Women's Annual Checkups
It may be time for your annual checkup. If you're like most women, you may wish you could go back to the time when "checkup" meant a few taps on the chest with a stethoscope and walking away with a lollipop in hand. As a grown woman you have more serious — and sometimes, more invasive — things to look forward to. But the annual once-over doesn't have to be a major source of anxiety, especially if you're prepared. Here, a decade-by-decade guide to getting the best exam possible.
Tests Every Woman Needs:
Everyone should get a standard yearly physical, during which you can expect a few basics — no matter what your age. Among them: height, weight and a head-to-toe skin check for any suspicious moles that might signal cancer. If you have a family history of certain diseases or if you have specific health concerns, you might also get a blood test that checks things such as your blood's iron level or your thyroid function. And if you have any special risk factors for coronary heart disease — that is, if you smoke, are very overweight, have diabetes or high blood pressure, or if you've had a close female relative who developed heart disease before age 65 — we may recommend an EKG or a chest X-ray.
Regardless of whether your primary care physician is an internist, a family practitioner or an ob-gyn, you should get a Pap test at least every three years (some doctors recommend them annually). During this procedure, a small tool to scrape a bit of tissue from the cervix; these cells will be tested for abnormalities that might indicate cancer. Pap tests also can detect human papillomavirus, or HPV, a sexually transmitted disease that can increase a woman's risk of developing cervical cancer.. Plus, every 10 years, you should get a booster shot against tetanus and diphtheria.
If You're 20 or Older...
In your 20s, in addition to the tests outlined above, you should also get your cholesterol checked; if it's normal, the test should be repeated every five years. You should also be provided with some general health and wellness counseling e.g. the importance of doing breast self-exams and practicing safe sex.
If You're 30 or Older...
When you're in your 30s, you can look forward to roughly the same tests and exams that you got in your 20s, plus any discretionary tests your doctor orders (for example, a mammogram if you have a family history of breast cancer). Also, your birth-control regimen may change, depending on whether you are trying to get pregnant or think you're finished with childbearing.
At 35, you should also start paying attention to your bones, whether that means doing weight-bearing exercise. (Pumping iron in the gym or starting a power-walking regimen) and getting enough calcium. Most women don't require a bone-density exam for another 15 years, but those who are significantly underweight or who've had an eating disorder may need the test early; that's because women who are very thin can stop having periods — and stop producing the estrogen that's required to maintain healthy bones.
If You're 40 or Older...
Beginning at age 40, you can add a mammogram to your health exam checklist. (Mammograms, which screen for breast cancer, are recommended every other year from ages 40 to 50, and annually after that.) Your doctor may also begin to focus on your diet and fitness, since this is the age at which most women put on weight. Another addition to your annual physical is screening for colorectal cancer by checking a fecal occult blood test, which evaluates any blood in your stool.
And even though the average age of menopause is 51, many women in their 40s are curious and/or apprehensive about the signs and symptoms of this upcoming hormonal shift. Women realize that there's a connection between menopause and lifestyle, and they may want to know more about the alternative things they can do.
If You're 50 or Older...
I endorse the following recommendations for breast cancer screening
- Annual mammograms, beginning at age 50
- Annual clinical breast exams
At age 50 you should have a screening colonoscopic examination to detect colon polyps and colorectal cancer. Beginning at menopause, you should add a bone density exam as well as a thyroid test to your checkup. (If you show signs of a thyroid problem, such as significant weight gain and persistent fatigue, you might be given this test earlier.) The influenza vaccine should be received annually, but starting at 65, you'll also be advised to get the pneumococcal pneumonia vaccine, although women with asthma or other respiratory diseases may need this earlier.
Guideline Calls Routine Pelvic Exams Unnecessary
By Roni Caryn Rabin : NY Times : June 30, 2014
Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, an influential medical group said Monday.
There is no evidence that such pelvic exams are useful and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, the American College of Physicians said in a new practice guideline for doctors.
The college’s guideline was published in the Annals of Internal Medicine and was accompanied by an article reviewing the scientific evidence. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor’s office with medical complaints or who are pregnant.
“The pelvic exam has become a yearly ritual, but I think it’s something women don’t necessarily look forward to,” said Dr. Sandra Adamson Fryhofer, an internist in Atlanta who is a former president of the college. “A lot of women dread it.”
The new recommendation contradicts guidelines from the American College of Obstetricians and Gynecologists, which immediately reiterated its support for yearly pelvic exams.
