As a woman becomes older and her supply of eggs diminishes, she eventually enters menopause, when her body undergoes a number of changes. Most women enter menopause between the ages of 45 and 55, although this varies. Some of the changes that menopause causes are obvious, while others can be more subtle. For example, menopause leads to changes in the uterine cervix that aren't apparent externally but may have significant effects.
The cervix gets its name from the Latin word for "neck," because it's the necklike, lowermost part of the uterus that opens into the vagina. At birth, a baby passes through the canal in the center of the cervix, called the endocervical canal. Because the cervix needs to support a fetus during pregnancy and keep it inside the uterus while it enlarges, its wall is filled with strong, fibrous tissue that contains abundant muscle.
The canal in the upper part of the cervix, called the endocervix, is lined with cells that make mucus, while the lower portion, called the ectocervix, is lined with cells specially adapted to withstand surface abrasion, with the junction between the two areas called the transformation zone. Extensive glands beneath the cervical lining produce lubricating mucus that flows into the vagina.
The cervical glands and the cells that line the endocervical canal make mucus in response to the female hormones that are produced by the ovary during the menstrual cycle. After menopause, when a woman's ovaries stop making these hormones, these cells and glands produce less mucus, often leading to dryness in the vagina, where mucus normally acts as a lubricant. A research study published in the October 2001 issue of "Fertility and Sterility" also found that cells lining the cervix change how they interact with each other after menopause, allowing less fluid from the underlying tissues to enter the cervical canal, further contributing to dryness in the vagina. Vaginal dryness can cause discomfort when it's severe, including a sensation of burning or itchiness, or pain during sexual intercourse.
After menopause, the uterus becomes smaller without monthly production of female hormones, although the degree of shrinkage is less in the cervix than in the rest of the uterus. The tissues that make up the cervix generally become thinner and less robust, and the transformation zone where the type of cervical lining changes tend to move higher up and slightly inside the endocervical canal. This change makes this zone more difficult to examine on a special visual exam of the cervix, called a colposcopy.
The endocervical canal or opening into the uterus may also become narrower or even close completely, a situation called cervical stenosis. This is usually not a problem, because regular menstruation ceases once a woman has become menopausal, so menstrual flow no longer needs to drain out of the uterus.
Although a woman no longer has periods after menopause, it's still important for her to visit a gynecological specialist regularly, because an exam that includes a Papanicolaou, or Pap, smear can still detect many possible problems after menopause. In this test, a doctor obtains a tissue sample from the surface of the cervix.
A Pap test can detect cervical cancer, which is the 9th leading cause of cancer deaths for American women and is more often diagnosed at a later stage in older women. This type of cancer is almost always caused by the human papilloma virus.
Other conditions that may be detected with a cervical exam include the presence of benign growths called polyps or other problems that can cause cervical bleeding. If you have any questions about menopause or menopause-related changes in the cervix, discuss these with your health care provider.