How Birth Control, Pregnancy, and Menopause Affect Your Pap Results
- Samantha Pieterse
- 3 days ago
- 9 min read
Your hormones tell a story, and sometimes, your Pap smear joins the conversation.
From birth control to pregnancy to menopause, your body moves through hormonal shifts that can subtly change how your cervical cells look under the microscope. These changes can sometimes reflect on your results, which can be concerning but are usually harmless.
Here's how hormones across every life stage can affect your Pap smear results, and how you can make sense of them.
What Your Pap Smear Checks, and What It Doesn't
A Pap smear is a quick, simple screening that looks for early cell changes on the cervix (the lower part of your uterus). These changes aren't cancer, but if left untreated, some could develop into cervical cancer over time.
It's not a pregnancy, and it won't tell you anything about fertility, but it's still one of the most effective ways to prevent cervical cancer in South African women.
Screening Recommendation (South Africa)
Women and anyone with a cervix should have a Pap smear every 3 years from the age of 25 to 65, or more frequently if advised by a healthcare provider. Regular screening is your best protection, even if you feel perfectly healthy.
🩺 If you're due for a Pap smear or just not sure when your last one was, you can book a quick screening at Mums & Bums Clinic in Centurion. We make it comfortable and easy to understand.
How Birth Control Can Affect Pap Smear Results
Hormonal contraception, whether it's the pill, injection, implant, patch, or hormonal IUD, can subtly influence your cervix. These changes can sometimes affect the appearance of your cervical cells. Below, we'll unpack how birth control interacts with your hormones, why it can occasionally lead to confusing Pap smear results, and what to do if your report mentions inflammation or irritation.
What Hormones Do to Your Cervical Cells
Hormonal birth control alters your body's levels of oestrogen and progesterone. These hormones affect not only your cycle but also the lining of your cervix. Because Pap smears collect cells from this area, even small hormonal shifts can alter how those cells appear. For example:
Lower oestrogen levels (common with methods like Depo-Provera or during breastfeeding) can make the cervical tissue appear thinner or "atrophic." This can be reported as cellular changes, but usually isn't linked to HPV or cancer.
Higher progesterone levels (as with some combined pills or implants) can make cervical mucus thicker, sometimes leading to a mild "inflammatory" look on your results, again, typically harmless.
Long-term hormonal use can also reduce natural vaginal moisture, which can make cells look more fragile or reactive.
If your report mentions inflammation or cellular changes, your healthcare provider will interpret them in context, making sure nothing more serious is hiding behind those normal fluctuations.
Can Birth Control Cause Abnormal Pap Smear Results?
Hormonal birth control doesn't cause abnormal Pap smear results or cervical cancer, but it can sometimes lead to results that look abnormal.
When your nurse or doctor reads your Pap smear report, they're looking for changes in the shape or maturity of cervical cells. Hormones can make those cells appear slightly different, which might prompt comments like:
"Inflammation" or "reactive changes" is often a temporary response to hormones, sex, or a minor infection.
"Atrophic changes" is a normal low-oestrogen effect, common with injections or during breastfeeding.
"ASC-US" is a mild, uncertain change that nearly always returns to normal.
These results typically don't mean something's wrong. Most women simply have a repeat Pap smear in 6–12 months to confirm everything's back on track. You can safely continue your birth control. There's no need to stop unless your healthcare provider recommends it.
If your Pap smear results mention HPV or high-grade changes, that's a different issue, unrelated to contraception, and your clinic will guide you through the next steps.
What to Do if Your Pap Smear Results Show Inflammation
Seeing the word "inflammation" on your Pap smear results can sound worrying, but it's usually nothing serious. In most cases, it simply means that your cervix was slightly irritated when the sample was taken.
Inflammation can happen for many reasons, like recent intercourse, a mild vaginal infection, or even the natural bacteria that live in the vagina. It doesn't automatically mean infection or cancer, and most women don't need treatment.
If your results show inflammation, your provider may:
Review any symptoms you've mentioned (such as discharge or discomfort).
