Can You Do a Pap Smear During Your Period?
For conventional cytology Pap smears, the test should ideally be postponed if you are menstruating and rescheduled at the earliest opportunity, but there are important exceptions when the test should proceed despite menstruation. 1
General Recommendation for Routine Screening
- The CDC explicitly recommends postponing conventional cytology Pap smears during menstruation and advising the patient to return at the earliest opportunity. 1
- The American Cancer Society states that screening is best performed in the absence of heavy menstrual flow to optimize specimen quality and interpretation. 1
- During the first 4 days of the menstrual cycle, up to 20% of smears may be of insufficient quality for cytologic diagnosis due to blood obscuring cellular detail. 2
Critical Exceptions: When to Proceed Despite Menses
Do not defer the Pap smear in the following situations, even during menstruation:
- Abnormal bleeding patterns including intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding—these symptoms require immediate evaluation and should not be delayed. 1
- Poor accessibility or follow-up concerns—if the patient is unlikely to return for a rescheduled appointment, perform the test during the visit rather than risk missing the screening opportunity entirely. 1
- Presence of mucopurulent discharge—this should not delay testing; simply remove the discharge carefully with a saline-soaked cotton swab before specimen collection. 1
Practical Considerations
- Recent research from 2025 found no significant difference in the diagnostic performance (sensitivity, specificity, or accuracy) of Pap smears collected during proliferative versus secretory phases of the menstrual cycle when compared against colposcopy. 3
- However, this study did not specifically address heavy menstrual flow, which remains the primary concern for specimen adequacy. 3
- Liquid-based cytology may perform better than conventional cytology during menstruation, though guidelines still recommend postponement when feasible. 1
Common Pitfalls to Avoid
- Never delay screening indefinitely waiting for "perfect" timing if the patient has concerning symptoms (abnormal bleeding) or is unlikely to return for follow-up. 1
- Do not assume all menstrual bleeding is normal—abnormal bleeding patterns warrant immediate evaluation regardless of timing. 1
- Avoid using this as an excuse to defer screening in patients with poor follow-up reliability, as the opportunity cost of a missed screening outweighs the risk of a slightly suboptimal specimen. 1