Abnormal Pap Smears: Causes, Next Steps, and Outlook

Getting a Pap Smear During Your Period

It's a common question many women have - can I get a Pap smear while on my period? A Pap smear is an important screening test for cervical cancer, but is it still effective if done during menstruation? Here we'll explore the safety, accuracy, and recommendations around scheduling a Pap smear exam while on your period.

What is a Pap Smear Screening For?

A Pap smear, also known as a Pap test, checks for cellular changes and abnormalities on the cervix to detect early signs of cervical cancer. Cells are gently scraped from the cervix during the exam and sent to a lab for analysis under a microscope.

In addition to checking for precancerous and cancerous cells, Pap smears also screen for infections like human papillomavirus (HPV). HPV is commonly transmitted through sexual contact and certain high risk strains can lead to cervical cancer.

Can You Get an Accurate Pap Smear During Menstruation?

Yes, it is possible to get an accurate Pap smear while you are on your period. In most cases, menstrual blood and flow does not interfere with the collection of cervical cells or the interpretation of test results.

However, some practitioners prefer to reschedule Pap smears to avoid getting blood on the collection equipment. The presence of blood could make analyzing the cervical cells in the sample more difficult.

Potential Issues with Testing During Menstruation

While an accurate result is still possible, getting a Pap smear while on your period has a few potential drawbacks:

• The blood and flow can make collection more difficult and get in the way of obtaining cells from the cervix.
• Blood may obscure the cervical cells, making microscopic interpretation less clear.
• Menstrual flow and cramps can make the procedure more uncomfortable.
• There is a small risk of contamination and false positives if menstrual blood gets on the collection equipment and mixes with cervical cells.

Recommendations from Health Organizations

Most major health organizations provide loose guidelines but do not forbid Pap testing during menstruation:

• The American College of Obstetricians and Gynecologists states that cervical cancer screening can be performed any time, regardless of menstrual cycle phase.
• The American Cancer Society simply recommends screening every 3-5 years for women 21-65 years old. No cycle-specific guidelines are given.
• The US Preventative Services Task Force recommends screening every 3 years for women 21-29 years old and every 5 years for women 30-65 years old. They do not make any statements about Pap smears and menstrual cycles.

So the major consensus is that - while a woman is not on her period may be preferable - Pap smears can still be performed accurately at any point in the menstrual cycle.

Talk to Your practitioner

Every practitioner may have a slightly different preference when it comes to Pap testing and menstrual cycles. Some are comfortable performing the exam at any time while others prefer to collect the sample at specific points.

If you schedule a Pap smear while on your period, call ahead to confirm the appointment. Discuss any concerns with your practitioner and whether they recommend rescheduling or not. They may have you come in anyway to perform other aspects of the well-woman exam.

Abnormal Pap Smear Causes and Risk Factors

Undergoing Pap screening can cause anxiety even under normal circumstances. The thinking typically goes - no news is good news when it comes to Pap smear results. But what if you get an abnormal Pap test result back?

While alarming, an abnormal result does not necessarily mean you have cervical cancer. There are many other explanations for irregular cells on your cervix. Understanding the possible causes can help put your mind at ease.

HPV Infection

One of the most common reasons behind an abnormal Pap smear is infection with certain strains of human papillomavirus (HPV). HPV is extremely widespread - nearly 80 million Americans are currently infected.

In most cases, the infection resolves without intervention within 1-2 years. However, some high risk strains can linger longer in the body and are linked to 99% of cervical cancers. HPV testing is now commonly bundled together with Pap smears to screen for precancerous changes caused by the virus.

Inflammation and Infection

Inflammation and non-HPV infections can also lead to cellular abnormalities on a Pap smear. Some examples include:

• Bacterial vaginosis
• Yeast infections
• Sexually transmitted infections like chlamydia and gonorrhea
• Irritation from vaginal medications, lubricants, or feminine products

In these cases, treatment of the underlying condition Often resolves the abnormal cells without additional interventions. Your practitioner can test for infections and provide appropriate antibiotic medications as needed.

Hormonal Factors

Hormone changes in the body at various life stages can trigger mild cellular changes on the cervix:

• Puberty - young women just becoming sexually active often have inflamed areas on the cervix from new exposure to sperm and pathogens.
• Perimenopause - fluctuating hormones during the transition to menopause can cause abnormal cell growth.
• After pregnancy - post-partum healing and inflammation contributes to abnormal cervical cell appearance.

For young women or those in menopausal transition, an irregular Pap is often a normal response to hormonal factors. Repeat testing in 6-12 months Often shows improvement as hormone levels stabilize.

Cervical Ectropion or Dysplasia

Changes in the appearance of glandular cells lining the cervical canal is another common Pap smear finding. Ectropion occurs when these fragile gland cells swell and extrude outside the cervical os, where they may get scraped during a Pap exam.

The condition is very common in adolescence but can happen at any age after irritation, injury, or childbirth. Symptoms include light menstrual bleeding between periods or after sex.

When to Worry About an Abnormal Pap Smear

While many causes of irregular Pap tests are benign, some results do require prompt follow up and re-testing. These more concerning test findings include:

• ASC-US - atypical squamous cells of undertermined significance. This means they do not appear completely normal but changes are not definitive cancer precursors either.
• LSIL - low grade squamous intraepithelial lesions that may become cancerous if left untreated
• HSIL - more serious precancerous changes thats require biopsy confirmation and rapid treatment

Talk to your doctor right away if your Pap results come back with one of these more worrisome diagnoses so next steps can be discussed.

What Happens After an Abnormal Pap Smear?

Understandably, receiving the news of an irregular Pap smear can be upsetting. But the important thing is prompt follow up care and sticking closely to your practitioner's monitoring plan. Here is what you can expect after being notified of abnormal cervical cell changes on your Pap test:

Repeat Pap Testing

The most conservative course of action is simply to repeat the Pap smear again in 6-12 months. Over 50% of initial abnormal results return to normal on the next exam without intervention. This watch-and-wait approach is appropriate for mild cellular changes.

HPV Testing

As cervical cancer screening has improved, HPV testing is now considered an essential follow-up for abnormal Pap results. Knowing your HPV status provides critical information for assessing your cancer risk and guiding treatment.

Colposcopy with Biopsy

If cell changes persist on repeat Pap exams or HPV testing confirms a high risk strain, your practitioner will likely refer you for a more advanced evaluation called a colposcopy.

During a colposcopy, your cervix is coated with solution and examined under high magnification to identify abnormal areas. Small tissue samples (biopsies) are taken to confirm precancerous changes under the microscope.

LEEP or Cone Biopsy

If the biopsy demonstrates moderate to severe cell changes (HSIL, CIN2-3), then an excisional procedure is recommended. This involves using a thin electrified wire loop to painlessly remove the abnormal transformation zone cells in a procedure called LEEP.

Rarely, a deeper cone biopsy may be performed to remove small portions of the cervix for analysis. This preserves reproductive capability while eliminating concerning cellular changes before they become cervical cancer.

The Takeaway

Receiving abnormal Pap smear results can raise concern. But the most important thing is close surveillance and follow up care until cellular changes resolve or definitive treatment occurs if needed. With the proper management plan, most cases of irregular Pap tests never progress to cervical cancer, allowing patients to maintain a peace of mind.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.