A pelvic exam consists of three elements: inspection of the external genitalia, examination of the vagina and cervix, and the bimanual examination, in which the physician inserts two gloved fingers into a woman’s vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus, ovaries and fallopian tubes.
The exam takes up time during an annual physical and often requires the presence of a chaperone in the room, which raises costs.
The American College of Physicians reviewed studies of the procedure and concluded that pelvic exams were not accurate diagnostic screening tests for ovarian cancer. A dozen studies have suggested that many women experience pain or discomfort during the exams, and that they may be particularly traumatic for women who have been sexually assaulted.
The reviewers said that they could not even locate studies that had assessed whether routine pelvic exams of asymptomatic women could reduce death or disease from ovarian and other cancers, or benefit women with common benign conditions such as pelvic inflammatory disease, fibroids or warts.
Until about a decade ago, physicians routinely performed pelvic exams before prescribing oral contraceptives, and they used the exams to screen women for sexually transmitted infections and obtain cultures for testing. Those practices have largely been abandoned, and urine samples are now used to test for sexually transmitted infections.
In recent years some experts have suggested that pelvic exams are so discomforting that they may deter women from going to the doctor altogether.
Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose. But, they say, experienced physicians can use pelvic exams to find other problems, such as noncancerous fibroids, and to identify changes linked to urinary incontinence and sexual dysfunction.
“Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another,” said Dr. Barbara S. Levy, vice president for health policy at the obstetricians and gynecologists’ group.
“I’m not sure there’s evidence to support most of what we do on physical exams,” Dr. Levy added. “Lack of evidence does not mean lack of value.”
The new guideline comes as more routine procedures are critically evaluated in light of scientific studies, part of a move toward evidence-based medicine. Over the past few years, several new sets of guidelines have urged scaling back screening procedures for women in particular.
In 2009, the United States Preventive Services Task Force recommended postponing routine mammograms to detect breast cancer until age 50, provoking wide controversy. Many women have ignored the advice.
More recently, the task force, the American Cancer Society and the obstetricians and gynecologists’ group have recommended that, with some exceptions, women ages 21 to 65 should receive Pap smears every three years instead of annually
By Roni Caryn Rabin : NY Times : June 30, 2014
Doctors should stop performing routine pelvic exams, a key component of regular physicals for women, an influential medical group said Monday.
There is no evidence that such pelvic exams are useful and plenty to suggest that the procedure provokes fear, anxiety and pain in many women, the American College of Physicians said in a new practice guideline for doctors.
The college’s guideline was published in the Annals of Internal Medicine and was accompanied by an article reviewing the scientific evidence. The recommendation applies only to routine checkups for healthy women, not to women who visit the doctor’s office with medical complaints or who are pregnant.
“The pelvic exam has become a yearly ritual, but I think it’s something women don’t necessarily look forward to,” said Dr. Sandra Adamson Fryhofer, an internist in Atlanta who is a former president of the college. “A lot of women dread it.”
The new recommendation contradicts guidelines from the American College of Obstetricians and Gynecologists, which immediately reiterated its support for yearly pelvic exams.
A pelvic exam consists of three elements: inspection of the external genitalia, examination of the vagina and cervix, and the bimanual examination, in which the physician inserts two gloved fingers into a woman’s vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus, ovaries and fallopian tubes.
The exam takes up time during an annual physical and often requires the presence of a chaperone in the room, which raises costs.
The American College of Physicians reviewed studies of the procedure and concluded that pelvic exams were not accurate diagnostic screening tests for ovarian cancer. A dozen studies have suggested that many women experience pain or discomfort during the exams, and that they may be particularly traumatic for women who have been sexually assaulted.
The reviewers said that they could not even locate studies that had assessed whether routine pelvic exams of asymptomatic women could reduce death or disease from ovarian and other cancers, or benefit women with common benign conditions such as pelvic inflammatory disease, fibroids or warts.
Until about a decade ago, physicians routinely performed pelvic exams before prescribing oral contraceptives, and they used the exams to screen women for sexually transmitted infections and obtain cultures for testing. Those practices have largely been abandoned, and urine samples are now used to test for sexually transmitted infections.
In recent years some experts have suggested that pelvic exams are so discomforting that they may deter women from going to the doctor altogether.
