Your cervical screening still matters

Smear tests can be uncomfortable during the perimenopause and menopause but help is available

• Low hormone levels can affect vaginal tissues, making a cervical screening painful
• Vaginal hormones and lubricants can help
• There are also steps you can take if you feel anxious about a test

Let’s face it, no one looks forward to going for a cervical screening (previously known as a smear test). Despite the fact screening prevents up to 3,900 cases of cervical cancer annually in the UK [1], the uptake rate by eligible women in England is only 68.7% [2].

While cervical cancer is more common in young women, particularly in those aged 25 to 45 years, incidence rates fluctuate in the older age groups and screening is recommended until the age of 65 [3].

Most forms of cervical cancer are caused by the human papillomavirus (HPV) – this common virus lives in the skin and cells lining the inside of your body and can be passed between people through close skin-to-skin contact. It can lie dormant in your body for years, without causing harm, before it is detected. When it’s dormant, it can’t be detected by a test but when it becomes active, it can be detected in a cervical screening. This is why it’s important to continue with your screenings.

In the event HPV is detected on the sample taken during your cervical screening, the tissue will be looked at in more detail to determine if there are any cells changes.  Further testing, treatment or more frequent screening may be the outcome of this test, depending on the results.

From the age of 25 to 50, you’re invited for screening every three years, while for those aged 50 to 64, you’re invited every five years.  If you’re experiencing perimenopausal or menopausal symptoms, you may have concerns over your screening.

How might the menopause affect my screening? 

During the perimenopause and menopause, low levels of oestrogen (and testosterone) can lead to thinning of the tissues in and around the vagina, it loses its elasticity and can become drier and more fragile. Common symptoms can include soreness and itchiness, and any kind of vaginal penetration can be uncomfortable, whether that be tampons, sex, or examinations using a speculum. These symptoms, along with urinary symptoms such as needing to pee a lot or having some accidents, tend to get worse over time without treatment. So rather than waiting for them to pass before attending a cervical screening, take action to treat them.

What can I do about it?

Speak to your doctor or nurse before your next examination is due and ask for vaginal oestrogen or vaginal hormones. It comes in a pessary, cream or gel that you insert directly into your vagina, usually at night time. Or you can ask about an Estring, which is a silicon ring that sits inside the vagina for 90 days, releasing a steady dose of oestrogen. Oestrogen helps restore your tissues so they are lubricated, plumper, stretchier and more healthy. It is safe to use these products long term and they have no associated risks.

You can also take HRT alongside using vaginal hormones, which will help boost hormones all over your body, and improve other menopausal symptoms at the same time.

Try keeping the area moist with daily use of specialist moisturisers and if you need extra help, such as for sex, lubricants can really help make things more comfortable.

When you go for cervical screening, make sure you’ve been using a vaginal hormone treatment for a few weeks already. Tell your nurse or doctor that you have soreness and dryness and ask them to explain everything as they go and ensure they use plenty of lubricant. You may be able to choose a smaller size speculum if you’re worried about the insertion. If you find it more comfortable lying slightly on your side, ask if that’s possible.

Remember, you can ask them to stop at any point.

If you have a particular anxiety about cervical screening, tell them when you’re booking the appointment. Also let them know in advance if you’re a survivor of sexual violence, have experienced FGM, or are trans or non-binary.

What does the future hold?

None of us look forward to cervical screening, but it shouldn’t be a traumatic experience and it can have far-reaching effects. NHS England aims to eliminate cervical cancer by 2040 by increasing uptake of the HPV vaccine and cervical screening.

The NHS is looking to trial self-sampling – where you take your own test – as part of its screening programme. Research by King’s College London showed that just over half of women would choose self-sampling if they were given the choice, and, importantly, 70% of those who are not currently attending regular screening would also choose self-sampling, which could have a great impact in early detection.

References

1. Shiraz A, Schiemer R, Staley H, Matsushita T, Hasegawa T, Bryant A, Inoue E, Egawa N, Gajjar KB. (2023), ‘Human papillomavirus (HPV) self‐sampling to encourage the uptake of cervical screening’, Cochrane Database of Systematic Reviews, Issue 11. doi: 10.1002/14651858.CD014502.

2. NHS Digital Cervical screening annual/england 2022 2023

3. Cancer Research cancer statistics