Menopause E-Consult with Dr. Vivien Brown
Question
A 65-year-old nulliparous divorced woman presents for her annual examination. She reports that she has been in a new sexual relationship for the past year. Her gynecologic history is notable for uterine fibroids. She has no history of abnormal Pap tests or human papillomavirus (HPV) infections. She is not a smoker, has had three total lifetime partners, and has no history of sexually transmitted infections. At the woman’s insistence, a Pap test was performed and showed a high-grade intraepithelial lesion with high-risk HPV detected. Subsequent Pap tests showed cervical dysplasia, and she eventually opted to proceed with a hysterectomy. Although this situation is extreme in terms of the woman’s age, what are the guidelines for Pap tests and the HPV vaccine for midlife women and beyond? How old is too old for cervical cancer screening?
Submitted by Wen Shen, MD, MPH, FACOG,
Baltimore, Maryland