Gynecologists agree that pelvic exams are not good tools for screening for ovarian cancer, which is notoriously difficult to diagnose. But, they say, experienced physicians can use pelvic exams to find other problems, such as noncancerous fibroids, and to identify changes linked to urinary incontinence and sexual dysfunction.
“Not everything we do in life can be studied in a randomized trial powered to find a scientifically valid answer one way or another,” said Dr. Barbara S. Levy, vice president for health policy at the obstetricians and gynecologists’ group.
“I’m not sure there’s evidence to support most of what we do on physical exams,” Dr. Levy added. “Lack of evidence does not mean lack of value.”
The new guideline comes as more routine procedures are critically evaluated in light of scientific studies, part of a move toward evidence-based medicine. Over the past few years, several new sets of guidelines have urged scaling back screening procedures for women in particular.
In 2009, the United States Preventive Services Task Force recommended postponing routine mammograms to detect breast cancer until age 50, provoking wide controversy. Many women have ignored the advice.
More recently, the task force, the American Cancer Society and the obstetricians and gynecologists’ group have recommended that, with some exceptions, women ages 21 to 65 should receive Pap smears every three years instead of annually
The Annual Appointment Loses Some Relevance
By Tara Parker : NY Times : March 19, 2012
For nearly three generations, women have been taught that annual Pap smears, mammograms and visits with their doctor were essential to good health.
Now all that is changing. National guidelines are urging less frequent screening for breast and cervical cancer. The declining use of menopause hormones means that older women no longer need to check in with their doctors to obtain annual refills. Women are delaying childbirth, and some birth control methods are effective for five years, giving women even less incentive to schedule a regular appointment.
For many women who have been making annual gynecological visits since their teens, the advice that it’s no longer necessary is unsettling.
“I worry this is the wrong message,” said Miriam Richards, a 52-year-old nurse in Raleigh, N.C., who was treated for precancerous dysplasia as a result of an annual Pap smear. “I think it’s a bad road to go down because I feel like women, especially young girls, need to stay vigilant.”
But medical experts continue to preach that when it comes to cancer screening, more is not necessarily better. For years, women were advised to start mammography screening at 40; then, in 2009, the United States Preventive Services Task Force raised the recommended age to 50 — and specified every two years, rather than annually.
Last week, the task force and medical groups, including the American Cancer Society, recommended cervical cancer screening with the Pap smear no more than every three years, and said women should not begin screening until age 21. In the past, screening was recommended every one to two years, within a few years of becoming sexually active.
The concern is that more frequent cancer screening, whether of the breast or the cervix, leads to more false positive results — and unnecessary, intrusive and painful biopsies that lead to stress, discomfort and, in the case of cervical cancer screening, bleeding and future risks for women in pregnancy.
The changing landscape of cancer screening is certain to have an effect on women’s health care, although nobody is certain what it will be. Women have long been the most frequent users of health care, particularly for pregnancy care and pediatric visits for their children. But even when pregnancy and pediatric care are removed from the equation, women are still 33 percent more likely to visit the doctor, according to the Centers for Disease Control and Prevention. The rate of doctor visits for annual exams and preventive services for women is double that of men.
And importantly, gynecologists often use the annual visit to bring up nonreproductive issues: smoking, weight gain, high blood pressure, depression.
“I understand the strong relationship that has been formed with a woman’s doctors during what may be her annual visits,” said Dr. Wanda Nicholson, a member of the preventive services task force and associate professor at University of North Carolina at Chapel Hill. ”But our recommendation addresses only cervical cancer screening. It’s not meant to alter or change women’s ability to access their clinicians to discuss other concerns.”
Dr. Susan Love says that while annual doctor visits may feel reassuring, there is no evidence that they yield better health outcomes.
“There is no data that yearly physicals do anything,” said Dr. Love, a breast cancer researcher and prominent women’s health advocate in Santa Monica, Calif.
“In the current health care system, you rarely have the same doctor forever. And so the relationship you build in the 15 minutes you have will be for naught when you actually get sick.”
Some women say the new guidelines will not dissuade them from regular doctor visits, and may in fact make them more willing to schedule appointments, knowing they are less likely to be subjected to a pelvic exam and a Pap smear.
A 33-year-old Atlanta mother of two, who asked that her name not be published, said her insurance pays for just one wellness visit a year, and she would like to switch to a general practitioner for her care, rather than use up the payment on a visit to a gynecologist.
