Pap Smear During Menstruation
No, Pap smears should not be performed during menstruation and should be postponed until after the menstrual period ends. 1, 2, 3
Primary Recommendation
If a woman is menstruating, the Pap smear should be postponed, and she should be advised to have the test at the earliest opportunity after her period ends. 1, 2, 3
This recommendation applies specifically to conventional cytology Pap tests, as menstrual blood can interfere with specimen adequacy and interpretation. 1
Rationale and Evidence Quality
The CDC guidelines consistently recommend postponing Pap smears during menstruation across multiple iterations (1998,2010), making this a well-established standard of care. 1
During the first four days of the menstrual cycle, approximately 20% of smears are of insufficient quality for cytologic diagnosis due to blood contamination. 4
However, one recent community-based study from 2025 found no significant difference in diagnostic performance between proliferative and secretory phases of the menstrual cycle when compared to colposcopy. 5 Despite this finding, guideline recommendations take precedence and consistently advise postponement during active menstruation. 1
Important Distinction: Mucopurulent Discharge
The presence of mucopurulent discharge should NOT delay the Pap test. 1, 2, 3
In this situation, the test can be performed after careful removal of the discharge with a saline-soaked cotton swab. 1, 2, 3
This is a critical distinction: discharge does not compromise the test in the same way menstrual blood does. 1
Clinical Pitfalls to Avoid
Do not confuse menstrual bleeding with other types of vaginal discharge - only active menstruation requires postponement. 1
Do not unnecessarily delay screening for weeks - reschedule at the earliest opportunity after menstruation ends, ideally within the same cycle. 1
If the patient is unlikely to return for follow-up, clinical judgment may favor obtaining the specimen despite suboptimal conditions, though this is not the standard recommendation. 1