How often should an older woman have a Pap smear?

Oct 14, 2025 3 min read •

senior care women's health Preventive Health

Cervical cancer deaths have been reduced by more than 50% in the last 30 years, largely due to routine screening with Pap tests. This remarkable success has led to a re-evaluation of screening guidelines, prompting many to ask: How often should an older woman have a Pap smear? The answer is nuanced and depends on several key factors.

Quick Summary

For women over 65 with a history of regular screening and no abnormal results, Pap smears can often be discontinued. Factors like a history of cervical abnormalities, compromised immunity, or exposure to DES may require continued screening, based on your doctor’s personalized recommendation.

Key Points

Age 65 Guideline: Many women over 65 can stop Pap smears if they have a history of adequate, normal screening results and no increased risk factors.
Adequate History: To stop screening, an older woman typically needs three consecutive negative Pap test results or two consecutive negative co-test results (Pap and HPV) in the last 10 years.
Risk Factors Dictate Continuation: A history of high-grade abnormal Pap results, cervical cancer, a weakened immune system, or exposure to DES requires continued screening past age 65.
Annual Wellness Exams Still Important: Even without a Pap smear, annual gynecological exams are recommended to address other health concerns related to aging.
Shared Decision-Making: The decision to stop or continue screening should be made in consultation with a healthcare provider, based on a personal risk assessment.
Hysterectomy Consideration: Women with a total hysterectomy for non-cancerous reasons generally do not require further Pap tests.

Understanding Updated Cervical Cancer Screening Guidelines

Cervical cancer screening guidelines have significantly evolved, moving from annual Pap smears to less frequent testing based on age and test type. This change is due to the understanding that cervical cell changes, mainly caused by persistent human papillomavirus (HPV) infections, develop slowly. For women over 65, the frequency of Pap smears depends on individual risk factors and a history of screening.

Screening Recommendations for Women 65 and Older

Leading health organizations like the USPSTF and ACOG state that women over 65 may stop cervical cancer screening if certain conditions are met.

When Can Screening Safely Stop?

Adequate Negative Screening History: Discontinuing Pap smears is an option after age 65 for women who have had at least three consecutive negative Pap test results or two consecutive negative HPV or co-test results within the past 10 years.
No High-Risk History: This applies to women with no history of high-grade precancerous lesions (CIN grade 2 or 3) or cervical cancer.
Hysterectomy for Benign Conditions: Women who have had a total hysterectomy for non-cancerous reasons typically do not need further Pap tests.

Factors That May Require Continued Screening

Some women over 65 need to continue regular cervical cancer screening. Your doctor will assess your individual risk factors, which include:

A history of cervical cancer or high-grade abnormal Pap tests within the last 20 years.
A weakened immune system due to conditions like HIV or treatments such as chemotherapy.
Exposure to diethylstilbestrol (DES) before birth.
New or multiple sexual partners, which increases the risk of new HPV exposure.

Pap Test vs. Co-Testing

For women under 65, screening options often include co-testing, which combines a Pap and HPV test. Understanding the differences is relevant for those requiring screening after 65.


Feature	Pap Test Only	Co-Testing (Pap + HPV)
Detects	Abnormal cervical cells	Abnormal cells AND high-risk HPV types
Frequency (Age 30-65)	Every 3 years	Every 5 years
Main Advantage	Identifies potential cell changes	Identifies the root cause (HPV) for most changes
Screening After 65	May be stopped based on normal history	May be stopped based on negative co-test history

The Role of the Annual Gynecological Exam

Regular gynecological care remains important, even if Pap smear frequency changes. Many experts recommend an annual wellness visit regardless of your Pap smear schedule for several reasons:

General Health Discussion: These visits are an opportunity to discuss concerns like menopause, bladder health, bone density, or sexual function.
Other Screenings: Your doctor can also address other vital screenings, such as mammograms, colorectal cancer screening, and blood pressure checks.
Risk Re-Evaluation: Your doctor can reassess your risk factors for cervical cancer or other conditions based on any changes in your health history.

The Decision to Stop Screening: A Shared Choice

Deciding to stop Pap smears should be a joint decision with your healthcare provider, based on a review of your medical history and test results. Do not stop screening based solely on age, particularly if you have a history of abnormal results or other risk factors.

What to Discuss with Your Doctor

Review past results: Confirm recent negative Pap and HPV tests with your doctor.
Evaluate risk factors: Share your full medical history, including any immune system issues or prior treatments.
Discuss concerns: Talk to your doctor about any anxieties about stopping screening.
Consider other screenings: Discuss other important health screenings needed with age.

For more detailed information, consult authoritative sources and discuss your specific situation with a healthcare professional. You can read more about cervical cancer screening guidelines from sources like Mayo Clinic News Network and others.

Conclusion: Personalizing Your Preventive Care

For many older women, routine Pap smears are no longer necessary, thanks to a better understanding of cervical cancer progression. Knowing how often an older woman should have a Pap smear depends on her health history and risk factors. Stopping screening after age 65 is an option for low-risk women with adequate negative tests. However, continued regular gynecological exams are still recommended for other aging health concerns. Working with your doctor ensures you make an informed decision for your health.

Frequently Asked Questions

Women over 65 can generally stop Pap smears if they have a history of three consecutive negative Pap results or two consecutive negative co-test results within the last 10 years, and no history of high-grade cervical abnormalities or cancer.

No. The guidelines state that screening can be stopped, but it is not mandatory. Women with risk factors, such as a history of abnormal results or a compromised immune system, should continue screening as recommended by their doctor.

Co-testing involves a Pap smear and an HPV test performed together. For women aged 30-65, it's a recommended option every five years. It can be a part of the screening history that allows older women to stop testing if results are negative.

If you had a total hysterectomy (removal of both uterus and cervix) for non-cancerous reasons, you do not need a Pap smear. If you have a history of cervical cancer or precancerous lesions, your doctor may recommend continued vaginal cuff smears.

Factors requiring continued screening include a history of high-grade abnormal Pap results or cervical cancer within the last 20 years, a compromised immune system (e.g., HIV), or exposure to DES.

Yes. Even if you no longer need Pap smears, annual wellness exams are important. They provide an opportunity to discuss other health concerns, such as menopause, and to conduct other necessary screenings.

You should discuss this with your doctor. They can review your medical records to confirm if you have met the criteria of multiple consecutive negative tests over the past decade.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.