“I need to talk about more than reproductive issues with my doctor,” she said. “I don’t want to talk to my gynecologist about my foot pain, but at the general practitioner we talked about foot and knee pain, he checked my skin for suspect moles, did blood work and I got a tetanus booster. We talked about my dad having precancerous colon polyps removed. You feel like you can talk about more things with a G.P.”
Ms. Richards, the nurse in North Carolina, says she is unsure how the changes will affect women’s relationships with their doctors.
“First the mammogram issue and now the Pap issue,” she said. “It’s either going to make us more determined to get what we need, or we’re going to have a more cavalier attitude. It’s the young girls I worry about.”
By Tara Parker : NY Times : March 19, 2012
For nearly three generations, women have been taught that annual Pap smears, mammograms and visits with their doctor were essential to good health.
Now all that is changing. National guidelines are urging less frequent screening for breast and cervical cancer. The declining use of menopause hormones means that older women no longer need to check in with their doctors to obtain annual refills. Women are delaying childbirth, and some birth control methods are effective for five years, giving women even less incentive to schedule a regular appointment.
For many women who have been making annual gynecological visits since their teens, the advice that it’s no longer necessary is unsettling.
“I worry this is the wrong message,” said Miriam Richards, a 52-year-old nurse in Raleigh, N.C., who was treated for precancerous dysplasia as a result of an annual Pap smear. “I think it’s a bad road to go down because I feel like women, especially young girls, need to stay vigilant.”
But medical experts continue to preach that when it comes to cancer screening, more is not necessarily better. For years, women were advised to start mammography screening at 40; then, in 2009, the United States Preventive Services Task Force raised the recommended age to 50 — and specified every two years, rather than annually.
Last week, the task force and medical groups, including the American Cancer Society, recommended cervical cancer screening with the Pap smear no more than every three years, and said women should not begin screening until age 21. In the past, screening was recommended every one to two years, within a few years of becoming sexually active.
The concern is that more frequent cancer screening, whether of the breast or the cervix, leads to more false positive results — and unnecessary, intrusive and painful biopsies that lead to stress, discomfort and, in the case of cervical cancer screening, bleeding and future risks for women in pregnancy.
The changing landscape of cancer screening is certain to have an effect on women’s health care, although nobody is certain what it will be. Women have long been the most frequent users of health care, particularly for pregnancy care and pediatric visits for their children. But even when pregnancy and pediatric care are removed from the equation, women are still 33 percent more likely to visit the doctor, according to the Centers for Disease Control and Prevention. The rate of doctor visits for annual exams and preventive services for women is double that of men.
And importantly, gynecologists often use the annual visit to bring up nonreproductive issues: smoking, weight gain, high blood pressure, depression.
“I understand the strong relationship that has been formed with a woman’s doctors during what may be her annual visits,” said Dr. Wanda Nicholson, a member of the preventive services task force and associate professor at University of North Carolina at Chapel Hill. ”But our recommendation addresses only cervical cancer screening. It’s not meant to alter or change women’s ability to access their clinicians to discuss other concerns.”
Dr. Susan Love says that while annual doctor visits may feel reassuring, there is no evidence that they yield better health outcomes.
“There is no data that yearly physicals do anything,” said Dr. Love, a breast cancer researcher and prominent women’s health advocate in Santa Monica, Calif.
“In the current health care system, you rarely have the same doctor forever. And so the relationship you build in the 15 minutes you have will be for naught when you actually get sick.”
Some women say the new guidelines will not dissuade them from regular doctor visits, and may in fact make them more willing to schedule appointments, knowing they are less likely to be subjected to a pelvic exam and a Pap smear.
A 33-year-old Atlanta mother of two, who asked that her name not be published, said her insurance pays for just one wellness visit a year, and she would like to switch to a general practitioner for her care, rather than use up the payment on a visit to a gynecologist.
“I need to talk about more than reproductive issues with my doctor,” she said. “I don’t want to talk to my gynecologist about my foot pain, but at the general practitioner we talked about foot and knee pain, he checked my skin for suspect moles, did blood work and I got a tetanus booster. We talked about my dad having precancerous colon polyps removed. You feel like you can talk about more things with a G.P.”
Ms. Richards, the nurse in North Carolina, says she is unsure how the changes will affect women’s relationships with their doctors.
“First the mammogram issue and now the Pap issue,” she said. “It’s either going to make us more determined to get what we need, or we’re going to have a more cavalier attitude. It’s the young girls I worry about.”
