The Ins and Outs of Women's Health; When to have exams and what should be included.

Written by Michelle M. Williams, ND

This week is National Women’s Health Week from May 13-19 and is a great time to check in with ourselves on how we are doing and what we know about the annual preventative exam. If you are anything like me, I find every reason to have the excuse that I am “too busy” to go to the doctor and get a check up…  

But, I’m here to tell you, the annual preventative wellness exam is of utmost importance! 

As one of my professors in college said, “women are like a luxury sedan, they have so many intricacies that need regular maintenance to continue running beautifully.” We are intricate and if we provide ourselves with the proper care and prevention we deserve, we are providing ourselves with the opportunity to live a long healthy “luxurious” life!

So… in this post, I want to talk to you about the details of the annual wellness exam and when certain screenings need to be taking place. It is so easy to get bogged down with all of the information coming at you from every source, and don’t get me started on all the scary information you can find on the World Wide Web. Most of my clinical decisions and recommendations are based on the guidelines set forth by the American College of Obstetricians and Gynecologists (ACOG), the United States Preventative Services Task Force (USPSTF), American Association of Family Physicians and ASCCP (formerly known as The American Society for Colposcopy and Cervical Pathology). I take all of the various recommendations from each of these particular sources and formulate, based on clinical experience and guidance from my mentors, what I believe is the most “adequate screening guidelines for prevention”. 

For starters, from the day we are born we are recommended to see the doctor for our well child checks, these begin as monthly checks and eventually progress into annual preventative wellness visits. As we venture into adolescence and young adulthood, we tend to fall off the wagon for our annual preventative wellness visits, but really they are still recommended and some might argue of greater importance. For young women from the age of puberty, which varies, until age 21, a regular age appropriate screening physical is recommended. This should include conversations around menstrual cycles, physical changes, sexual activity and prevention of transmission for sexually transmitted infections (STI) and pregnancy as well as safety at home and school, substance use and abuse and mental health. The physical exam includes the regular well child check stuff such as; heart, lung, abdominal etc. Women before the age of 21 are not recommended to have a pelvic exam or screening pap unless there is reason to suspect an STI or there are pelvic abnormalities that need to be further evaluated. 

Once a woman hits age 21, along with her annual preventative wellness exam, the recommendations now include beginning screening Pap smears and clinical breast exams. However, contrary to previous recommendations, the dreaded HPV (human papilloma virus) is not recommended as a screening tool. This only happens if there are cellular abnormalities found on the Pap smear. After that initial screening Pap smear, as long as it is normal, a woman does not need to return for a repeat Pap smear for 3 years per ASCCP guidelines.  I do, however, recommend she return for her annual preventative wellness exam. In addition to the pap, a pelvic exam to evaluate for ovarian, cervical and uterine abnormalities should be performed. If she is sexually active then I will commonly recommend an STI screening if she has not had one recently or has changed partners. One important aspect of the annual exam, I continue to place value in, is educating a woman on self- breast exams and what is considered normal variations and what changes are concerning. Several of the organizations listed above no longer recommend the self breast exam, however, I feel that every woman, if educated on warning signs, is more likely to catch a malignancy earlier than might be caught during her annual clinical breast exam.

Once a woman hits her 30’s she is in an entirely different screening bracket. Now is when we start screening for that pesky HPV virus. The reason we have moved from screening before 30 to starting after 30 is because research has found that women in their 20’s are more likely to clear the virus and not suffer from cervical dysplasia. This has cut down on a lot of unnecessary LEEP procedures and more happy healthy cervixes. So, after a woman hits 30, she is now recommended to have a screening Pap smear with HPV co-testing for high risk HPV 16 and 18. HPV 16 and 18 are the most common strains causing cervical cancer known, though there are other strains, these are the most feared. Once that Pap comes back normal with a negative HPV she is good for 5 years…you heard it 5 years!!! This is great news right?! As long as those Pap result remain normal and negative for HPV she stays on the 5 year plan until age 65 when the recommendations are to stop the screening pap unless there is clinical suspicion that warrants continuing or if she has had a series of abnormal Pap smears. Remember though ladies, like the younger women, I still recommend the annual preventative exam to evaluate for other illnesses that seem to creep in as we age…

Aging women are at a higher risk for breast cancer, endometrial/uterine cancer, ovarian cancer, heart disease, high blood pressure, elevated cholesterol, thyroid diseases and even autoimmune diseases. Just like that luxury sedan, we need to continue to get our annual maintenance to ensure we run beautifully for many more years to come! 

Thanks for reading and CHEERS to a happy, healthy and LUXURIOUS life! 

In addition to offering women’s screening exams, I offer natural and integrative therapies for fertility, menstrual irregularities, mood disorders, fatigue, pain, menopausal changes, weight gain and many more. If you like what you have read here and are looking for an integrative approach to women’s health click on the clinic link closest you for scheduling information!