Will HPV Testing via Menstrual Blood Mean the End of Pap Smears?

A routine Pap smear is one of the many uncomfortable maintenance requirements of having a cervix, but there may be an easier, more pain-free way of identifying cancer-causing human papillomavirus (HPV).

A new study conducted by researchers in China, published in the journal JAMA Network Open, found that menstrual blood from sanitary pads may be a feasible and accurate alternative to HPV and cervical cancer screening.

The researchers collected 137 sanitary pads from 120 women who were premenopausal and had already been diagnosed with high-risk HPV—meaning that the virus has a higher chance of progressing into cervical cancer.

Cervical cancer can be cured if detected at an early stage. The overall five-year survival rate for cervical cancer is around 66% but the percentage increases greatly to 90% if it’s treated while the cancer is still localized.

Through DNA analysis of the menstrual blood, researchers were able to effectively identify high-risk HPV in 94.2% of the patients. This method had a higher accuracy than cervical testing at detecting HPV infection with multiple strains.

Detecting HPV via menstrual blood could be a “convenient and noninvasive approach,” the researchers wrote. They added that technicians should collect pads from the second day of menstruation as that is typically when people bleed the most.

Increasing Accessibility

HPV is usually tested during a routine gynecologist visit, where a ThinPrep liquid pap smear is obtained by scraping both the outside of the cervix and the endocervical canal, according to Tara Scott, MD, medical director of integrative medicine at Summa Health System.

There are also at-home HPV tests that allow you to swab your own endocervical canal and mail the swab back to the manufacturer for laboratory testing.

The new study noted that earlier surveys of people with overdue screening found that 29% were afraid of the stigma of gynecological examination and 14% had fear of pain. While self-sampling HPV testing is an alternative that may improve participation levels, most existing studies are based on various sampling brushes inserted into the vagina and could have caused discomfort, according to the researchers.

Scott said this new method of collecting menstrual blood could enable many more people to access screening.

“People who do not have access to care, women who are too busy to come in, women with disabilities—mental and physical—could be screened more often,” she said. 

Pap Smear Is Here to Stay

Although this new research is vital in terms of expanding how HPV can be detected, Scott said it’s unlikely that we’ll be getting rid of Pap smears anytime soon because they serve many additional purposes.

“HPV is the leading cause of cervical dysplasia but there are also other types of cervical cancer that are not associated with it,” she said. “Part of the Pap smear is the pelvic exam—visually looking at the vulva, vagina, and cervix for abnormalities along with palpation of the uterus, ovaries and pelvis. This is still important.”

Scott noted that since the 120-person sample size used in this research is relatively small, larger studies are needed to validate its results. Still, there is always value in finding new ways to prevent and treat cervical cancer, which killed 4,290 people in the United States in 2021.

“Cervical cancer is deadly,” she said. “Early detection and treatment has shown to be very successful, so expanding the way that HPV can be detected is huge.”