For some women, getting pregnant and having children is an important goal. For others, not so much. Either way, maintaining a healthy reproductive system is critical for overall good health, and that means regular checkups with a gynecologist or other gynecological health care provider over your life span.
“If we talk about evolution, the whole system is set up to get us pregnant,” says Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and founder of MadamOvary.com, a website devoted to women’s reproductive health care. “All the stuff is there to get us pregnant, but there’s a lot of things that are going on there as well” that may be bothersome to women who don’t intend to have children just as much as for those who do.
There are a few different health care providers who may be able to look after your reproductive health, Minkin says. “It can be a pediatrician” for young women. “If it’s a nurse practitioner, that’s fine.” The key is to look for “someone who’s qualified and the woman feels comfortable with. That’s the most important thing.”
A gynecologist is a doctor who specializes in caring for a woman’s reproductive system. Some gynecologists are also obstetricians, meaning that they can take care of general gynecological health as well as help with pregnancy and delivery. Your primary care physician or a nurse practitioner might also be able to handle most of your gynecological health care needs, and a nurse midwife can also provide care for this delicate and complex system.
The Female Reproductive System and Sexual Organs
The female reproductive system and sexual organs include the:
— Fallopian tubes
— Other tissues and structures
It’s all governed by a variable mix of hormones — primarily estrogen and progesterone — that are produced mainly in the ovaries. (The adrenal glands and adipose tissue also generate some estrogen, the Hormone Health Network reports.)
In a healthy woman of childbearing age, this rise and fall of hormones happens on an almost-monthly schedule and allows for the punctual arrival of menstruation — that’s when the uterus sheds its lining when pregnancy has not occurred during the previous month. This results in the vaginal discharge of uterine tissue, cells, mucus and blood commonly called periods.
It’s a cycle that can be easily disrupted by a number of factors, including stress, nutrition, other health problems and disease states, and pain and heavy bleeding associated with this monthly cycle is one of the most common reasons women seek care from a gynecologist, Minkin says. “Cramping, pain, heavy bleeding — things of that nature can interfere with a young woman’s life, so it’s a good idea to get a checkup” if you’re having those issues.
Dr. Jessica M. Vaught, a gynecologist and director of minimally invasive surgery at Orlando Health, says many women don’t realize that painful cramping, pain during sex and heavy or long-lasting periods aren’t normal, but talking to a health care provider about any symptoms you’re experiencing could lead to better quality of life. “Some women think heavy cycles are normal, but if we begin really questioning and find out you have to call off work for two days every month, that’s not normal.” Such problems may be the result of a number of problems including hormonal imbalances, uterine fibroids and polyps, all of which need to be addressed.
Routine Exams and Screening
An important component of routine gynecological care is screening for cervical cancer. The cervix is the lower portion of the uterus that connects to the vagina, and cancer in this tissue “was once one of the most common causes of cancer death for American women,” the American Cancer Society reports. However, that rate dropped off significantly as the Pap smear — a simple screening test that collects cells from the cervix that are analyzed in the lab for signs of cancer — became more commonplace. Like a mammogram, a Pap smear can spot signs of cancer earlier, when it’s more treatable.
Similarly, cervical cancer has been associated with the human papillomavirus. The National Cervical Cancer Coalition reports that HPV is found in “about 99 percent of cervical cancers. There are 100 different types of HPV, most of which are considered low-risk and do not cause cervical cancer.” Still, your gynecologist can screen you for these viruses and offer a vaccine against the ones most commonly associated with cervical cancer.
Minkin says that while there’s some debate over when to commence screening, many providers recommend starting routine Pap smears beginning at age 21. “There are some different philosophies on this, but we aren’t recommending that they be done until age 21. Not because funky things can’t happen before then,” but the chances of an abnormality developing into cancer are less likely. The American Academy of Family Physicians notes that “most observed abnormalities in adolescents regress spontaneously, therefore screening Pap smears done in this age group can lead to unnecessary anxiety, additional testing, and cost.”
The American College of Obstetricians and Gynecologists recommends Pap smear screening every three years for women between the ages of 21 and 29 years. For women aged 30 to 65, the ACOG recommends having a Pap test and an HPV test (called co-testing, which is preferred) every five years or a Pap test alone every three years. If you’re over the age of 65, the ACOG says “you do not need screening if you have no history of cervical changes and either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past five years.”
[See: The Real Sperm Killers.]
However, routine care can and probably should start earlier. Minkin says most young women begin having regular gynecological exams in their mid-to-late teens. Because of this, pediatricians may be tasked with giving some young women their first or several annual gynecological exams.