Offer a simple treatment if there's a clear infection present.
Repeat the Pap smear in 6–12 months to make sure the cells have settled back to normal.
If you feel perfectly fine, there's no reason to panic. The best step is simply to keep up with your regular screening, because that's what catches meaningful changes early.
💬 If your results mention inflammation or minor changes, bring them along to your next visit or book a results consultation at Mums & Bums. We'll explain what's normal and when to recheck.
How Pregnancy Can Affect Pap Smear Results
Pregnancy is another life stage that brings significant hormonal changes, and your cervix feels it too. These shifts can temporarily change your cervical cells, which is why Pap smear results during pregnancy sometimes seem abnormal.
If you're wondering whether it's safe to do a Pap smear during pregnancy, the answer is absolutely. In fact, the Cancer Association of South Africa (CANSA) recommends a Pap smear as part of routine pregnancy screening if you have not had one recently.
Most of the differences you may see on Pap smear results during pregnancy are caused by normal pregnancy changes, such as:
Increased blood flow and cell turnover, which make the cervix softer, more sensitive, and more likely to bleed slightly after a Pap smear.
Higher oestrogen levels, which can make cervical cells look plumper or more active ("reactive changes").
Immune and hormonal shifts, which can alter how the body responds to mild infections or inflammation.
These changes don't mean anything is wrong with you or your baby. If your report shows mild abnormalities, your provider will usually wait until after birth, when your cervix has settled back to normal, to repeat the test.
If the results show high-grade changes or HPV positivity, your healthcare provider will monitor things more closely during pregnancy and plan treatment for after delivery if needed.
After birth, your hormone levels return to baseline, and your Pap smear results usually do too. But as the years go on and oestrogen levels begin to fall, a new set of changes can appear, this time linked to menopause.
How Menopause Can Affect Pap Smear Results
Menopause changes more than just your cycle. It can also influence what your Pap smear looks like. These changes can make Pap smear results look different from those taken in your younger years. Understanding how menopause can affect your results helps you know what to expect at your next screening and when a repeat test or minor adjustment might provide a clearer picture.
Why Pap Smear Results Can Look Different After Menopause
Lower oestrogen levels after menopause cause natural changes to the cervix and vaginal tissue. The lining becomes thinner, less elastic, and more sensitive, a process called atrophy. To a lab technician, these atrophic cells can sometimes mimic mild abnormalities, even though there's no infection, HPV, or cancer present. You might also notice some spotting or discomfort during the test because the cervix is more delicate.
The key thing to know is that these changes are hormonal, not harmful. They mean your body is showing the effects of lower oestrogen. Your nurse or doctor will interpret these results in the context of your overall health.
How to Get the Most Accurate Pap Smear Results After Menopause
A clear Pap smear result starts with a healthy sample, and after menopause, a few small steps can make that easier. The goal is to collect enough healthy cells to get an accurate reading.
If your last Pap smear showed inflammation or atrophic changes, your healthcare provider might recommend a short course of vaginal oestrogen before your next test. This helps gently rehydrate and strengthen the cervical tissue so the sample better reflects your true cell health.
You can also improve accuracy by:
Avoiding any vaginal creams, lubricants, or pessaries before your Pap smear (unless your nurse advises otherwise).
Avoiding intercourse or douching for 24–48 hours before your appointment.
Letting your provider know if you're on any hormonal or non-hormonal vaginal treatments.
These tweaks help ensure that everything has been checked properly.
Do You Still Need Pap Smears After Menopause?
Regular Pap smears are still important after menopause. In South Africa, cervical screening is recommended every three years from ages 25 to 65, or longer if you've ever had an abnormal result or tested positive for HPV.
Even after your periods stop, the cells on your cervix can still change, especially if you've had HPV in the past. Continuing your Pap smears ensures any new or delayed cell changes are caught early, when they're easiest to treat.
You may be able to stop screening after age 65 if:
You've had three consecutive normal Pap smears in the last 10 years, and
You've never had abnormal results or HPV, and
You're not immunocompromised (for example, living with HIV or on long-term immunosuppressant medication).
