In postmenopausal women, the cervix becomes smaller and flattened, so that the vaginal fornices become shallow. The cervix usually looks pale but may be congested at times. The SCJ is usually situated within the endocervical canal and may not be completely visible (type 2 or 3 TZ). The epithelium is thin and gets damaged easily during manipulation. There may be blotches of bleeding beneath the epithelium, which are known as petechial haemorrhagic spots. These haemorrhagic spots should not be confused with punctation.
There is no change in the normal atrophic epithelium after application of acetic acid. The atrophic epithelium does not stain with iodine, because of the loss of glycogen in the superficial cells of the epithelium.