Cervical cancer is one of the few cancers we actually know how to prevent. With HPV vaccination, routine screening, and early treatment of precancerous lesions, the disease is largely avoidable. Yet every year, thousands of women still develop cervical cancer, including about 14,000 women in the U.S. alone. When people think about cervical cancer prevention, the focus is usually on younger women: HPV vaccination for adolescents and Pap smears during the reproductive years. What is discussed far less often is what happens to screening behavior as women age, particularly as they transition through menopause. This question became the focus of a research project I worked on examining cervical cancer screening patterns among middle-aged and older women in the U.S. One thing quickly became clear: Screening participation tends to decline after menopause.
At first glance, this might not seem surprising. Menopause often represents a major transition in a woman’s life. Many women stop seeing gynecologists as frequently, reproductive health may feel less immediately relevant, and some may assume that their risk of cervical cancer has diminished with age. But biologically, the story is more complicated. The average age at which cervical cancer is diagnosed in the U.S. is around 50, an age when many women are in the middle of perimenopause or early post-menopause. Persistent HPV infections acquired earlier in life can take years, even decades, to progress into cervical cancer. This means that the risk does not simply disappear once reproductive years are over.
In our study, we used data from the Health and Retirement Study, a nationally representative longitudinal survey of middle-aged and older adults in the U.S. We examined multiple waves of the dataset and compared women who were premenopausal or perimenopausal with women who had already gone through menopause. What we found was consistent across different analyses: Women who had transitioned into menopause were less likely to receive a Pap smear several years later compared with women who had not yet reached menopause. In one of our analyses, women who had gone through menopause were about 24 percent less likely to have had a Pap smear four years later. This decline remained even after adjusting for other factors that might influence screening behavior.
These findings do not necessarily mean that women consciously decide to stop screening. More likely, a combination of factors contributes to this pattern: changes in health care engagement, misconceptions about age-related risk, and perhaps insufficient emphasis from clinicians about the importance of continued screening. In many ways, menopause may unintentionally become a quiet turning point where preventive care begins to fade from focus. Current guidelines from the American Cancer Society and other professional organizations recommend that women continue cervical cancer screening until age 65, provided they have not had a hysterectomy and meet other clinical criteria. The rationale is simple: Cervical cancer prevention depends on identifying abnormal changes before they progress to invasive disease. Stopping screening too early could mean missing those opportunities.
Although our study focused on U.S. data, the implications extend far beyond the U.S. Globally, cervical cancer remains a major public health problem. In countries such as Nigeria, cervical cancer is still one of the leading causes of cancer-related deaths among women. Screening programs are often limited, and access to preventive care can be inconsistent. In such settings, early discontinuation of screening due to misconceptions about age can further widen existing prevention gaps. At the same time, the global health community has set an ambitious goal: the elimination of cervical cancer as a public health problem. Achieving this goal will require not only expanding HPV vaccination but also ensuring that screening programs reach women across the entire life course. Older women cannot be an afterthought in these efforts. It is important to clarify that the solution is not indefinite or indiscriminate screening. Instead, what is needed is clearer communication about when screening should continue and when it can safely stop. Patients should feel empowered to ask these questions, and clinicians should be proactive in guiding these decisions based on evidence and risk. Menopause marks an important stage in life, but it should not mark the end of conversations about cervical cancer prevention. As populations continue to age and prevention strategies evolve, we must ensure that the progress we have made in reducing cervical cancer risk does not unintentionally leave older women behind. Cervical cancer prevention should remain inclusive, and that means remembering that risk does not simply disappear with menopause.
Nenrot S. Gopep is a physician and public health researcher committed to improving health outcomes through evidence-based medicine, prevention, and health equity. Originally trained in Nigeria, her early clinical experiences caring for patients affected by preventable diseases inspired her focus on public health and population-level interventions. She earned her Master of Public Health in epidemiology from Georgia Southern University.
Dr. Gopep’s research spans infectious diseases, cancer prevention, cardiometabolic health, and global health systems. Her work includes studies on the relationship between stress, depression, anxiety, and hypertension, cervical cancer screening after menopause, coinfection dynamics between COVID-19 and monkeypox, and wastewater-based epidemiology for early detection of antimicrobial resistance. Her broader scholarship also examines postoperative infections, HIV prevention strategies, malaria vaccine awareness, obesity trends in U.S. youth, and the gut microbiome.
She shares professional updates on LinkedIn and participates in community outreach through HopeHill Foundation.
