, testing with an HPV/Pap cotest every 5 years or a Pap test every 3 years is still acceptable. To read about the reasons for the changes, see ACSs Updated Cervical Cancer Screening Guidelines Explained.

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    Who Needs Pap And Hpv Tests More Often

    Your doctor or nurse may recommend getting Pap and HPV tests more often if:

    • You have had treatment for abnormal Pap results or cervical cancer in the past. Women with a medical history of precancerous cells or cervical cancer may need to be tested more often, because their medical history puts them at higher risk in the future.
    • You are living with HIV. Women who are living with are at higher risk of cervical cancer and other cervical diseases because of a weakened immune system. All women living with HIV should get an initial Pap test at the time of the HIV diagnosis and a second Pap test 12 months later. Some experts recommend a second Pap test or Pap and HPV test 6 months later, so talk to your doctor or nurse. After three normal Pap tests in a row, women living with HIV can get follow-up Pap tests every 3 years.
    • Your mother was exposed to diethylstilbestrol while pregnant with you. Daughters, and possibly granddaughters, of women who took DES while pregnant with them have a higher risk of cervical cancer and some other types of cancer. Learn more about DES and cancer from the National Cancer Institute website.
    • You have a weakened immune system because of organ transplant, chemotherapy, or steroid use. HPV may not go away on its own in a person with a weakened immune system.

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    Do I Still Need A Pap Smear Now That I Am Menopausal

    Even if you are menopausal or postmenopausal, you should continue to have Pap or HPV tests. Women who have had a total hysterectomy for a noncancerous condition and have not had a previous history of precancerous Pap tests may be able to stop Pap screening depending on their medical history and risk of contracting human papilloma virus . Screening may also be discontinued at ages 65 or 70 if women have had at least three normal Pap tests in a row and no abnormal Pap tests in the previous 10 years.

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    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 changes in the vagina like inflammation 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.

    Vaginal Dryness And Discomfort

    How Often To Get a Pap Smear

    Vaginal dryness, itching, and discomfort may start during perimenopause and continue into menopause. A person with any of these symptoms may experience chafing and discomfort during vaginal sex. Also, if the skin breaks, this can increase the risk of infection.

    Atrophic vaginitis, which involves thinning, drying, and inflammation of the vaginal wall, can sometimes occur during menopause.

    Various moisturizers, lubricants, and medications can relieve vaginal dryness and associated issues.

    Learn more about atrophic vaginitis here.

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    The Womans Clinic Is Here To Help

    Although we cant stop menopause, there are ways to make it more comfortable and easy to manage. If youre approaching menopausal age and have begun feeling some physical or mental changes and are concerned about your health care, schedule an appointment with us to discuss your concerns and we can lend a hand in helping to determine coping strategies, treatment options, or other ways of managing the changes in your body.

    Although One Might Not Immediately Associate Cervical Cancer With Older Women About 20% Of The Diagnoses Are Among Women 65+

    Cancer of the cervix, or cervical cancer, is the second most common type of womens cancer worldwide, and in the U.S., Hispanic women have the highest incidence rate in the nation. However, it is also one of the most preventable and treatable types of cancer as it provides a wide margin for detection and effective treatment with minimal discomfort when detected early.

    Cervical cancer has a slow progression and tends to occur during a womans midlife, with the bulk of diagnoses among women ages 35 to 55. Thanks to the widespread use of a screening test commonly known as the Pap smear or Pap test, the mortality rate in the United States alone has declined about 2% every year, as it can detect abnormal cell changes in the cervix or cervical cancer early when it is easy to treat successfully.

    Despite that silver lining, there are still many women who have never had a Pap test or havent had one in the last three to five years. The CDC recommends that women should start getting Pap tests at age 21 or within 3 years of becoming sexually active, whichever comes first.

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