Regular gynecological visits are a cornerstone of preventive health care for women. Early detection and treatment of many gyn conditions can minimize their long-term consequences. EVEN THOUGH pap smears are no longer recommended for everyone every year, yearly breast and internal pelvic exams are recommended for all women after the age of 18. Consultation should be scheduled for younger patients if sexual activity is being considered or they are having gyn problems.
It is appropriate for adolescents to begin to build a patient-physician relationship with a gynecologist when they are 13-15 years old. The first visit is intended to establish a rapport with someone who, over time, may become a trusted source of women’s health care information. An internal pelvic exam is not typically performed. Once a young woman feels comfortable enough, an abbreviated exam including a breast exam, abdominal exam and visual inspection of the external genital area will be done.
The pap smear is a screening test that checks for pre-cancer of the cervix. Current pap smear screening guidelines for patients who have never had an abnormal pap smear per the American College of Ob/Gyn (ACOG) are to have them done every 3 years starting at age 21, and then to decrease the frequency to every 5 years starting at age 30. At age 30, a test for high risk HPV (Human Papilloma Virus) is done along with traditional examination of the cervical cells for abnormalities. At present, the screening for HPV is only covered by insurance every 5 years. However, women have the option, per the guidelines, to have pap smears every year without HPV testing. Patients who have had abnormal pap smears, with or without HPV, will have the frequency of their pap smears individualized for their particular circumstances. In addition, your particular practitioner may feel that more frequent surveillance is warranted even without a history of abnormal paps. ACOG also suggests that pap smear testing be stopped completely in woman who have had the cervix removed at the time of hysterectomy, and at the age of 65 for others. Nonetheless, the recommendation is still to have a yearly gyn examination, though Medicare will only cover a routine visit every 2 years.
Pap smears usually identify pre-cancerous cells with more than enough time for treatment to prevent progression to cancer. Because it is a screening rather than a diagnostic test, pap smears can also be read as abnormal because of inflammation, infection, and/or atrophy (a result of decreased estrogen in the body). Sometimes there are really pre-cancerous cells but the changes are mild enough (low-grade changes) to be very likely to go away without treatment. High-grade changes are likely enough to worsen that treatment is recommended. An office procedure called colposcopy with biopsies is the diagnostic test used to tell the difference.
Most women should start getting regular mammograms at the age of 40, every 1-2 years, with yearly testing recommended as of age 50. Having this important breast screening test before age 40 may be appropriate based on a woman’s specific personal and family history. We encourage everyone to do breast self exams as often as needed for patients to learn what is normal for them. After that, self-exams should be done no more than once a month to check for changes. For women having periods, the best time to do them is about a week after one’s period starts. Even doing BSE once every few months could help you identify a problem earlier than your next office exam would allow and that can make a difference!
For information regarding the newest type of mammogram test, see 3D Mammography.
DEXA Bone Density Scans
This test to screen for bone loss (osteopenia and osteoporosis) should be done at age 65. It is not recommended sooner unless there are significant risk factors other than age alone. If the first DEXA is normal, it is very unlikely that osteoporosis will develop over the following 10 year period.
Initial screening colonoscopy is now recommended for everyone at the age of 45, and sooner if indicated because of a positive family history in a parent or sibling. The frequency of later colonoscopy screening is then individualized based on the findings at the initial study and family history. Until recently, the age to start was 50, so please check with your insurance company to confirm coverage for the procedure.
Because high cholesterol, thyroid dysfunction and diabetes are so common, regular labwork is recommended in the absence of any symptoms as follows:
cholesterol testing every 5 years as of age 45,
thyroid stimulating hormone (TSH) every 5 years as of age 50,
a fasting glucose test every 3 years as of age 45.
Screening for diabetes should be done every 1-2 years in women who have had gestational diabetes with one or more of their pregnancies. Likewise, women who had high blood pressures during pregnancy are at increased risk of developing hypertension later and should have their blood pressures checked regularly.
More information regarding current screening recommendations can be found at www.ACOG.org.