For women, many biological milestones revolve around pregnancy and childbirth (think puberty, periods, birth control, fertility issues). Most start regular visits with an OB-GYN in their teens to make sure everything is in order. But what about those who have already gone through menopause? If reproduction is no longer on the table, should they still visit the OB-GYN?
Absolutely. In fact, according to Dr. G. Thomas Ruiz, an OB-GYN at MemorialCare Medical Group in Fountain Valley, California, “It is just as important to see your OB-GYN after menopause as during the childbearing years.” Changes in a woman’s body related to a lack of estrogen can affect bladder control, vaginal function, bone density, temperature control and emotional lability, he says. Not only that, but breast, endometrial, ovarian and cervical cancers occur commonly in women over the age of 50 — another reason for an annual checkup.
“The average age of menopause is 51 years old, plus or minus six years or so, that is still a very young woman,” says Dr. Jocelyn Craig, a urogynecologist/OB-GYN and the medical director of the Center for Women’s Pelvic Health at Long Beach (California) Medical Center. “When regular periods stop, irregular or abnormal uterine bleeding can still occur, and your doctor needs to know about that. Bleeding after sexual intercourse is also not normal, and you would want to discuss this with your doctor.”
Dr. Yen Tran, an OB-GYN at Orange Coast Medical Center in Fountain Valley, California, advises that if a woman experiences vaginal discharge, vaginal bleeding, itching in the vaginal or vulva area, lesion or discoloration in the vaginal area, pelvic pain or painful intercourse, they should visit multiple times each year to monitor the symptoms. In addition, current recommendations indicate that women should get Pap smears every two or three years, even after having a hysterectomy if they have history of moderate or severe cervical dysplasia — even if they are above age 65, Tran says.
So what does a postmenopausal visit to the OB-GYN entail? The exams typically include checking for early signs of vaginal atrophy, vulva lesions, lichen sclerosis, precancerous cells in the vulva regions or early signs of bladder or rectal prolapse, Tran says.
Additionally, Dr. Mary O’Toole, an OB-GYN at MemorialCare Saddleback Memorial Medical Center, Laguna Hills, California, says she also addresses menopause symptoms, osteoporosis/bone health, aging, sexuality and anxiety/depression with her patients as well as making sure they are up to date with their mammogram, bone density and colonoscopy.
But for a lot of women, their annual visit to the OB-GYN is more than just a pelvic exam: For many, it’s their only routine medical appointment each year, O’Toole says.
“As a patient ages, other health issues may arise, such at elevated blood pressure, heart disorder or diabetes, so I recommend also establishing care with an internist/family M.D,” O’Toole explains. “I still recommend regular GYN visits because a woman’s internist may not feel comfortable… [performing] breast exam[s] and/or pelvic exam[s].”
A urogynecologist is another option for those with pelvic health issues. According to Craig, urogynecology is a fellowship-recognized hybrid specialty because physicians who train in this fellowship must first be board certified OB-GYNs or urologists.
Urogynecology addresses both surgical and nonsurgical issues of bowel, bladder and female pelvic organs, Craig explains, including urinary or fecal incontinence, pelvic organ prolapse, painful bladder syndrome (also called interstitial cystitis), chronic bladder infections and pelvic or sexual pain issues. While the majority of patients who see a urogynecologist are postmenopausal, it’s not the case across the board, Craig says.
But while a urogynecologist may be helpful for some postmenopausal women, it’s typically only necessary after a referral. In fact, often an OB-GYN will still manage annual female exams and issues of breast, bone and menopausal symptoms and then refer the patient to a urogynecologist for other specific pelvic health issues, Craig says.
“Seeing a urogynecologist is OK, but most women have established relationships with their OB-GYNs and feel a lot more comfortable in discussing other issues like low libido, hot flashes… and other psychosocial issues affecting their well-being in addition to the pelvic exam,” Tran adds.
So, ladies, continue to book those yearly OB-GYN appointments, even after menopause. No one is a fan of the stirrups, but it’s an important part of your health maintenance.