Diagnosis
Smear test: Everything you need to know before your appointment
Article produced in association with Spital Clinic
Cervical screening saves thousands of lives from cervical cancer in the UK every year.
The programme has changed significantly in recent years, and understanding what it now involves — and what your results actually mean — is probably the most useful preparation you can do before your appointment.
Why Cervical Screening Exists — and What Changed in 2025
The NHS cervical screening programme now uses HPV primary screening — a method NHS England describes as testing for the human papillomavirus (HPV) rather than looking directly for abnormal cells.
If HPV is not found, the sample is not examined further; if HPV is found, the same sample is then checked for cell changes.
The reason HPV sits at the centre of this approach is straightforward. Nearly all cervical cancers are caused by certain high-risk types of HPV — and HPV is extremely common.
Most people encounter some form of it during their lives, and the body usually clears it without any treatment.
The problem arises when high-risk HPV persists, because over time it can cause cell changes in the cervix that, if left undetected, may eventually develop into cancer.
Cervical screening is therefore a prevention test, not a cancer diagnosis. Its purpose is to find those cell changes early, when treatment is straightforward and effective.
A significant change took effect in England on 1 July 2025.
The screening interval for those aged 25–49 was extended from three years to five years, in line with the 50–64 age group — so everyone aged 25 to 64 in England is now invited every five years.
The interval in Northern Ireland currently differs; Cancer Research UK has current details.
Who Is Invited and How to Book
NHS England invites everyone with a cervix aged 25 to 64, with the first letter usually arriving a few months before a person’s 25th birthday.
Invitations are sent automatically and are linked to GP registration — the simplest way to make sure yours arrives is to be registered with a GP and keep your contact details up to date. If your invitation hasn’t come through, any GP surgery can arrange an appointment.
Trans men and non-binary people registered as female with their GP will receive invitations automatically.
Those registered as male will not — but can self-refer through the NHS cervical screening programme website or ask their GP to arrange a test.
People over 65 are not routinely invited but are not excluded.
Anyone who has never been screened, or whose most recent result was abnormal, can request screening through their GP or a clinic.
Appointments are most commonly offered at GP surgeries, carried out by a nurse or doctor.
For those who prefer a different setting, shorter waits, or an appointment outside NHS hours, a private smear test can be arranged through specialist gynaecology clinics, often within a few days.
What Happens at a Smear Test Appointment
The test itself takes less than five minutes, with the full appointment lasting around ten minutes.
Knowing what happens — step by step — removes most of the uncertainty that makes it feel more daunting than it actually is.
You undress from the waist down and lie on an examination table, knees bent and falling gently apart.
The nurse or doctor applies a little lubricant and gently inserts a small speculum, which is opened just enough to make the cervix visible.
A small, soft brush sweeps a cell sample from the surface of the cervix. The speculum is removed, and you get dressed.
That is the entirety of the test.
A little preparation helps both comfort and sample quality.
Avoid vaginal medicines, lubricants, and creams for at least two days beforehand, as residue can interfere with the results. Avoid scheduling during your period for the same reason.
Loose-fitting clothing — a skirt or wide-leg trousers — makes undressing and repositioning much easier.
If you are going through the menopause, vaginal dryness can make speculum insertion uncomfortable.
Cancer Research UK notes that using a short course of oestrogen cream or pessaries for around two weeks beforehand can help considerably — though stop two days before the appointment to avoid affecting the sample.
It is worth mentioning to your GP when you book.
Most people feel some pressure or mild discomfort, but it does not usually hurt.
If you find it painful, you can ask for a smaller speculum, insert it yourself, or try lying on your side — all are standard adjustments. Light spotting afterwards is normal and usually clears within a few hours. You can ask to stop at any point.
Understanding Your Results
The most common result — received by 87 in every 100 people screened — is HPV not found.
That means no high-risk HPV was detected, your risk of developing cervical cancer before the next screen is very low, and nothing further is needed until your next invitation arrives in five years.
The other results fall into two categories. Nine in every 100 people are told HPV was found, but no cell changes were detected.
This is not a cancer result and does not require immediate treatment — it means high-risk HPV is present and the cervix is being monitored.
The pathway is a repeat screen at one year; if HPV is still present, another repeat at two years. Only if it persists at that point is a colposcopy referral made.
Four in every 100 people receive an HPV-positive result alongside detected cell changes, and are referred directly for colposcopy.
That referral is not a diagnosis of cancer.
A colposcopy is a closer examination of the cervix, carried out in a clinic using a magnifying device, allowing a clinician to look in detail at any flagged cell changes.
