Hello, and welcome back to Making Sense of Women's Health. I am Roberta Bass, and today we are talking about a really important topic that can save lives, and that is cervical health.

So, January the 20th to 26th marks Cervical Cancer Prevention Week. So this is the perfect time to shine a spotlight on this crucial issue. Cervical cancer is one of the most preventable cancers, yet many women miss out on potentially life-saving screening tests.

In the UK, women aged 25 to 64 are invited to cervical screenings every three to five years, depending on your age. This is a really simple test. I know it can be embarrassing, but it can detect abnormal changes in the cervix before they develop into cancer.

However, it is important to remember though that not all cervical health issues mean cancer, but many symptoms like bleeding or pain can be caused by non-cancerous conditions, including infections or hormonal changes.

So, in today's episode, we're going to discuss the common causes of those symptoms, the role of menopause, and most importantly, why regular smear tests are vital for your health.

Smear Tests and Why They’re Vital
When I assess patients in my clinic, I always ask if they are up to date with their smear tests, and most of the time, worryingly, the answer is no. Sometimes that's due to the fact that they've been pregnant when they've been called, or they've just not got round to it.

Some is because they're too worried and scared to go and have it done. Sometimes it's actually because they're too young. But it is such a vital part of maintaining your cervical health.

Common Cervical Health Concerns

One of the most common cervical health concerns is actually non-cancerous. It is called cervicitis, and this actually refers to inflammation of the cervix. This is often caused by infections like chlamydia or gonorrhea, and it can result in symptoms such as:

• An unusual discharge
• Bleeding after intercourse
• Mild pelvic pain

Most cases are treatable with antibiotics. So, if you are noticing any of those symptoms, it's really important that you go and see the doctor.

Cervical polyps are another thing. These are small benign growths that can form on the cervix. They are quite common, but they are rarely harmful. But they can cause some light bleeding or spotting.

Cervical ectropion, also known as cervical erosion—now, this occurs when you’ve got, like, the soft glandular cells that are normally actually within the cervical canal. They’re just growing on the outer surface of the cervix.

It is more common in younger women and during pregnancy. It is also quite common if you use hormonal contraception. It can cause some spotting after intercourse and, again, an increase in discharge. It is harmless and often resolves on its own.

Cervical Cancer

The biggie then is cervical cancer. So, we really need to know the symptoms. They do overlap.

Cervical cancer is when we get abnormal cells in the cervix. They’re often caused by the high-risk HPV strains. So, while in the early stages, cervical cancer is often asymptomatic—meaning you don’t get any symptoms—recognising symptoms as the disease progresses is really crucial for early diagnosis and treatment, particularly as we’re thinking, we’re getting these smear tests routinely every three to five years.

If you’re getting symptoms between those times, then you need to get it checked out.

Symptoms to Watch For:

• Abnormal vaginal bleeding—this could be between periods if you’re still having periods, or after intercourse.
• Unusual discharge—watery, bloody, or with a foul smell.
• Pain, particularly pelvic pain unrelated to menstruation or pain during intercourse.

In more advanced stages of cervical cancer, you may also get:

• Leg swelling
• Urinary or bowel changes
• Blood in urine
• Worsening pain

We mentioned HPV—so one of the leading causes of cervical cancer is HPV 16 or 18. Most HPV infections do clear up on their own, but persistent infections can cause these abnormal cell changes.

Smoking, as with so many things, is another big risk factor. Smoking doubles the risk of cervical cancer by weakening the immune system, reducing the ability to fight HPV.

HPV and Risk Factors
Other things that also weaken the immune system, such as HIV or AIDS, or medications that suppress the immune system—there are certain ones for rheumatoid arthritis and other rheumatological conditions that suppress the immune system. They can all increase the risk of developing cervical cancer.

Early exposure to HPV or having multiple partners also elevates the risk, and also long-term use of oral contraceptives is associated with a slightly increased risk if it’s used for more than five years.

A big thing that’s going to increase your risk is if you’re not having regular screening. So, women who miss screenings are more likely to have a late-stage diagnosis. So, if you catch it early, before you even get any symptoms, if you’re having those regular screens, then it’s much more treatable.

HPV is the leading cause of cervical cancer, and most people will have it at some point in their lives because it is passed through sexual contact. That is why now teenagers, younger people, are offered the vaccinations. I know both of my children have had them at school, trying to even prevent that from happening. And so, it’s a great way for us to think about preventing HPV and obviously reducing the risk generally of cervical cancer.

Adults may be offered it as well, so it’s worth discussing that with your GP if you haven’t had the vaccine.

Menopause and Cervical Health
We’ll kind of come back around to other issues now with cervical health, so particularly thinking of menopause. So, we’ve listed a few already—things that can cause problems like infections, like polyps, like cancer—but also menopause hormonal changes can affect your cervical health.

As estrogen levels decline, the vagina and cervical tissues can become thinner, drier, and more fragile, and it’s often known as vaginal atrophy. So, this can again lead to:

• Pain during intercourse
• An unusual discharge
• Spotting or bleeding after sex

While these symptoms are often caused by menopausal changes, it is really important to get them checked out because, as you’ve heard, these symptoms could also mean infection or abnormal growths or cancer.

But if it’s purely menopause-related, treatments like topical estrogen creams or sometimes pessaries—so you get like a little tablet that inserts vaginally—can be really helpful. If you can’t have local HRT, so you can’t have the cream, then there are vaginal moisturisers that can be really helpful as well to help relieve some of those symptoms.

Red Flags to Watch For
Postmenopausal bleeding always needs to be investigated. Whether you think it’s due to vaginal atrophy or not, it’s essential to get it checked out.

There are things that we call red flags, and as you possibly can imagine, these are things that we look out for when we need medical attention—either urgently or at least kind of go and see somebody fairly soon.

And we’ve mentioned a lot of these things as we’ve gone along, but I just want you to be clear with what you’re taking away from this episode.

Examples of Red Flags:

• Bleeding after intercourse. This may well be due to dryness. It may be due to the cells growing in the wrong place or inflammation, but it needs to be looked into.
• Changes to your menstrual cycle. Now, this is difficult coming into perimenopause because it may be that that is normal for perimenopause because it will change. But if you have a regular cycle and then suddenly you have heavier or irregular bleeding, that needs to be looked into.

Conclusion
Thank you so much for joining me today, and I hope that this episode has empowered you to take control of your cervical health. See you next time.