Is it okay to perform a Pap (Papanicolaou) smear on a patient who started menstruation yesterday?

From the Guidelines

It is not ideal to perform a Pap smear on a patient who started menstruation yesterday, as the presence of menstrual blood can interfere with the quality of the sample. However, according to the most recent guidelines 1, a conventional cytology test should ideally be scheduled for 10–20 days after the first day of menses, but liquid-based cytology can be performed at any time during the menstrual cycle. This suggests that while it's not optimal, the decision to perform a Pap smear during menstruation may depend on the type of cytology test being used. Some key considerations include:

• The type of cytology test: liquid-based cytology can be performed at any time, while conventional cytology should be scheduled 10-20 days after the first day of menses 1.
• The potential for inaccurate results due to menstrual blood interfering with the sample.
• The clinical urgency of the Pap smear: if it's urgently needed, the healthcare provider might proceed with the test but should document the menstruation status and consider the potential need for repeat testing if the sample is deemed inadequate. In routine screening situations, it's best to reschedule the appointment for a time when the patient is not menstruating, to ensure the most accurate sample collection. Additionally, patients should avoid vaginal intercourse, douching, using vaginal medications, or inserting tampons for 24-48 hours before the test to ensure the most accurate sample collection, as recommended by previous guidelines 1.

From the Research

Performing a Pap Smear During Menstruation

• The provided studies do not directly address whether it is okay to perform a Pap smear on a patient who started menstruation yesterday 2, 3, 4, 5, 6.
• However, it is generally recommended to avoid performing a Pap smear during menstruation, as blood and cellular debris can interfere with the accuracy of the test results.
• Some studies suggest that a Pap smear can be performed at any time, but the accuracy of the results may be affected by the presence of blood or other cellular debris 2.
• The American Society for Colposcopy and Cervical Pathology provides guidelines for the management of abnormal Pap smear results, but does not specifically address the timing of Pap smears in relation to menstruation 6.

Considerations for Pap Smear Timing

• The studies provided focus on the effectiveness of Pap smears in detecting cervical cancer and precancerous lesions 2, 3, 4, 5.
• They do not provide clear guidance on the optimal timing for performing a Pap smear in relation to a patient's menstrual cycle.
• It is essential to consider the potential impact of menstruation on Pap smear results and to consult with a healthcare provider for personalized guidance 2, 3, 4, 5, 6.

Pap Smear Effectiveness

• The studies demonstrate the effectiveness of Pap smears in detecting cervical cancer and precancerous lesions 2, 3, 4, 5.
• They highlight the importance of regular Pap smear screening for the early detection and prevention of cervical cancer 2, 3, 4, 5.
• However, they do not provide specific guidance on the timing of Pap smears in relation to menstruation 2, 3, 4, 5, 6.