This study correlated the cytological features of cervical swabs from postmenopausal women with the histological findings and the detection of human papillomavirus (HPV) using filter hybridization analysis. Of 17 postmenopausal women seen at colposcopy for an abnormal Papanicolaou (Pap) smear, most often squamous atypia, HPV DNA was detected in one (6%) cervical swab. Biopsy-proven cervical squamous intraepithelial lesions (SILs) were noted in two of the 17 (12%). The HPV DNA detection rate was equivalent to that found in 47 postmenopausal women who had hysterectomies for noncervical disease. The rates of HPV detection and biopsy-proven SIL in premenopausal women seen at colposcopy was 55% and 66%, respectively. The HPV DNA detection rate for postmenopausal women with biopsy-proven SILs as determined by in situ hybridization was 19/26 (73%), which is equivalent to the rate in premenopausal women. It is concluded that squamous atypia in postmenopausal women is rarely associated with either biopsy-proven SIL or HPV DNA detection and thus, in many cases, may represent atrophic changes.