Introduction Cervical screening and colposcopy in postmenopausal women can present challenges. The impact of low oestrogen levels on the cervical epithelium can mimic low grade cytological changes and genitourinary symptoms of the menopause can lead to patient discomfort. Although evidence supports offering cervical screening in this cohort, a type 3 transformation zone leading to unsatisfactory colposcopy is prevalent after the menopause.

Methods This is a retrospective cohort study of 276 consecutive postmenopausal women who had their first visit to the colposcopy clinic between 2020 and 2023. The aim of this audit was to evaluate the reason for referral and colposcopic and histological findings for these women.

Results The mean age of the cohort was 57 (range 43-79). There were 39 referrals requesting screening due to difficulties obtaining a sample in the community and 237 referrals for colposcopy. Reasons for colposcopy referral included HPV positivity on two consecutive tests with negative cytology (32% n=76) and HPV positive/atypical squamous cells of undetermined significance or low grade cytology (35% n=83). HPV positive/high grade cytology accounted for 6% (n=14) of referrals. ‘Suspicious cervix’ at time of screening accounted for 18% of referrals (n=42). Of those who underwent colposcopy, 80% had a satisfactory colposcopic exam . A diagnosis of cervical cancer or high grade disease was found in 8% (19/237).

Conclusion/Implications This audit provides an insight into colposcopy in the postmenopausal population. Whereas screening in this age group can be challenging, this study shows evidence of the presence of significant pathology.