Smear Tests: What You Need to Know

I get asked all the time in clinic: “When should I book my smear test?” “Do I still need them after the menopause?” “What’s this HPV thing?” 

So let’s break it down. Cervical screening (what many still call a smear test) saves lives – but the rules around when and how often you need it have changed over the years. And in the UK, they’re different to what you might see online, especially from American sources.

Here’s what you need to know to stay informed and protected.

What is cervical screening – and what’s it looking for?

Cervical screening is a test to help prevent cancer. It doesn’t diagnose cancer – it looks for a common virus called HPV (human papillomavirus) that can cause abnormal cells in the cervix.

If these abnormal cells are found early, they can be treated before they turn into cancer.

Thanks to cervical screening and the HPV vaccine, cervical cancer is now one of the most preventable cancers in the UK. 

Who is invited for screening in the UK?

The NHS Cervical Screening Programme invites:

• Everyone with a cervix aged 25 to 64
• You’ll be invited every 3 to 5 years, depending on your age and past results 

Here’s how it works:

If you’re under 25, you’re not invited – because abnormal changes in the cervix are very common at this age and usually clear up on their own. Screening earlier often leads to unnecessary worry and treatments that do more harm than good.

Why not screen every year? Isn’t more better?

This surprises many people, but more frequent screening doesn’t actually improve outcomes – and can increase harm.

Cervical cancer develops slowly. It usually takes years for HPV to cause changes that might lead to cancer. So testing every 3 to 5 years is enough to catch anything early – without putting people through unnecessary investigations or treatments for cell changes that would have gone away naturally.

What is HPV and why does it matter so much? 

HPV (human papillomavirus) is very common. Around 8 in 10 people will get it at some point. Most of the time, your body clears it on its own and you won’t even know you had it.

But certain “high-risk” types of HPV can cause changes in the cells of the cervix. If left untreated, these changes can sometimes lead to cervical cancer.

That’s why the NHS now uses HPV primary screening. It means your smear sample is first tested for high-risk HPV:

• If HPV isn’t found, you’re at very low risk and you’ll be recalled in 3 or 5 years (depending on your age)
• If HPV is found, your sample is checked for abnormal cells – and you might be monitored more closely or referred for a colposcopy

Does the HPV vaccine mean you can skip screening?

No. While the HPV vaccine (offered to girls and boys in school) protects against the most common high-risk types, it doesn’t protect against all of them.

If you’ve had the vaccine, that’s fantastic – it massively reduces your risk – but you still need to attend screening when invited. 

Do you still need screening after menopause? 

Yes – as long as you’re under 65, you should still go for screening.

Even if you’re no longer sexually active, you still need screening because HPV can be dormant for years before causing problems.

After 65, you’ll usually stop being invited – but only if your last few tests were normal. If not, you might be followed up longer. 

Do you need screening after a hysterectomy?

That depends: 

• If your cervix was removed (total hysterectomy) for a non-cancer reason, and you had normal screening before, you don’t need smear tests anymore
• If you had treatment for cervical cell changes or cancer, you may still need follow-up tests – check with your GP or specialist

What happens during a smear test?

The test only takes a few minutes. A nurse or doctor uses a small soft brush to take a sample of cells from your cervix.

Yes, it can be a little uncomfortable – but it shouldn’t hurt. If it does, say so – there are ways to make it easier, especially if you’re nervous, menopausal, or have had previous trauma. 

What if you feel anxious or embarrassed?

You’re not alone. Many people put off smear tests because of anxiety, previous bad experiences, or fear of pain.

Please speak to your practice – we’re here to help. You can:

• Ask for a longer appointment
• Request a female clinician
• Bring a friend or support person
• Talk through concerns beforehand

What happens if your result is abnormal?

Don’t panic. Most abnormal results do not mean cancer.

It just means something needs checking again – or you might be referred to a clinic called colposcopy for a closer look.

The aim is to prevent cancer by treating any abnormal cells early, before they cause harm.

Your 3-step reminder

1. Check your post – the NHS will write when you’re due
2. Book your appointment – most GP surgeries offer flexible times
3. Keep going – even if you’ve had normal results before

Takeaway Message

• Cervical screening is free, quick and could save your life
• The test looks for HPV – the virus that can cause cancer
• You’ll be invited from age 25 to 64, every 3 to 5 years
• You don’t need it before 25, don’t need it every year, and can stop after 65 if your results have always been clear
• If you’re nervous, speak up – we can help make it easier

And if you’ve been putting it off? Please book it today.