Can a pap smear be done while a patient is menstruating?

Can a Pap Smear Be Done During Menstruation?

Ideally, schedule the Pap smear to avoid menstruation, but do not defer screening if the patient has abnormal bleeding or if return access is difficult. 1

General Recommendation

• Postpone the Pap smear if the patient is menstruating and reschedule at the earliest opportunity, according to CDC guidelines 1, 2, 3
• The test is best performed in the absence of heavy menstrual flow to optimize specimen quality 1

Important Exceptions - When to Proceed Despite Menses

Do not defer the Pap smear in the following clinical scenarios:

• Abnormal bleeding patterns including intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding 1
• Accessibility concerns when the patient is unlikely to return for follow-up 1
• Presence of mucopurulent discharge - the test can be performed after careful removal of discharge with a saline-soaked cotton swab 1, 2, 3

Technical Considerations

Impact on Specimen Quality

• The first four days of the menstrual cycle show a very high percentage of unsatisfactory smears, with only 80% being of sufficient quality for cytologic diagnosis 4
• Blood is one of the most common causes of unsatisfactory results in liquid-based cytology 5
• However, recent research demonstrates no significant difference in diagnostic performance (sensitivity, specificity, or accuracy) between Pap smears collected during proliferative versus secretory phases of the menstrual cycle 6

Quality Improvement Strategies

• When blood is present but screening cannot be deferred, reprocessing specimens can improve adequacy rates by approximately 56% 5
• The presence of blood can be avoided in many cases by scheduling appropriately, which reduces the risk of missing significant lesions 5

Clinical Pitfalls to Avoid

• Do not routinely screen during active menstruation when rescheduling is feasible, as this increases unsatisfactory specimen rates 1, 4
• Do not delay screening indefinitely waiting for the "perfect" timing if the patient has concerning symptoms or poor follow-up reliability 1
• Do not assume menstrual blood invalidates all results - modern liquid-based cytology can often overcome blood interference through reprocessing 5