The annual gynecological exam, also known as a gynecological well-visit, is a yearly preventative and diagnostic examination which serves to maintain the wellness of female patients, as well as monitor any ongoing physical and hormonal conditions. This annual visit is an opportunity for doctors to counsel patients about maintaining a healthy lifestyle and minimizing health risks. The annual gynecological exam includes a routine breast and pelvic exam, and may include a screening for sexually transmitted diseases, such as chlamydia or gonorrhea. A Pap test may also be performed depending on the age and sexual history of the patient. The American College of Obstetricians and Gynecologists recommends that women begin annual pelvic exams at the age of 21.
During the annual well-visit, a physical examination will be performed to assess the patient's overall health. The examination may vary based on the patient's age and sexual history, but most annual gynecological examinations may include the following:
- Pelvic exam
- Breast exam
- Pap smear
- HPV screening
- Blood pressure check
- Height and weight measurement
- Urine screening
- Cholesterol screening every 3 to 5 years
- Complete blood count
- Thyroid screening
- Screening for blood in stool
In addition, there are several other tests that may be recommended for patients. These may include monthly self-examination of the breasts, mammograms, bone density screenings, skin and mole examinations, blood sugar tests and others, based on age, individual medical history, family history, and lifestyle habits.
Mammogram
A mammogram is an X-ray examination of the breast. It is performed to detect breast cancer in its earliest stages, often before any signs or symptoms of the disease are present.
Mammography allows doctors to detect small tumors that are easier to treat than larger, more developed tumors. And it can also detect small abnormal growths in the milk ducts of the breast, called ductal carcinoma in situ (DCIS). Early removal of these growths will remove the risk of future harm. Mammograms are an effective way to detect cancer early and can aid in the goal of successfully treating and beating the disease.
Reasons for a Mammogram
A mammogram can show abnormalities, such as a tumor, in the breast tissue long before they can be felt. Mammograms may be performed for screening or diagnostic purposes.
Screening Mammograms
Screenings involve producing images of both breasts in order to detect any tumors that cannot yet be felt under the skin. They can also detect calcium deposits that may indicate breast cancer.
Diagnostic Mammograms
Diagnostic mammograms are performed after a lump or other sign of breast cancer has been detected or after abnormalities were present during a screening mammogram. This procedure targets a specific area of the breast and takes more detailed images from many different angles.
Both screening and diagnostic mammography can help diagnose breast diseases, lumps, cysts and benign and malignant tumors.
Candidates for a Mammogram
It is recommended that women older than 40 have mammograms annually. Patients with the following risk factors should take extra care to be screened regularly:
- Personal or family history of breast cancer
- Abnormal changes in the breast
- Long-term use of hormone therapy
Studies have shown that regular screenings can help reduce the number of breast cancer deaths in women. Detecting cancer early and treating it immediately, before it spreads, increases a patient's chance of remission.
Preparing for the Procedure
Patients should not schedule a mammogram the week before they have their period, as the breasts are usually tender at this time.
The doctor may ask the patient not to wear deodorant or lotion under the arms or on the breasts on the day of the mammogram. Otherwise, there is no special preparation needed for the procedure.
The Mammogram Procedure
During a mammogram, the breast is placed on a small platform and compressed with a paddle while it is exposed to a very low dose of radiation. Compression helps even out the thickness of the breast so that all breast tissue can be visualized, and it also holds the breast still to minimize blurring of the image caused by patient movement. Images of the breast tissue are produced and then displayed on a computer screen for the doctor to view.
The patient may experience pressure on the breast from the compression, which may be uncomfortable if the breasts are sensitive. Most patients tolerate the mammogram procedure with no problem.
Risks of a Mammogram
A mammogram is considered to be a safe procedure for most women, including those with breast implants. Patients should advise their doctors if they are pregnant or have any preexisting medical conditions.
Menopause
Menopause is the time in a woman's life when her menstrual period has stopped. Menopause is caused by a decrease in the ovaries' production of the hormones estrogen and progesterone, which eventually results in the ovaries' ceasing to produce eggs, and the end of menstruation.
A woman has reached menopause when she has not had a menstrual period for at least 12 months. Menopause is a natural process that takes several years. During this time, fertility decreases, and periods often change in duration, frequency, and amount of blood flow. This stage is known as perimenopause, and it is often when symptoms of menopause begin. The average age that menopause occurs is 51, although it may occur prematurely in women who have had total hysterectomies or have received chemotherapy or radiation treatments.
Symptoms of Menopause
The symptoms of menopause can vary, with some women experiencing no symptoms at all and others experiencing multiple severe symptoms. The first phase of menopause often begins with irregular periods, and can include the following symptoms:
- Insomnia
- Hot flashes
- Night sweats
- Fatigue
- Discomfort during intercourse
- Vaginal dryness or itchiness
- Urinary tract infection
- Bladder control issues
- Weight gain
- Thinning hair
- Dry skin
Menopause can also have mental and emotional effects, causing mood swings, depression and irritability.
Diagnosis of Menopause
Menopause is usually diagnosed based on symptoms. In some cases, blood tests are used to make an accurate diagnosis, and rule out any underlying conditions. Two tests are typically used.
Follicle-Stimulating-Hormone Test
A follicle-stimulating-hormone (FSH) test measures the level of follicle-stimulating hormone in the blood. When a woman's estrogen levels begin to decrease, the pituitary gland in the brain causes FSH to be released, stimulating estrogen production by the ovaries. If a woman's levels of FSH are rising, menopause is often the most likely cause.
Thyroid-Stimulating-Hormone Test
A thyroid-stimulating-hormone (TSH) test measures levels of thyroid-stimulating hormone in the blood. It helps to determine whether hypothyroidism is responsible for symptoms; an underactive thyroid can cause symptoms similar to those of menopause.
Vaginal pH testing is also used to help diagnose menopause; pH levels increase to about 6 from the reproductive years' average of 4.5.
Treatment of Menopause
Treatment for menopause varies depending on the individual. One treatment is hormone-replacement therapy (HRT), in which medication containing estrogen or progesterone is prescribed to replace the hormones that are deficient within the ovaries. These synthetic forms of hormones are delivered through pills, patches or creams. However, there are risks associated with HRT, including heart disease, stroke and breast cancer. Risks may vary depending on a woman's health history and lifestyle. Before deciding if HRT is appropriate, a woman should discuss its risks and benefits with her doctor.
Women suffering from depression or mood changes due to menopause may benefit from taking antidepressants or anti-anxiety medications. Low-dose vaginal estrogen, which is available in a pill or cream form, can be prescribed to help reduce dryness within the vagina. Medication is also available to treat the osteoporosis often caused by menopause. Women who maintain a healthy and active lifestyle may experience less discomfort during menopause.
Complications of Menopause
In addition to temporary discomfort and symptoms, menopause can cause long-term health complications for women. The bone disease osteoporosis is a common concern for women who have been through menopause. During menopause, production of estrogen, which supports bone mass, decreases. The drop in estrogen causes bones to become less dense, and prone to fracture and injury. Additional complications of menopause may include the following:
- Cardiovascular disease
- Urinary incontinence
- Sexual dysfunction
Women experiencing menopause should consult with their physicians for effective treatment of symptoms, and recommendations for reducing the chances of complications.
