4 big reasons you’re not too old to need a gynecologist

Not unlike a lot of women, for whatever reason — busy schedule, working full time, raising then-teenagers, no longer having babies and no major issues “down there” — I stopped going to my OB-GYN for my annual exams once I hit my 40s. 

“Unfortunately, that’s very common,” says Dr. Emmekunla Nylander of Buffalo OB/GYN. “As soon as they’re done having children, many women forget about themselves. It shouldn’t be that way. A lot of times I’ll see an older new patient who hasn’t seen their gynecologist since their last child was born.”

It’s fairly typical for women to put off gynecological visits, agrees Dr. Benjamin Margolis, assistant professor of gynecologic oncology at Albany Medical Health System. “But as a specialty, OB-GYNs also perform a lot of primary care functions,” he says, ticking off screenings for bone density, breast cancer, cervical cancer, sexual health, weight and diet as examples. “Clearly there’s a lot of overlap with a primary care doctor, but there are a lot of things we do that a primary care provider may not.”

As the baby boom generation ages, gynecologists are increasingly urging older women to get back into the habit of an annual visit. Here’s why.

#1 Cancer Screening

The risk of gynecological cancers — cervical, uterine, ovarian, vaginal, and vulvar — increases with age. Your gynecologist can spot any changes during your annual exam. “Cancers can still develop after age 55,” says Nylander. “So you want to screen to try to prevent these things from happening or catch it early.”

Human papillomavirus, or HPV, can lead to cervical and other cancers, but can lay dormant and go undetected for decades until menopause, according to doctors. “People get exposed to HPV early in life, or when they become sexually active without using any protection,” says Nylander. “Most people don’t have signs or symptoms until something causes something to affect the immune system. I’ve seen patients in their 50s and 60s who suddenly have HPV,” which if untreated can lead to cancer.

The North American Menopause Society urges: “Baby boomer women, and all women who have had multiple partners, should not stray too far from their Pap smear or HPV test at menopause until we know more about the increased risk of HPV flareup at menopause.”

Most women, says Margolis, “don’t think about the vulva and things that can impact the vulva.” But abnormalities on the external part of the vagina, such as precancerous lesions or melanomas, are more common with age, he says, “and something we can really only screen for by looking.”

Treatment of lesions early on may be fairly noninvasive, says Dr. James Woods, a professor of obstetrics and gynecology at the University of Rochester. However, left untreated, the lesions can develop into cancer — and invasive, potentially disfiguring surgery may be necessary.

Nylander agrees. “We don’t want to have to deal with issues after they become active problems,” she says.

#2 Menopause 

By age 55, most women have already gone through “the change” and may be experiencing the symptoms — hot flashes, mood swings, memory issues, problems sleeping, loss of libido, weight gain, painful sex, and other issues that accompany the loss of estrogen and other hormones brought on by menopause.

“Menopause is not just ‘having a bad day,’” says Woods, who specializes in treating menopause. “We’re talking (symptoms lasting) 20 years of a woman’s life.” 

While menopause symptoms were brushed off in the past as part of aging and something women just had to live with, Woods says health complications related to menopause are “enormous.” Hot flashes, for instance, can increase a woman’s cardiovascular risk, he says, and osteoporosis can cause falls and fractures that lead to premature death.

Woods, whose practice is certified by the North American Menopause Society, recommends that women see their providers simply to stay up to date on treatments, such as estrogen creams and patches, that can significantly reduce symptoms. “I spend so much time unraveling the misinformation” that women get from their friends or remember from a widely reported Women’s Health Initiative hormone replacement therapy study in the early 2000s, says Woods, who also writes monthly online essays addressing specific symptoms of menopause.

The 2002 study, Margolis adds, gave hormone therapy “a bad rap” when it reported higher incidences of breast cancer among women taking hormones. Since then, he says, “the data has been combed through and refined and it’s found there’s a subset of people for whom estrogen does seem to be very safe and effective and widely prescribed.”

Speaking with their gynecologist can help women sort through the information they get from what Margolis calls “Dr. Google and Dr. Facebook.” “Otherwise it can be really tricky for people in terms of knowing what information they can trust,” he says.

Woods agrees the panic created by the study in the early 2000s persists today. He notes there are safe low-dose hormone replacement therapies that can “reverse most symptoms of menopause” and leave women “very happy in their menopause years.”

#3 Sexual / Intimacy Issues

Sometimes, menopausal changes can impact a woman’s sexual function, says Margolis, noting that vaginal dryness, painful sex and decreased libido — or hypoactive sexual desire disorder — are common. “That, in and of itself around their 50s and 60s is an important time for people to be talking to their OB-GYNs about their sexual function, their anatomy, and interventions that can help,” he says.

Medications and other non-medication-based therapies can help maintain vaginal elasticity and moisture, increase sexual satisfaction and function, and boost libido, he says. “Honestly, even kind of normalizing sexual issues, putting a name to something, and acknowledging that something is a problem can provide a lot of reassurance and relief to someone who is struggling,” Margolis adds.

#4 Pelvic Disorders 

Prolapse, or protrusion of the uterus from the vagina, back and pelvic pain, and urinary and fecal incontinence are all pelvic disorders that become more common as women grow older. “Age is definitely a big risk factor,” says Margolis.

Prolapse is more common in women who have had vaginal deliveries, says Margolis, and there are surgical and nonsurgical treatments. Incontinence has “many treatment options,” he says.

“When it comes to urinary incontinence it’s all about quality of life,” he adds. “There are surgeries, medications and lifestyle changes that can all be employed to help people.

Those interested in getting more information about local specialists who can help with menopause and postmenopause issues can find a list at the North American Menopause Society website.

Top illustration: iStockphoto.com/nazarkru.

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