As research continues how to address women’s health, it’s not uncommon to discover information that seems confusing or even contradictory. Let’s take a look at five issues on my radar.
Pap smears: Numerous studies note that pap smears are one of the most cost-effective screening tools at our disposal. Indeed, the rate of cervical cancer in the U.S. has plummeted as its use has increased. Today’s guidelines suggest that women should have their first pap smear at age 21, regardless of their age at sexual onset, and adhere to a schedule of every three years until age 30 if no abnormalities are discovered. After that, the timing can be decreased to every five years with HPV testing as long as the results remain normal. It is important to get a pelvic exam every year, even when a pap smear isn’t part of it.
Mammograms: This screening test generates quite a bit of press because health organizations often differ in their frequency recommendations. Most physicians recommend women without a family history of breast cancer have their first mammogram at age 40, and subsequently every one or two years as long as no abnormalities are found. The National Cancer Institute recommends screenings every one to two years. Those with breast cancer in their family must be more vigilant, especially if a first-degree relative (mother, sister or child) has been diagnosed before age 50. Early screening is based on risk factors. A woman’s lifetime risk of developing breast cancer is 12.08 percent or one in eight. Currently, there’s an evolution away from breast self-examination toward the concept of breast self-awareness, meaning a woman’s awareness of the normal appearance and feel of her breasts. Mammograms are considered a primary screening tool and their use affects breast cancer statistics. Breast cancer mortality has been decreasing steadily due to earlier detection and improved treatments.
Sexually transmitted diseases: Anyone who’s sexually active can contract a sexually transmitted disease; I offer to test all patients during their annual exam. Testing for gonorrhea and chlamydia is recommended for anyone between 13 and 25 who is sexually active. Most young people don’t think having something like chlamydia can affect them long term, but it can lead to pelvic inflammatory disease, which can cause infertility.
Infertility: This issue is more prevalent than ever, since many women are waiting until later in the life to have children. While infertility is considered an issue after one year of trying to get pregnant, I often suggest evaluation (of both partners) begin at the six-month mark, since it can take a while.
Menopause: Women who haven’t had a menstrual period in one year without any pathologic or physiologic cause are considered to be in menopause, but peri-menopause, when ovarian function starts to decline and periods can be irregular, can start much earlier. The average age of menopause in the U.S. is 51. Hormone replacement therapy can help women who experience significant symptoms – including insomnia, hot flashes and memory loss – but I recommend it be used in as low a dose as possible for as short a time as possible.
This is an overview of some common women’s health issues. Women should discuss their specific concerns with their own doctor.
Dr. Stella Huang specializes in obstetrics and gynecology at Sutter Health, a partner of Solano Coalition for Better Health.