Particularly if a young woman is considering having sex for the first time, that’s a great time to commence a relationship with a gynecological health care provider, as this person can help you navigate questions about contraception and discuss your risk of contracting a sexually transmitted infection, which increases if you’re having unprotected sex or sex with multiple partners. A younger woman who’s having problems with the regularity of her cycle, heavy periods or other symptoms may also want to visit with a gynecological health care provider to be sure everything is OK.
During an annual exam, “we’re looking for normal development,” Vaught says, and “making sure the breasts are normal and the GYN organs are normal. We also do want to have a good discussion about safety,” meaning a frank discussion about whether you’re dealing with an abusive partner or other danger. “A lot of times the gynecologist is the one person that women will open up to about abuse issues and sexually related problems and infections that they won’t talk to anyone else about.” The annual exam is intended to provide “a picture of overall health. Those organs are part of our health and we’re making sure those organs are healthy, too.”
Minkin recommends visiting with your gynecological health care provider annually for a checkup throughout your life, but if you’re having any problems you may want to visit with your doctor sooner. If you experience bloating, fatigue and irritability around your period, those could be signs of premenstrual syndrome, which your provider may be able to treat. “Women with very bad PMS may have a condition called premenstrual dysphoric disorder or PMDD,” which can also be treated, Minkin says.
Of course, discussions of fertility and your wishes relating to having children will be part of the gynecological care you receive over the course of your lifetime. “Women do need to consider the issues involved,” such as work, school and relationships. In discussing fertility, your gynecologist will talk to you about how to prevent pregnancy when you’re not ready for it, but also “if you’re getting ready to have a child, how do we promote things” so that you can become pregnant more easily.
Vaught says that because “the average age of moms today is older” than it was in previous generations, “that provides new challenges in getting pregnant and the pregnancy itself.” Having a discussion with your provider when you’re younger can help you make the right preparations so that becoming pregnant later on is easier.
Cycle Changes and Other Problems
Changes in your cycle may send you to the doctor’s office, too, but Vaught notes that not every change is a sign of a problem. “One of the biggest things that women have a hard time understanding is that their reproductive health will change as they go on this journey. A lot of times women will come into my office in their 40s, and they’ll say, ‘My cycle’s never been like this.’ And I’ll say, ‘But you’ve never been this age before.’ Unfortunately, our organs are under no orders to act the same as they did three years ago.”
Therefore, she says it’s important to know that while cycle changes may be concerning, they’re not necessarily problematic. “If it’s causing problems, then yes, we need to pay attention to it. But we also need to accept the idea that the cycle is affected by a lot of things — it’s affected by medications, by stress, by your weight and it is going to change.” Working with your doctor to determine whether the changes you’re experiencing are actually a problem is a good idea, because there could be ways to address it.
Similarly, Vaught says that while some patients may have questions about their hormonal balance, it’s not always a simple answer. “Everyone is very interested in hormonal balance and I have people coming in all the time saying, ‘I think my hormones are off.’ The problem with female hormones is that they may very well be, but my ability to detect that in a lab test, especially when you’re still having your period, is very small.” That’s because our hormones are “designed to change levels every week. That’s how we get our cycle.”
This all stems from a fundamental misunderstanding of how a woman’s body changes over time. “Our bodies weren’t made for them to have the same answer every week. If they were, then our reproductive system wouldn’t work.”
[See: Why Can’t I Get Pregnant?]
Lastly, your gynecologist can help you with understanding the bigger changes your body will go through later on, once menopause approaches. Menopause is the cessation of menstruation resulting from a “shutting down of ovarian function,” Minkin says. Because the ovaries are no longer supplying an egg every month and hormonal levels change, that can lead to a range of “whacky symptoms,” such as vaginal dryness, hot flashes, nighttime sweating and achiness. She says some women have extreme achiness that’s misdiagnosed as an autoimmune disorder such as lupus before it becomes clear that it’s related to a reduction in estrogen from menopause.
For many women, menopause is a lengthy process that takes a few years to fully complete. The transitional phase is called perimenopause, and it can begin in a woman’s 40s or even her late 30s. One of the challenges around menopause is that it doesn’t happen on the same timeline for every woman. The average age for women in the U.S. to be in menopause is 51, but Minkin says 1 percent of women will be fully menopausal by age 40, while some may complete the process in their mid-50s.
No matter when it occurs, the symptoms of menopause can be managed. Talk to your gynecologist about what strategies will work best for you.
If you have questions about your reproductive or sexual health, don’t hesitate to talk to a health care provider you trust. The most important thing, Minkin says, is “to be comfortable with the provider. Don’t be embarrassed. These are common problems and she or he will be able to help guide you.”
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