Is Cervical Cancer Screening Still Necessary After Menopause?

Key Takeaways

• Cervical cancer screening should continue, even after menopause – unless when a woman has had a total, non-cancerous hysterectomy.
• Doctors usually recommend regular screenings until the age of 69 if a lady has:
  • 3 consecutive negative cytology tests
  • Or 2 consecutive negative Human Papilloma Virus (HPV) tests in the last 10 years, with the most recent test occurring within the last 5 years.
• The recommended cervical cancer screening schedule is as follows:
  • From the age of 25: A Pap smear every 3 years, or
  • From the age of 30: An HPV test every 5 years, or
  • A co-test (Pap and HPV tests) every 5 years

Pap smear continues to be an effective tool for early detection of cervical cancer, which is the 10th most common type of cancer affecting women in Singapore.

Question arises among postmenopausal women: Is cervical cancer screening still necessary? The short answer is yes. As long as you haven’t had a total hysterectomy for non-cancerous reasons, cervical cancer screening should remain a part of your healthcare routine, as abnormal cervical cell changes, which are responsible for cervical cancer, can still occur even after menopause.

However, screening recommendations may differ from those for younger women. Several factors, such as your past cervical cancer screening results and certain medical conditions that suppress the immune system or abnormalities of the cervix, can also influence the screening frequency.

Here, we’ll explain why cervical cancer screening remains important after menopause – covering its benefits, recommended frequency, and when it may be appropriate to stop.

What Does Cervical Cancer Screening Look for in Postmenopausal Women?

There are 2 main types of tests: a Pap test and an HPV test 

A Pap test, which involves collecting cells from the cervix, screens for both non-cancerous and cancerous abnormal cervical cell changes. While these changes are less frequent in postmenopausal women, they can still occur, particularly in women with previous exposure to human papillomavirus (HPV).

If detected early, non-cancerous abnormal cell changes can be managed easily, long before they progress into a cancer. Meanwhile, in cases where cancerous abnormal cell growth is found, early detection significantly improves the chances of successful treatment.

A HPV test detects the presence of high risk HPV virus which is most often the cause of cervical cancer. HPV can lie dormant in the body for weeks, months, or even years before being detected. This means you could still be at risk of cervical cancer due to earlier exposure, even if you’re now postmenopausal.

How Often Should You Get Screened for Cervical Cancer After Menopause?

While the recommended screening schedule for women aged 25–29 is a Pap smear every three years, and for women aged 30 years above, a HPV test once every 5 years

However, these are only general guidelines. Your doctor may recommend and schedule more frequent screening if:

• You’ve had abnormal Pap or HPV test results in the past
• You have a history of cervical cancer or non-cancerous changes
• You have a weakened immune system, either due to HIV or certain medications

How Common is Cervical Cancer After Menopause?

Cervical cancer can occur at any age, but it’s rarely diagnosed in younger women in their 20s. Most cases are first diagnosed later in life, or between the ages of 35 and 44, with the median age being around 50 – hence, a regular cervical cancer screening remains necessary until at least the age of 69. 

While entering postmenopause doesn’t automatically raise your risk of cervical cancer, certain factors can influence the likelihood of developing the disease at this stage of life, including:

• Your history of regular cervical screenings

Your history of cervical screenings tells your risk of cervical cancer after menopause. Regular screenings help detect abnormal cell changes in the cervix early, often long before they have a chance to develop into cancer.

However, if you’ve consistently missed scheduled screenings or never had one, any abnormal cell growth may go unnoticed. These changes are usually asymptomatic in the early stages and can only be identified through Pap smears and HPV tests – without screening, they’re unlikely to be detected.

Though not always, these abnormal cell changes in the cervix may develop into cervical cancer. That’s why staying on track with regular screenings remains essential, even after menopause.

• Whether or not you’ve received the HPV vaccine earlier in life

Your risk of cervical cancer after menopause is lower if you’ve received full doses of the HPV vaccine. HPV vaccinations help build immunity against high-risk strains of the human papillomavirus, specifically types 16 and 18 that are known to cause cervical cancer.

The vaccine works best when given before any exposure to the virus, or before the onset of sexual activity, which is why it’s usually given to young girls. Women who were not vaccinated earlier in life may still carry a risk of HPV infections, especially if they were previously exposed to the virus.

However, receiving the complete course of the HPV vaccine doesn’t mean you can skip cervical screenings altogether. Regular testing remains necessary, as the vaccine may not protect against all high-risk HPV strains and can’t treat existing infections or abnormal cervical cell changes.

• The number of sexual partners over your lifetime and early onset of sexual activity

The number of sexual partners you have suggests the risk of HPV infection, which is transmitted through sexual contact. The risk increases with more partners over your lifetime – though it’s also possible to get exposed to the virus even with just one partner.

Most HPV strains are harmless and often clear up on their own. However, without regular screening, it’s difficult to know which strains you’ve been exposed to, which in some cases, may lead to cervical cancer later in life, including after menopause.

• Having a weakened immune system

Having a weakened immune system reduces the body’s ability to clear up HPV infections. Individuals who are immunocompromised are also more susceptible to experiencing faster progression of abnormal cervical cell changes – from non-cancerous to cancerous.

A weakened immune system is mainly caused by two factors: having an existing human immunodeficiency virus (HIV) and the consumption of immunosuppressant medicines. If this applies to you, a more tailored screening schedule may be recommended to closely monitor your cervical health.

• Smoking

Smoking is a significant risk factor for cervical cancer. It weakens the immune system and chemicals damage the cervical cells.

• Use of birth control pills and giving birth multiple times

Using birth control pills and having multiple childbirths are associated with a higher risk of cervical cancer. While the exact reasons aren’t fully understood, these factors may influence the hormonal environment in the cervix, increasing the likelihood of HPV causing abnormal cell changes.

• History of sexually transmitted infections infection

Sexually transmitted infection (STI) like chlamydia, spread through sexual contact. Previous exposure to chlamydia increases the risk of cervical cancer, as the bacteria make it harder for the body to clear up HPV on its own.

The good news is, cervical cancer is highly curable, as long as it’s detected and treated early. Regular screenings consisting of Pap smear and HPV test help to identify the abnormal cell changes before they progress to more serious health concerns.

When is it Safe to Stop Cervical Cancer Screenings?

Pap smears remain important even years after menopause. However, most doctors no longer recommend routine Pap smears for women over the age of 69, only if certain conditions are met.

You may be eligible to safely stop Pap smears entirely if you meet at least two of the following conditions:

• You’ve had a total hysterectomy for non-cancerous reasons (If the hysterectomy was partial or due to cervical cancer, screening may still be recommended)
• You have no personal or family history of cervical cancer

In addition, you must meet all of the following screening history requirements:

• At least 3 negative Pap smear results 
• At least 2 negative co-tests in the last 10 years with the most recent test occurring within the last 5 years 
• At least 2 negative HPV test results in the last 10 years with the most recent test occurring within the last 5 years 

Final Thoughts: Stay on Top of Your Cervical Health

Cervical cancer is a highly preventable disease, yet it remains a leading cause of cancer-related deaths among women. Undergoing regular cervical cancer screening , even after the onset of your menopause, ensures timely intervention – before the abnormal cell changes progress into cancer.

We understand that the thought of cervical cancer screening may feel more intimidating as it should – given that after menopause, you may experience changes like vaginal dryness or reduced elasticity.

With years of professional experience in providing women’s health screening, we can make the experience easier. From using a smaller speculum, applying more lubricants, to providing a calm, respectful environment, your comfort is our top priority.

Stay on top of your cervical health – book your cervical cancer screening today.

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