Pap Smear During Menstruation
If you are menstruating, a Pap smear should be postponed, and you should reschedule for the earliest opportunity after your period ends. 1
Why Pap Smears Should Be Postponed During Menstruation
- According to the Centers for Disease Control and Prevention (CDC) guidelines, conventional cytology Pap tests should not be performed during menstruation as the presence of blood can interfere with proper interpretation of the results 1
- The presence of menstrual blood can obscure cervical cells and potentially lead to unsatisfactory samples that may require repeat testing 1
- Postponing the test until after menstruation improves the quality of the specimen and increases the likelihood of obtaining an accurate result 2
Alternative Considerations
- If you have a mucopurulent discharge (not menstrual blood), this should not delay your Pap test - the test can still be performed after careful removal of the discharge with a saline-soaked cotton swab 1
- In most instances, even with some infections present, Pap tests can be reported as satisfactory for evaluation without needing to repeat the test after treatment 1
Special Populations
Pregnant Women
- Pregnant women should have Pap smears as part of routine prenatal care, but should also avoid testing during menstruation 2
- A swab and Ayre's spatula should be used for obtaining Pap tests in pregnant women, with cytobrushes specifically not recommended due to risk of disrupting the mucous plug 2
HIV-Infected Women
- HIV-infected women should follow specific screening protocols (initial test, repeat at 6 months, then annually if normal) but should also avoid testing during menstruation 2
Clinical Implications
- When a Pap test is postponed due to menstruation, it's important to reschedule at the earliest opportunity to maintain appropriate screening intervals 1
- There is no evidence that the phase of the menstrual cycle (proliferative vs. secretory) affects the diagnostic performance of Pap smears when they are performed outside of the menstrual period 3
- Proper documentation of Pap test results, follow-up appointments, and results of follow-up should be clearly recorded to ensure appropriate care 4
Common Pitfalls to Avoid
- Do not perform a Pap test during menstruation as it may lead to unsatisfactory results requiring a repeat test 1
- Do not confuse menstrual bleeding (which should delay testing) with mucopurulent discharge (which should not delay testing after proper cleaning) 1
- Do not assume that women with external genital warts need more frequent Pap tests than women without warts 1