Most people who attend colposcopy do not have cervical cancer — NHS England is clear on this. If a biopsy is taken or cells are removed, there is a small risk of bleeding and infection, both well-managed.
Those who prefer not to wait for an NHS appointment can access a private colposcopy at specialist clinics.
Results usually arrive by post or through the NHS App within two to six weeks. Samples are kept for ten years.
HPV can remain in the body for many years without symptoms, so a positive result says nothing about recent exposure or transmission history.
HPV, the Vaccine, and When to See a GP Without Waiting
Nearly all cases of cervical cancer are linked to high-risk HPV.
The virus spreads through skin-to-skin genital contact, vaginal, anal or oral sex, and sharing sex toys — it does not require penetrative sex to pass between people. The vast majority of people who carry it clear it naturally and will never know they had it.
The UK’s HPV vaccination programme, which began in 2008, has meaningfully reduced risk in younger age groups.
But vaccinated people still need to attend cervical screening — the vaccine does not protect against all high-risk HPV types. Vaccination and screening work together; one does not replace the other.
Cervical screening runs on a schedule, but some symptoms need attention straight away — do not wait for your routine invitation.
According to NHS England, these include unusual vaginal bleeding, bleeding after sex, bleeding during or after the menopause, heavier periods than usual, changes in vaginal discharge, pain during sex, or persistent lower back or pelvic pain.
These symptoms do not confirm anything, but they need investigating without delay.
Attending every invitation remains the single most important thing anyone in the eligible age group can do — and with the 2025 extension to five-year intervals, each appointment now covers a longer window than it once did.
The extension of the English screening interval to five years is backed by strong evidence about the accuracy of HPV primary screening.
Simply turning up remains, by some margin, the most protective thing anyone in the eligible age group can do.
This article is for informational purposes only and does not constitute medical advice. For personal health concerns, consult a qualified healthcare professional. Cervical screening eligibility and intervals may vary; refer to current NHS guidance or your GP for the most up-to-date information applicable to your circumstances. This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
A vaccine trial will test whether an mRNA jab can help stop precancerous cells developing into bowel and ovarian cancer in people with Lynch syndrome.
The first stage is due to launch this summer and will assess whether the jab can train the immune system to recognise and eliminate precancerous cells before cancer develops.
Around 175,000 people in England have Lynch syndrome, but only five per cent, or around 10,000 people, know they have it.
The inherited condition increases the risk of developing bowel cancer by 80 per cent and is linked to around 1,100 bowel cancer cases each year.
Lynch syndrome is also linked to a far higher risk of bowel, womb and ovarian cancer, alongside other types including stomach, pancreatic, kidney and skin cancer.
While the syndrome does not directly cause cancer, the genetic changes can lead to more abnormal cells developing, which then multiply and increase the risk of cancers such as bowel, prostate and endometrial cancer.
It is caused by an alteration in a mismatch repair gene. Carriers do not have any symptoms.
The new Intercept-Lynch trial is part of a scientific collaboration between the University of Oxford and Moderna, while Cancer Research UK has backed the vaccine’s development.
Once patients receive the new mRNA-4194 jab, experts will analyse their immune responses, assess the best dose and check whether the jab is safe.
The second phase of the study will include multiple centres across the UK, including Oxford, and is expected to begin in 2027.
The aim of the trial is to train the immune system with a vaccine to recognise abnormalities and stop them developing into cancer.
Professor David Church, Cancer Research UK senior cancer research fellow in the University of Oxford’s centre for human genetics and lead investigator of the trial, said: “People with Lynch syndrome are at risk of cancers over their entire lives.
“So, it’s very common, for instance, a woman to have a first cancer of her womb, and then some years later have a bowel cancer, or vice versa.
“The targets we’ve chosen for the vaccine were chosen based on their sharedness across multiple cancer types in Lynch syndrome, so we think they should provide broad protection, if the vaccine works.”
In people with Lynch syndrome, mutations can build up, making the cells containing them more likely to turn into cancerous cells.
However, those mutations can be made visible to the immune system and, with enough stimulation, the immune system can attack the abnormal cells and stop cancer from forming.
Professor Church said the mRNA jab acts as “an instruction manual” for the body to attack precancerous cells.
He added that, as with many vaccines, patients may need a booster jab at some stage.
On whether similar approaches could help prevent cancers not caused by Lynch syndrome, Professor Church said: “In terms of proof of principle that we can train the immune system to recognise these cancer-associated alterations and enhance the immune response against them to prevent these pre-cancers or prevent the progression of pre-cancer to cancer, that proof of principle should give us insights that are generalisable.”
