The study compared the diagnostic accuracy of HPV testing from menstrual blood collected by a minipad with cervical samples collected by a physician during cervical cancer screening in China. Participants were 3068 women aged 20-54 years with regular menses between September 2021 and January 2025. The minipad HPV test had a sensitivity of 95% (80% interval 99.7%) for detecting CIN2+, comparable to the clinical test (92.1%, 77.5% to 97.9%; P=1.00). Specificity was lower than with medical sampling (89.1%, 88.0% to 90.2% vs. 90.0%, 88.9% to 91.1%; P=0.001). Negative predictive value was the same (99.9% vs. 99.9% to 100.0%; P=1.00), positive predictive value similar (9.9%, 7.1% to 13.5% vs. 10.4%, 7.4% to 14.3%; P=0.82), and screening effectiveness similar (10.1 vs. 9.6 referrals per CIN2+; P=0.82). HPV positive women or with atypical cells on ThinPrep cytology were referred for colposcopy with biopsy. The study is registered at ClinicalTrials.gov NCT06082765.