Q: I’m reluctant to have a smear test because since the menopause it has become uncomfortable, leaving me sore for a few days afterwards. I’ve just had another invitation for screening and keep putting it off. Is it OK to miss it now that I’m in my 50s?
A: Please don’t be put off having this potentially life-saving test as there are ways to make it easier and more comfortable. Cervical screening (or a smear test) is to check for abnormalities in the cells of your cervix. It is simple and relatively noninvasive but saves many thousands of women’s lives. It does this by picking up a high-risk type of human papillomavirus (HPV) early on so it can be treated in good time and prevent cancer. Over many years HPV can cause changes to these cells which, if left untreated, can in some cases turn into cervical cancer. Unfortunately for some, around the time of the menopause the test can become daunting.
The natural drop in oestrogen levels that occurs with the menopause can leave the lining of the vagina thinner, dryer and more fragile. This affects up to 40 per cent of menopausal women and may make a cervical screening procedure more uncomfortable. Although most women don’t find it a problem, for some the fear of soreness is enough to make them avoid the test.
The NHS target for cervical screening is for 80 per cent of women aged between 25 and 64 to be screened regularly. But according to Public Health England, take-up has dropped and last year fell to 71 per cent – the lowest for 20 years. In some areas the rate is as low as 50 per cent. To combat this, earlier this month the government launched its first cervical screening ad campaign in England, which avoided the word ‘smear’ as it’s thought that this may be putting people off.
Women between 25 and 49 are invited to be tested every three years, and those aged 50 to 64 every five years because the risk of cervical cancer decreases in this age group. However, the risk is still real, which is why I urge you not to put off your test.
There are ways of making the procedure easier if you find it painful, for example by using a vaginal moisturiser, such as Replens (available in pharmacies) for a few weeks prior to soften and restore moisture. Talk to your pharmacist as you need to be careful which products you choose – some can make the inflammation worse and upset your natural bacterial balance. An ultra-low oestrogen cream or pessary, prescribed by your doctor, can also relieve symptoms. You start with a daily dose for one or two weeks, then twice a week for a few weeks before the procedure. In suitable patients this can be used long-term to diminish vaginal dryness and improve both elasticity and sex life. Stop using any local preparation at least two days before the test so it doesn’t interfere with it.
Back pain? I have good news!
As a GP, I wish I could refer my patients suffering from arthritis, back pain or other musculoskeletal conditions to a physiotherapist quickly. The frustration is that patients have to wait to see me, then wait again for the physio. But good news – that is all about to change: booking direct access to a physiotherapist will soon be available in GP surgeries.
A recent study found that allowing patients to self-refer directly to physiotherapists sped things up, reducing the need for painkillers (use of which increases risk of addiction to opioids such as codeine or tramadol) and decreasing the requirement for long-term physio. When it comes to back pain, for example, being seen promptly by a physiotherapist reduces the need for expensive, ongoing treatment by a fifth. That’s because we know that the sooner patients get mobilised and started on the right exercises, the better. Hopefully these coming changes will mean that patients get the specialist treatment they need in a timely and cost-effective way.
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