David Berman, chief development officer at Moderna, said: “By applying mRNA technology earlier in the patient journey, we aim to harness the immune system when it can have the greatest impact.
“We are proud to bring this innovation to the UK, building on our long-standing collaboration with leading UK institutions to advance mRNA research and development.”
Changes in lymph nodes may help show which breast cancer patients face higher or lower risk of the disease spreading, researchers have found.
The findings could support more tailored care, new treatments and help more people avoid unnecessary treatment.
Dr Simon Vincent is chief scientific officer at Breast Cancer Now, which funded the research:
He said: “These findings suggest that changes to the structure of the lymph nodes are more than just a consequence of the cancer. They can also play an active role in helping breast cancer progress.
“With one person tragically dying from breast cancer every 45 minutes in the UK, we urgently need research like this so that we can better understand who is most at risk of their cancer progressing and becoming incurable. Only then we can find ways to stop it.
“With a better understanding of how lymph nodes change as breast cancer spreads, we could find new targets for future treatments for types of breast cancer that are harder to treat.”
Lymph nodes, a key part of the immune system, help the body fight infections and cancer. In breast cancer, the lymph nodes in the armpit are often the first place the disease spreads to.
At the moment, everyone with invasive breast cancer has to undergo surgery to remove lymph nodes so doctors can check for cancer cells.
Invasive breast cancer means cancer that has spread beyond where it first developed in the breast into nearby tissue.
While this is effective, it can lead to long-term side effects such as swelling of the arm, known as lymphoedema, and may be unnecessary for some patients, particularly those with early-stage disease or those whose cancer responds well to treatment.
The study analysed 331 lymph node samples from people with different types of breast cancer and compared them with healthy lymph nodes from people free from the disease.
It found that breast cancer could change the structure of a network that supports the lymph nodes.
Crucially, some of these changes could occur before doctors were able to spot any cancer cells in the network.
Some changes were linked to a better chance of survival, while others were associated with a poorer prognosis.
Dr Amy Llewellyn and Dr Kalnisha Naidoo from King’s College London, together with professor Sophie Acton at University College London, compared the 331 samples with healthy lymph nodes in people free from the disease.
They looked at fibroblastic reticular cells, known as FRCs, a group of cells in lymph nodes that provide their structure, control fluid flow and activate different immune cells.
The study showed that the structure of this FRC network could change before the cancer had spread and differed depending on the type of breast cancer, any spread and whether someone had received chemotherapy.
Chemotherapy uses medicines to kill cancer cells or slow their growth.
The researchers said the findings could help doctors better understand who is most at risk of breast cancer spreading.
Dr Llewellyn said the first large-scale analysis of FRC in human lymph node tissue from breast cancer patients was addressing the “urgent need” for a better understanding of the area’s biology.
Article produced in association with Spital Clinic
AMH has become one of the most-requested blood tests in private women’s health. The number it gives back is useful, but only when it is read in context.
AMH testing in the UK has gone mainstream over the past few years. Home-testing kits sell it as a snapshot of “your fertility”.
Private clinics include it in screening packages. On social media, individual AMH results are now routinely treated as a verdict on whether a woman will be able to have children.
That reading isn’t accurate. Anti-Müllerian Hormone (AMH) does carry useful information, but only inside a wider clinical picture.
Looked at on its own, it produces a lot of unnecessary anxiety, and often hides the questions that matter more.
What AMH measures
AMH is a hormone produced by the small follicles in the ovaries, the ones that haven’t yet been recruited for ovulation. Because these follicles are relatively stable across the menstrual cycle, the test can be done on any day, without needing to be timed to a period.
A higher AMH level tends to indicate a larger pool of these follicles. A lower level suggests the pool is smaller. That, broadly, is what the result shows.
The HFEA, the UK’s independent regulator of fertility treatment, describes AMH as an indicator of ovarian reserve, while making clear that fertility test results of this kind “are not guaranteed” as a predictor of fertility outcomes.
Put simply: AMH is a count of what is there. It says nothing about how well the body will use it, and it cannot predict if or when conception will happen.
Where AMH fits in a modern fertility assessment
In current UK private practice, AMH is rarely tested in isolation. A meaningful fertility assessment will pair it with a fuller hormone profile (FSH, LH, oestradiol, prolactin and thyroid function), along with markers such as Day 21 progesterone, vitamin D and rubella immunity where relevant.
This is the structure used in a trying-to-conceive screening, and there is a reason for it: each of these tests answers a different question that AMH on its own cannot.
