Share on PinterestCould testing menstrual blood offer a less invasive option for HPV screening? Image credit: Maskot/Getty Images
- A new study suggests that testing menstrual blood for human papillomavirus (HPV) could offer a viable alternative to clinician-collected cervical samples.
- Findings suggest accuracy is similar between menstrual blood samples and standard cervical samples for detecting high-grade precancerous lesions.
- Self-collection during menstruation could lower barriers to cervical cancer screening by offering a noninvasive, more convenient option.
- The approach may help increase screening uptake, particularly among people who face access, comfort, or privacy challenges with traditional screening methods.
HPV is a common and usually asymptomatic infection that can affect both males and females. While most infections typically clear on their own, certain high-risk strains can cause cervical cancer.
Evidence highlights that cervical cancer is the fourth most common cancer in women. Thus, cervical cancer screening forms an important part of routine healthcare for people who have a cervix.
For those aged 30 to 65, health experts recommend cervical cancer screening using an HPV test every 5 years. This test involves examining a sample of cervical cells for HPV strains that can cause cell changes on the cervix.
However, many barriers exist for cervical screening, and these factors can contribute to decisions to decline attendance. These can include pain and discomfort, embarrassment, previous negative experiences, trauma, or the unavailability of female practitioners.
A new study, published in The British Medical Journal (BMJ), could offer a shift in cervical cancer screening, suggesting that blood collected via a standard sanitary product could accurately detect HPV compared with clinician-obtained cervical samples.
Menstrual blood testing may thus offer a noninvasive, convenient alternative to traditional screening, with diagnostic performance that closely mirrors current methods.
Menstrual blood testing about as accurate as cervical sample testing
The study enrolled over 3,000 women aged 20 to 54 years across both urban and rural communities in Hubei Province, China, between 2021 and 2025. Each participant provided three different samples.
These included menstrual blood collected using a minipad affixed to a standard sanitary pad, and two clinician-collected cervical samples.
The research team then compared the performance of HPV testing across the different sample types, focusing on sensitivity (the ability to correctly identify individuals with high-grade cervical lesions) and specificity (the ability to correctly identify those without disease).
The sensitivity of menstrual blood samples was 94.7%, which was slightly higher than the 92.1% result for clinician-collected cervical samples. However, specificity was slightly lower, with 89.1% for menstrual blood and 90% for cervical samples.
Both approaches showed identical negative predictive values of 99.9%, indicating that a negative result reliably ruled out significant cervical lesions. Positive predictive values and referral rates for follow-up testing were also similar.
These results suggest menstrual blood testing could offer an effective and noninvasive alternative for identifying individuals with clinically relevant HPV infections and warrants further investigation.
Potential changes to routine screening
HPV testing is central to modern cervical cancer screening because persistent infection with high-risk HPV types can lead to cervical cancer.
Yet not all people with a cervix attend routine screening, often due to concerns about discomfort, stigma, privacy, or accessibility.
By enabling self-collection of menstrual blood at home, this approach could reduce barriers and potentially streamline screening programs without compromising accuracy.
Anand Singh, BSc, MBBS, MRCOG, a consultant gynecologist at the Cadogan Clinic, who was not involved in the study, noted that this method could add to self-sampling approaches already aiming to reduce barriers:
“Menstrual blood-based HPV testing could fit into this evolving pathway in several ways. Firstly, as an additional self-sampling option alongside or instead of vaginal swabs, particularly for those who find current methods invasive or uncomfortable.”
“Second, as a home-based, mail-in screening tool integrated into screening invitations, perhaps targeted at non-attenders. Finally, as an alternative primary screening tool in current national guidelines,” said Singh.
“One major advantage of menstrual blood–based HPV testing is its non-invasive nature and convenience,” he added.
“Unlike conventional smear tests, no internal pelvic examination is required; testing is done discreetly during normal menstruation at home, which could appeal to people deterred by embarrassment, discomfort, previous trauma, or cultural concerns — all very common reasons for lower uptake,” the gynecologist explained.
However, he also highlighted that further evaluation and validation will be necessary before this method can be integrated into national screening programs.
Improving HPV testing accessibility
In addition to reducing barriers, offering menstrual blood testing may also enhance uptake and encourage more people to participate in screening.
Krishnansu Tewari, MD, a gynecologic oncology surgeon at MemorialCare Todd Cancer Institute Women’s Specialty Center at Long Beach Medical Center in Long Beach, CA, who was likewise not involved in the study, added:
“It may have a role in terms of the patient experience. At this time self-collection of HPV testing has been shown to benefit patients in rural/underserved areas but if patients are already wearing a menstrual mini-pad this may be easier than self-collection procedures.”
For the study, a WeChat mobile app was also available to access test results and advice from healthcare providers. The study authors note that the utility of integrating results with a mobile health app could potentially further improve accessibility and follow-up.
Limitations and next steps
Although promising, it is important to highlight that these findings are observational. As such, the authors caution that causal conclusions are premature.
For future studies, larger, diverse populations across multiple countries will be important to confirm these results and determine real-world screening effectiveness.
Although this approach may offer a viable alternative to those who avoid invasive tests due to discomfort, privacy concerns, cultural stigma, or previous trauma, it may not be suitable for everyone as Singh explained:
“[T]his method is only applicable to those who are actively menstruating with regular cycles; it would not directly serve post-menopausal individuals, those on amenorrhoea-inducing hormonal regimes, and be potentially more inconvenient for women with very irregular and unpredictable menstruation.”
Similarly, Tewari also noted that this method may miss individuals who do not menstruate regularly. He also added that “this method may be appropriate for menstruating patients who otherwise fit the criteria for self-collection for HPV testing.”
“However, what is missing is any report on patient-reported outcomes, which would allow us to understand how difficult/cumbersome or how relatively easy HPV testing of menstrual blood using mini-pad to collect the sample is,” Tewari said.
If the results are validated in broader settings, menstrual blood-based HPV testing could eventually become an alternative or adjunct to clinc-based cervical screening, offering a practical option for those who face barriers to traditional care.
