Your “Not-So-‘Well’-Women-Exam” at every decade: 30-40’s

“March Madness” is all about “March Wellness” at dryepez.com.

If so, some of your fears of going to the gynecologist have been replaced by knowledge of what actually happens at your “well-woman” annual gyne visit.  You have hopefully been engaging in fact based conversations with your girlfriends about HPV and cervical cancer, as well as Pap-tests and why not getting screened every year is actually ok for some women.
If so…I’m LOVING it!  My goal in starting this website was to provide you with enough knowledge that would give you the courage to engage in meaningful interactions having to do with your body and health.
 
But, what happens when you are scheduling a visit to the gynecologist because something is not going right? 
Every decade in our life presents different health concerns and therefore our gyne exam is based on these age-specific issues.
Here is a general guide on what women should focus on at each decade in their life and the corresponding workup to expect at their gynecology visit.
The list should help you be ready for your exam and know what concerns or problems to bring up with your gynecologist.
Remember, these are only general guidelines and by no means is this an all encompassing list of all the problems that can arise or a particular physicians approach to a problem.  If you have a specific problem, feel free to send me your questions/comments below.
PART 2:
30’s
Our 30’s can be overwhelming….work, relationship, kids. It’s important to remember to focus some of that energy on you.  Diet and exercise is essential to staying healthy, maintaining your appropriate body mass index (BMI), and shedding the baby fat that didn’t just “come off” on it’s own.  You can find a BMI calculator on-line.
45-60 minutes of exercise/day for 4 days a week is appropriate.
Waking up an extra hour early before the kids or going to the gym straight from work is sometimes the only way to get the job done….but you will feel better for that one hour of “me” time.
In addition, it will decrease your risk for breast cancer, hypertension, diabetes, heart disease, and increases your sex drive….nuff said!
If you could handle 4-5 hours of sleep or less a night in your 20’s you are struggling in your 30’s to keep up.
Sleep is critical to your well being, focus, and is a big trigger for headaches and hypertension.
Arianna Huffington encourages us in her new book Thrive, what medical experts have been promoting for decades– but only she can put so eloquently “Sleep your way to the top!” see her interview with Marie Forleo.
Knowing your family history is very important.   Specifically, any family history of breast, ovarian, or colon cancer is important for early screening. as well as qualifying for genetic testing that may be covered under Affordable Health Care Act.
Fertility becomes an issue in this decade.  Yes ladies, that clock does have a timer on it, unfortunately, and the alarm starts going off at age 35.  You can press the snooze button a few times, but not too much longer.
We will have a specific fertility blog from our Infertility specialists in the coming month so stay tuned!
If you have been attempting pregnancy for 12 months and are younger than 35, or if you have been trying for 6 months and are over the age of 35, then you need to visit your gynecologist.  If you have irregular menses at any age, you should see your doctor prior to attempting pregnancy.
Many women have heavy, absent or irregular bleeding, Polycystic Ovarian Syndrome is a common diagnosis that affects many women in their 20’s and 30’s. It is a disorder that is caused by many factors coming together including: insulin resistance, androgen (hormones that promote male characteristics) excess, and menstrual irregularity.
These factors then cause the following signs and symptoms typical of the disorder:
-infertility, obesity, excess hair on face, chest, thighs, acne, multiple small cysts on ovaries.
In their 30’s women usually present with difficulty getting pregnant or absence of a menses.  Blood work and an ultrasound may be performed for diagnosis.
Treatment depends on whether or not you are attempting pregnancy but will always include weight loss.
Either oral contraceptive pills to regulate your cycle or a medication to induce ovulation may be right for you if attempting pregnancy.
But a thorough discussion with your gynecologist is needed about lifestyle changes.
40’s
“40’s are the new 30’s”
Women today are feeling most accomplished in their 40’s. Car-seats out , promotion and self-confidence in.
So keep up the good work with your body as well.  Don’t let your screening go astray.
Breast cancer screening with mammograms start at age 40 and occur on an annual basis thereafter.
Thinking about bone health is important for women in their 40’s and starting a calcium and vitamin D supplement as well as performing weight bearing exercises to strengthen bones should be initiated.
By this time many women are done with having children.  However you can still get pregnant and your risk for a miscarriage is much higher.  So, you should be practicing some method of contraception.  Sterilization is an option for many partners.  Whether it be male or female sterilization, many less invasive techniques are now available.  For women, there is an in-office sterilization method that is a permanent, non-surgical transcervical procedure.  It is called Essure sterilization, ask your gynecologist for more details.
Perimenopause is defined as a transitional period before menopause during which your hormones may begin to fluctuate.  Average age of menopause is 51, some women begin to experience changes in their cycles, including heavy bleeding and a longer interval in between menses, as early as 5 years prior to the onset of menopause.
Some women may experience heavy menses that can last for weeks and cause severe anemia. It is important to see your gynecologist and get a full work-up of your condition.
You should undergo an endometrial biopsy during your visit to rule out endometrial cancer as the cause for the bleeding.  You may also be scheduled for a special ultrasound called a sonohystogram to evaluate the outside and the inside of your uterus for a structural abnormality like a polyp or a fibroid, both of which can cause irregular or heavy bleeding.
There are hormonal and operative management options for heavy bleeding as well as endometrial ablative techniques that burn/scar the inside lining of your uterus to decrease the amount of future bleeding.
Many women at this age undergo operative management for heavy bleeding by means of a hysterectomy.
There are many minimally invasive options available for women who decide to get their uterus removed.  Many of these options leave small incisions and allow a faster healing time.
They include a vaginal hysterectomy, laparoscopic hysterectomy, and robotic assisted hysterectomy.
Discuss these different options with your gynecologist and see which is best for you.
  A common concern for women is the decreased sex drive that occurs in their 40’s and 50’s, sometimes due to their overwhelming schedules with kids and work.  This is an important topic to bring up with your gynecologist and attempt to arrive at solutions that may help increase your libido or vaginal dryness.
As usual, a good place to start is a daily cardiovascular exercise regimen to increase your heart health, breast health, and sexual health!
It will get you strong and ready for life and love in your 50’s and beyond!
Stay tuned for Part 3 of  Your “Not-So-‘Well’-Woman-Exam” at every decade.