It is this combination, not the AMH number on its own, that gives a clinician enough information to say anything meaningful about an individual’s reproductive picture.
Misconception 1: “A low AMH means natural pregnancy isn’t possible”
This is the misconception that causes the most distress, and it is consistently wrong.
Several large prospective studies of women in their 30s and 40s trying to conceive naturally have found that women whose biomarkers, including AMH, pointed to a diminished ovarian reserve were no less likely to conceive within twelve cycles than women with reassuring results.
That is why neither UK regulators nor national guidance treat AMH as a test that can predict natural fertility in women who have no known infertility issue.
The reason is simple. Natural conception only requires one good egg, released in a normal cycle, in the right window.
AMH doesn’t measure egg quality, and it doesn’t reveal whether ovulation is happening. A woman with low AMH may still ovulate every month with high-quality eggs.
A woman with high AMH (often the pattern seen in polycystic ovary syndrome) may not be ovulating regularly at all.
The NHS emphasises that age is the strongest single predictor of natural fertility. A 35-year-old with a low AMH and regular cycles is, on average, more likely to conceive naturally than a 40-year-old with a normal AMH and irregular ones.
If AMH comes back low for someone who is trying to conceive, the more useful question isn’t whether pregnancy is still possible (the answer is almost always yes), but whether there is reason to investigate the wider picture now rather than waiting twelve months.
Misconception 2: “A normal AMH means everything is fine”
The opposite assumption is just as risky.
AMH tells you about egg quantity. It does not tell you about:
- Egg quality, which is closely tied to age
- Whether ovulation is happening regularly
- Whether the fallopian tubes are open
- Whether there are structural issues such as fibroids, polyps, ovarian cysts or endometriosis
- Sperm parameters in a male partner
- Whether implantation will succeed
A reassuringly normal AMH at 38 still sits alongside age-related changes in egg quality. A slightly lower-than-average AMH at 28 may carry no real-world implications at all.
That is why no UK clinical body recommends AMH as a routine screening test for healthy women who have no fertility concerns. NICE’s fertility guideline, NG73, treats AMH as one component of a broader investigation, not as a verdict in itself.
Imaging is the natural counterpart to the blood test. A transvaginal pelvic ultrasound directly visualises the small follicles that produce AMH, the antral follicle count. It also picks up structural findings a blood test will never reveal, including ovarian cysts, fibroids, polycystic ovarian morphology, and abnormalities in the uterine cavity. A full ovarian reserve assessment normally includes both.
Where the AMH number actually matters
There are three settings in which AMH carries real, decision-relevant information.
Before IVF or egg freezing. AMH is one of the better predictors of how the ovaries are likely to respond to stimulation medication.
A higher AMH usually predicts more eggs collected per cycle, and a very low AMH may shape decisions about protocol or whether to bank cycles before treatment.
During a fertility investigation. If a couple has been trying for twelve months, or six months if the woman is over 35, AMH becomes part of a wider assessment that should also include ovarian ultrasound, a fuller hormone profile, semen analysis and an assessment of tubal patency.
As context for women planning ahead. Women who want to understand their reproductive options before they are ready to conceive (for example, ahead of a decision about egg freezing) can find AMH informative, provided it is interpreted alongside age, antral follicle count, and other markers, by a clinician who can place the number in context.
Reading the number properly
For anyone who has had an AMH test, three things make the result more useful:
- Pair it with age. A “normal” AMH at 25 means something very different from the same number at 38. Age is doing more work in the equation than the AMH value itself.
- Pair it with imaging. Ultrasound shows what is actually in the ovaries today, rather than relying on a single biochemical marker.
- Read it with a clinician. A number on a screen, with no context, no follow-up and no plan, is the worst way to use a test that, properly interpreted, can be very informative.
AMH is a useful tool. It just isn’t the headline it has often been turned into.
Disclaimer
This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment. Clinical guidance referenced reflects published HFEA, NHS and NICE information available as at May 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article. This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes. Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
Menopause2 weeks agoPerimenopause misinformation ‘putting women at risk’
Hormonal health3 weeks agoNHS urged to update website following renaming of PCOS
News2 weeks agoWomen still being failed when they reach menopause, experts say
Insight4 weeks agoPCOS renamed after decade-long campaign to end ‘cyst’ misconception
Entrepreneur2 weeks agoWomen’s Health Innovation Summit opens submissions for 2026 Innovation Showcase
Insight1 week agoBritish women among angriest in Europe, health survey reveals
News2 weeks agoThree menopause innovators shortlisted for Femtech World Award
Fertility4 weeks agoAI could transform ovarian care through personalisation, study finds