If you don't meet all those conditions, it's safest to continue testing. We can help you decide when it's appropriate to stop, or whether you might benefit from an HPV-only test instead.
Even if Pap smears are no longer recommended, continue with routine women's health checks, such as breast exams and general wellness visits.
Your Pap Smear Results: When to Worry and When It's Just Hormonal
Not every abnormal Pap smear result means something's wrong. In fact, many reports that sound alarming are simply showing the typical effects of hormones.
Hormones can temporarily affect cervical cells, leading to results that include terms like "ASC-US" or "minor cell changes." These usually settle on their own once your hormones stabilise. Your nurse may recommend a repeat Pap smear in six to twelve months, just to confirm everything's back to normal.
That said, some results do need closer follow-up. You should always check in with your clinic if your report mentions:
High-grade changes (HSIL or AGC): these need further testing, such as colposcopy.
Persistent HPV positivity, especially for high-risk strains.
Repeated abnormal results over multiple tests.
📖 Want to dig deeper into what each Pap smear term actually means?
Read our full guide: Understanding Pap Smear Results in South Africa. It breaks down each result type, so you know exactly what's worth worrying about.
Book Your Pap Smear in South Africa, Visit Mums & Bums Clinic in Centurion
Hormonal changes may feel confusing, but your cervical health shouldn't have to be. Regular Pap smears help you stay one step ahead, and a clear explanation from a trusted nurse can make all the difference.
Your body changes through every season of life, and that's completely normal. Regular screening helps you stay informed, allowing you to focus on living well rather than worrying about results.
At Mums & Bums Clinic in Centurion, we take the time to go through your results with you, answer every question, and guide you through contraception, pregnancy, or menopause care safely and confidently. Whether it's your first Pap smear or a routine check, we'll make sure you leave feeling informed and reassured.
👉 Book online or call to schedule your Pap smear today, and let's keep your women's health simple and stress-free.
Pap Smear FAQs: Pregnancy, Birth Control, and Menopause
Can birth control affect Pap smear results?
Yes. Hormonal birth control can slightly change how cervical cells look, sometimes leading to mild inflammation or "reactive" results. These changes are usually harmless and not linked to cancer. If your results mention inflammation, your nurse may repeat the Pap smear in 6–12 months to confirm all is normal.
Is it normal to have inflammation on a Pap smear?
Yes, mild inflammation is one of the most common findings. It can happen after sex, from vaginal bacteria, or due to hormonal changes from birth control, pregnancy, or menopause. In most cases, it's nothing serious and clears on its own without treatment.
Is it safe to have a Pap smear during pregnancy?
Yes, Pap smears are safe during pregnancy. If you're due for one, your nurse can do it at your first antenatal visit. The test doesn't harm your baby or affect your pregnancy. You may notice light spotting afterwards, as the cervix is more sensitive, but this is completely normal and typically settles quickly.
Can pregnancy affect Pap smear results?
Pregnancy hormones increase blood flow and soften the cervix, which can make Pap smear results look slightly inflamed or reactive. These changes are normal and harmless to you and your baby. If minor cell changes appear, your clinic will recheck after delivery, once your hormones have settled.
Why do Pap smear results change after menopause?
After menopause, lower oestrogen levels thin the cervix and vagina, causing "atrophic" cells that can mimic mild abnormalities. These results are hormonal, not dangerous. A short course of vaginal oestrogen before retesting can help restore clearer, more accurate Pap results.
When should I worry about Pap smear results?
You only need to worry if your results mention high-grade changes (HSIL/AGC) or persistent HPV positivity. These findings need further testing, such as a colposcopy. For minor inflammation or ASC-US changes, a repeat Pap in a few months is usually enough.
How often should I have a Pap smear in South Africa?
In South Africa, women and anyone with a cervix should have a Pap smear every 3 years from ages 25 to 65. If you've had previous abnormalities, HPV, or are living with HIV, your nurse may recommend more frequent testing.
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