February 4, 2026

expert reaction to testing menstrual blood for HPV

A study published in The BMJ looks at testing menstrual blood for human papillomavirus (HPV) during cervical cancer screening.

Marta del Pino, doctor at the Gynaecological Oncology Unit at Hospital Clínic in Barcelona, scientific coordinator at the Clinical Institute of Gynaecology, Obstetrics and Neonatology (ICGON) and associate professor at the University of Barcelona, said:

“The study evaluates whether it is possible to detect human papillomavirus (HPV) in menstrual fluid collected with a “minipad” and compares its performance with cervical sampling performed by professionals to detect precancerous cervical lesions (CIN2+).

“Overall, it is an interesting study because it proposes a non-invasive alternative to conventional HPV detection (performed by a doctor or midwife) and could be particularly useful for women who do not attend screening due to barriers such as discomfort, fear or difficulties in access.

“The study includes a large community sample (more than 3,000 women with regular cycles) and makes a direct comparison with professional sampling. In this context, HPV detection in menstrual samples collected with a mini-pad shows good sensitivity (similar to that of conventional cervical sampling) for identifying CIN2+, with a very high negative predictive value, i.e. a negative result greatly reduces the likelihood of CIN2+ lesions actually being present and can provide a high degree of clinical reassurance. That said, this study cannot be understood as a possible immediate replacement for current screening.

“There are important limitations: it includes only women who menstruate and have regular cycles, and it uses a prototype device that is not commercially available. Furthermore, as in many screening studies, not all women with negative results underwent biopsy; this may introduce verification bias and overestimate the performance of the test. It should also be considered that, by collecting material from the entire genital tract, the test could detect HPV infections that are not in the cervix, increasing false positives. In fact, as with any HPV-based strategy, the positive predictive value (i.e., the probability that a positive result actually corresponds to a CIN2+ lesion) is limited in the general population, and a significant proportion of positive results will not have a lesion.

“Before considering its use in clinical practice, implementation studies in other settings, comparison with other self-sampling methods already available, and cost-effectiveness and care pathway analyses would be necessary. In this context, it should be remembered that other non-invasive strategies with solid evidence already exist. Vaginal self-sampling for HPV, when analysed with PCR-based tests, has shown very similar performance to samples taken by professionals and is already included in international recommendations as an option to increase participation in screening.

“Urine, collected in a standardised manner, is also a promising sample, although with more variable results between studies and often with lower specificity. Therefore, the value of this research is to open up an additional alternative that could be beneficial in certain scenarios, but it still needs replication and implementation research.”

Xavier Bosch, emeritus researcher at the Catalan Institute of Oncology (ICO), principal investigator at the Bellvitge Biomedical Research Institute (IDIBELL) and professor of Health Sciences at the Open University of Catalonia (UOC), said:

“The work is very pioneering, although it is still in the research phase. At the moment, its clinical applications are unclear. These are the main points of interest:

“Menstrual blood, like any cervical-vaginal fluid and urine, can carry cells from the genital/urinary tract, including viral markers (DNA; RNA). Therefore, detection has some value. The importance of the study lies in determining whether this value is equal to the performance of the DNA test in already validated samples (cytology, urine or self-sampling) or whether it identifies some cases that escape conventional sampling.

“It must be demonstrated that blood does not interfere with the measurement of viral markers, a problem that was significant with the first PCR tests.

“Cultural aspects in the study populations should be highlighted. Studies on the acceptability of the procedure compared to medical/self-sampling should be anticipated.

“My first impression is that this is an area where we already have good tests and that collecting menstrual blood may add more confusion than benefit.”

‘Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study’ by Xun Tian et al. was published in the BMJ at 23:30 UK time on Wednesday 4th February 2026. 

Declared interests: 

Marta del Pino: No conflicts of interest.

Xavier Bosch: No conflicts of interest.