Visiting the gynecologist when you're older

What should older women ask their gynecologist?

As women get older, they have different needs when visiting their gynecologist. The body begins changing as menopause nears. Menstrual periods become irregular, hormone levels change. It can all be confusing for women. Dr. Katharine H. Taber, medical director of the Women's Wellness Center at Northwest Hospital, offers tips on what to ask their doctor as they age.

How do you define "older" and how is visiting a gynecologist different as you get older?

I define "older" as the age when a woman's body begins to transition toward menopause, so it's different for individual women. However, a general time frame is 45 because that's the average age that perimenopause begins, which includes physical changes that may involve irregular menstrual periods.

Additionally, gynecologists may need additional evaluations to assess older patients with certain conditions that wouldn't be considered abnormal at, say, age 20. In fact, aging means more routine screenings in general.

How often should an older woman see her gynecologist?

Every woman has different needs, depending on her personal medical history. It's vital for each woman and her gynecologist to agree with what is best for her. That said, a basic timeline is to see a gynecologist at least once a year for routine care, with further visits as necessary depending on the circumstances.

What are important exams and how often should older women have them?

Gynecological checkups are only part of women's health. Women must take care of their whole bodies so a variety of screenings are recommended. Again, the frequency depends on the individual and her personal and family history.

In general, older women should get cholesterol screenings , mammograms, Pap smears, colonoscopies, blood test for diabetes, bone-density exams, blood tests for HIV and sexually transmitted diseases, blood pressure checks, dental exams for oral cancer, eye exams for glaucoma and skin exams for cancer.

What is menopause?

When women naturally stop having menstrual periods for one year, they are experiencing menopause. The median age in the United States is 51. Menopause and perimenopause occur because female hormone levels fluctuate, often resulting in unpleasant symptoms.

Vasomotor symptoms or hot flashes are typical. They appear during perimenopause and peak about one year after menstruation ends. Most women who have hot flashes experience them daily, with a third of those women having more than 10 flashes a day. Vasomotor symptoms usually last between four and 10 years. African-American women report the most, and Asian women report the fewest.

In addition to hot flashes, less estrogen in the body can cause a thinning of the vagina's lining, which, in turn, can cause dryness, itching, discharge and painful intercourse.

What's the current thinking about hormone replacement?

Systemic hormone therapy is the most effective way to reduce the frequency and the intensity of hot flashes. Hormone therapy can be taken orally or using a patch, gel or spray. However, there are some risks associated with hormone therapy, including a possible increased risk of breast cancer, blood clots and pulmonary embolisms. It's important to talk to a doctor before starting, and throughout, any hormone regimen to ensure that benefits continue to outweigh risks.

The current recommendation is to use the lowest doses for the shortest amount of time necessary to lessen symptoms. Again, it's critical to discuss the options with a doctor to make sure that the hormone replacement therapy is safe and FDA-approved.

As an alternative to hormone therapy, selective serotonin and selective serotonin-norepinephrine inhibitors also appear to be effective treatments, however less so than hormone therapy. Additionally, some of these drugs may interfere with treatments for breast cancer. Paxil is the only nonhormonal therapy approved by the FDA to treat hot flashes.

Local therapies — creams, rings and tablets — are often recommended to relieve symptoms associated with the thinning of the vagina's lining. However, for women with a history of estrogen-sensitive cancers, their safety is unclear, so nonhormonal therapies are usually the first-line approach.

Vaginal lubricants and moisturizers (not douches) may also relieve symptoms. Some estrogen receptor modulators may also help with atrophic vaginitis and are safe for women with breast cancer. However, they carry an increased risk of blood clots and embolisms.

How do lifestyle choices affect older women?

If women stop smoking, lower depression/anxiety levels and lose weight if they're obese, they can usually decrease their hot flashes. Other common-sense approaches include wearing layered clothing and drinking cold beverages. Additionally, there's evidence that avoiding caffeine and alcohol may lessen hot flashes. Interestingly, there's insufficient evidence that herbal remedies, including soy, red clover, black cohosh, St. John's wort, gingko biloba, dong quai and ginseng, are beneficial. Likewise, acupuncture doesn't appear to be effective. Taking 800 IU of vitamin E daily has been associated with only one less hot flash per day.

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