How to Better Prepare for your Gynecological Visit
Hot Flashes. Night sweats. Ceased menstruation. Becoming increasingly moody. Yes, the dreaded menopause could be among you, however, you are not alone. Approximately 80 to 90 percent of women will experience menopausal or postmenopausal symptoms, yet only 20 to 30 percent will actually seek treatment. One way to make this process not as scary is to stop “grinning and bearing it,” and be aware as to what is taking place in your body by knowing exactly what to discuss with your physician at each visit. This way, you can make the most of your appointment time and get answers that will help during this transition.
There is an organized approach to having an effective self-evaluation prior to meeting with your physician and/or gynecologist. Get all of your thoughts in order, take account of your body – from the top on down. Jot down any concerns prior to your visit to be sure you discuss everything with your physician and nothing goes unaddressed. This will relieve you from having those awful “what ifs” that many women often ask themselves.
Discuss any cognitive and emotional changes such as mental fogginess, anxiety, crying, irritability, depression, and memory issues. Do you react differently than you used to? Do you suddenly feel overwhelmed, like a switch just turned on and you start crying? Do you feel something like a panic attack boiling over? Such feelings can be consistent with
hormonal changes that occur during menopausal years and affect you mentally and emotionally. People are often surprised by these changes, especially when they happen gradually over time. It’s important to keep in mind that there may be other contributing factors affecting women during this stage of life – children leaving home, caring for aging parents, changes with work or family, and other medical conditions. Being in touch with both a Primary Care Physician, and an OB/GYN is important during this time as treatment may benefit from a collaborative effort. Individual health providers take the problem as it exists, no matter what the causes are, looking specifically for contributing factors in their area of expertise.
Usually this is more of a primary care issue, but I include it since so many women have thyroid issues and often it comes up during an annual GYN visit. Thyroid dysfunction can cause bleeding changes and worsen other perimenopausal symptoms such as fatigue, hair loss and weight gain.
Osteoporosis and low bone mass (aka osteopenia) are common as people age. Osteoporosis or decreasing bone density can lead to an increased risk of fracture if you fall, which may lead to other complications as you age. Your physician may recommend calcium and vitamin D supplements as well as bone density
screening for high-risk patients. For low-risk women, screenings generally begin at age 65, but those with family history or other risk factors should be screened earlier.
Discuss with your doctor if you notice any breast skin changes, pain, nipple drainage, lumps, bumps or anything else you may be concerned about. Yearly mammogram screenings are recommended, and breast self-exams should be performed at least monthly. It is also important to inform your physician of any family history of breast or ovarian cancers.
Bladder dysfunction is a hot topic for many women as they age, including urine leakage or frequent urinary tract infections. Some issues can be alleviated with behavioral changes alone, while others may require medication or surgery.
Are you having changes in your monthly bleeding cycles? Menopause is technically defined as no period for 12 months. During this time, many women may be frustrated by the irregularity and unpredictability of their bleeding patterns. Women may become pregnant during this time, so birth control is still important to discuss.
If you are post-menopausal, discuss bleeding of any type. Often, it’s not cancer, but as a doctor, I’ve seen some minor spotting that led to a cancer diagnosis, so I take it very seriously. It’s worthy of a conversation so I can ask more targeted questions. Sexual changes and problems such as painful intercourse should be part of our discussion as well. During your exam, a Pap smear, the screening test for cervical cancer, is done for women who meet the current screening guidelines. But even if a Pap itself is not indicated, it is still important for a woman to have a thorough pelvic exam to check all the pelvic organs. Incidentally, women who have had a hysterectomy should continue with gynecological visits.
External Vulvar Health
Tell your physician if you have noticed skin changes, itching, ulcerated areas, lumps or bumps in your labia majora, perineum, or anus. Skin changes, including cancer can occur at any time, but especially after 40. A doctor can also note changes during an exam. Hemorrhoids are also common and can be tricky to treat but are important to discuss with your physician. A physician can also help diagnose pelvic organ prolapse (bulging or dropping pelvic organs), which can occur after pregnancy, with weight gain, or with gravity and aging.
Women who are widowed or divorced may become more sexually active and should discuss their concerns honestly and have conversations about screenings, prevention, and more.
Many women spend more time caring for others than for themselves. If some of these topics have been weighing on your mind, even if they’re only minor inconveniences, consider your own value and talk with your doctor.
*Dr. Schnatz’s article was also featured in the Boomer Magazine for the month of August*