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When it comes to your annual well-woman check-up, we know you want to be in and out the door in minutes. This is the most personal of health check-ups after all. While it can bring up subjects that are challenging to face and discuss, it’s important to have an open dialogue with your trusted gynecologist to protect your whole health.
So, what are you holding back? What should you be asking about?
We talked to Anthony Reed, MD, obstetrician and gynecologist with AdventHealth Medical Group, about some important things to discuss with your doctor at your next annual visit.
“Women should ask about the timing of their first mammogram, and at what frequency they should get them thereafter,” recommends Dr. Reed.
The American College of Obstetricians & Gynecologists (ACOG) recommends initiation of mammograms between 40 and 49 years of age. Women with average risk for developing breast cancer should follow up with screening mammograms every one-to-two years after that.
Some of the risk factors that could influence your mammogram recommendations include family history of breast cancer (especially a first-degree relative) and testing positive for a BRCA gene mutation, prior suspicious breast biopsy, early or late menopause, dense breasts, and more. The best determination for when to initiate mammography and how often to be screened can be made by your trusted care provider.
Genetic testing can be a very important step in a woman’s health journey, according to Dr. Reed.
“Talk with your doctor to see if you meet the criteria for genetic testing. There are many genetic tests that can screen for mutations that increase your risk for many types of cancer, not just BRCA. Your doctor can help you determine if genetic testing is right for you, and what type of genetic test is best.”
Dr. Reed adds, “Also ask about how to perform your own breast exams at home. Doing this on a regular basis can help you find any breast changes as soon as possible.”
“Since 2009, the guidelines for pap smear testing between the ages of 21 and 65 recommend a pap smear with cytology every three years,” shares Dr. Reed.
While some women are weary of skipping a year, Dr. Reed reassures us with the science, “If you had a cervical cancer cell today, it would take many years to show up on a pap smear test, so screening every three years is well within range.”
HPV Testing and Vaccination
HPV (or the human papilloma virus) has received a lot of attention because certain strains have been linked to an increased risk of cervical cancer.
Dr. Reed explains, “Depending on your age and risk factors, your gynecologist might order HPV testing along with your pap smear. It is possible that you could get a negative pap smear result, but test positive for HPV, at which point further testing helps determine if you have a high-risk type.”
It’s important to note that if you test positive for HPV it doesn’t mean you will get cervical cancer; it does mean, however, that you could be at a higher risk, and therefore, may require a more frequent screening interval to help protect your health.
One way to decrease HPV risk is with the HPV vaccine, called Gardasil 9.
“The HPV vaccine helps protect women from cancers that are caused by the HPV virus. Gardasil 9 can help prevent 9 cancer-causing types of HPV: 6, 11, 16, 18, 31, 33, 45, 52 and 58. It’s most often recommended from age 11 and into the teen years, but guidelines have changed recently to expand this to even women in their 30s to 50s who are at a higher-risk for getting HPV.”
From childbirth to aging, incontinence can affect woman at any age, and it’s nothing to be ashamed of, says Dr. Reed.
“If you leak when you laugh or pick up something up that’s heavy or find yourself running to the restroom to make it in time, please discuss these symptoms with your doctor. We can offer treatments to help you, many of which are not surgical.”
Starting Annual Woman Care Check-Ups
Mothers might be wondering when they should bring their daughters in for their first annual exam.
Dr. Reed recommends the first visit taking place around age 14 or 15.
He emphasizes, “I really try to connect with my young patients from the beginning and reassure both mom and daughter that this first visit doesn’t need to involve a physical exam. I offer the patient the option to choose whether they want to have mom in the room with them or not. The first several appointments for a young woman are for talking about how their body is changing, as well as how to best protect their health from many different aspects, including safe dating, reproductive health and so on.”
What’s considered normal? Well, that’s a hard answer to give because what’s normal for one woman may be different for another. But in general, there are some warning signs to mention to your doctor.
“Sometimes, patients will mention to me that, like them, their daughter always bleeds very heavily during their menstrual cycles. Sometimes, this leads me to make a referral to a hematologist to test for von Willebrand disease (VWD), which is a genetic disorder caused by lacking a specific clotting protein.”
Dr. Reed further advises, “If your period lasts longer than seven days, or your cycle occurs more frequently than every 21 to 235 days, call us and let us know. Also, if you’re saturating more than one pad an hour, that’s something we should know, too.”
Some patients whose menstrual pain is not relieved by over the counter pain relievers or who experience excessive period volume could be showing warning signs of endometriosis. Your gynecologist can assess your risk for endometriosis and offer solutions to help relieve your discomfort.
If you’re trying to conceive, when should you be worried about infertility? This is a common question that women want to ask.
Dr. Reed explains that for healthy women with no underlying conditions, they have a 20% chance of conceiving every month with an 85 to 90% chance of conceiving within 12 months.
“If after 12 months a woman is still having difficulty conceiving, we will talk in detail about the best way to boost their odds — sometimes, it’s a simple fix related to the timing of their cycle, while other times, there’s a condition like PCOS or endometriosis to address first.”
Even if you’re not due for a pap test, should you still go see your GYN? The answer is yes.
Dr. Reed concludes, “It’s important for women to come every year for their well-woman check-up because it creates the opportunity for us to have an open dialogue about their overall health and life. From breast exams to family planning and all of the things we’ve talked about today, there’s always something to discuss that can help promote and protect your whole health.”
Your whole health is our priority and our women’s health navigator is here to help you. She can assist you with making your annual check-up appointment, finding the care experts you need, answering your health questions and coordinating your care between multiple providers.
To speak with our women’s health navigator and take charge of your health today, call