Women's Health (basics of what you need to know)
I was able to talk with [Robin Cardwell MD, FACOG] and ask questions surrounding women’s health. I wanted you to be able to read answers for a variety of topics and I am so thankful to be friends with someone who is in the medical field surrounding women’s health. So let’s get to it!
What is a good rule of thumb for women’s health? Women’s health needs to be a priority on an individual as well as society level. You can’t function successfully as a mom, daughter, wife, employee, boss, etc unless you take care of yourself. That includes your physical, mental, emotional, and spiritual needs.
Why are annual pap smears/physicals important? Should I ever go more than once a year? A gyn annual exam is a yearly check in to review your menstrual pattern, family planning goals, discuss any concerning symptoms you are having, review you medical and surgical history, update your family history and social history, and do your physical exam. Tests will be performed and/or ordered including mammogram, pap smear, STD testing, bone density study etc based on your age and risk factors. So obviously there is a lot going on at this visit. If problems are identified during your annual, you may need follow up sooner than a year or if problems arise in the interval such as irregular bleeding, pain, abnormal discharge, etc.
How do I know if my period is normal? A normal cycle for an adult female is between 21-35 days from cycle day #1 to cycle day #1 of the next cycle. (day 1 of cycle is the day you start your period) It is common for teenagers and women nearing menopause to be more irregular. A period usually lasts 3-7 days with 1-3 days being heavy. About 10-80mL of blood is lost (usually no one measures that though themselves) A good general rule is bleeding through a super tampon or pad in less than 2 hours repeatedly is considered heavy.
Do I need to start having physicals by a certain age? We recommend routine pelvic exams and pap smears by age 21. If there are problems before that the workup may include an external or internal pelvic exam depending on the age, problem, and history of the patient. It is great when teens and preteens come in because we can do a lot of preemptive counseling about periods, sex, STDs, physical changes, substance abuse, consent, etc. These visits rarely include a pelvic exam.
PCOS awareness seems to becoming more popular…is having PCOs more common than we realize? I think it is more common than the general population realizes. Maybe that is because the symptoms are not something women talk about openly: acne, hirsutism (abnormal hair growth), irregular cycles, and infertility. The rate is about 10% depending on the criteria you use and the population studied.
What are my options if I am having a period but not ovulating? First of all, sometimes it is difficult to know if you are ovulating. It is not uncommon especially as we get older to have an occasional anovulatory cycle, but if you are having regular cycles every 21-35 days that are associated with some cramps, breast soreness, and other pms symptoms you are likely ovulating. Tests that show evidence of ovulation can be difficult to interpret such as basal body temperature, urine ovulation predictor kits, cervical mucus, and cervical consistency. If you are not ovulating the first thing you and your doctor will discuss is why. Sometimes even after all the tests your doctor may not find a reason. If it is due to thyroid issues for example addressing this may result in more regular cycles and ovulation. A big cause for anovulation and irregular cycles we see now is being overweight or obese. Everyone has a different BMI or body fat percentage where they will not ovulate whether it is because the weight is too low or too high. One person may not have regular cycles with a BMI of 30 and another person may still have regular cycles with a BMI of more than 50. Diet, exercise stress, and genetics play a role too. So in short identifying and treating the underlying issue is the first goal. Partially because that you make healthier as an individual but also because you will have a better chance for having a healthier pregnancy and delivery. You may also be a candidate for medication to help you ovulate. There are both oral or injectable medications available by prescription. The oral medications include clomid and letrozole in short they trick your brain into seeing less estrogen and cause it to increase the signals to your ovary to stimulate ovualation. Sometimes metformin is used in addition to these medications but acts differently by decreasing insulin resistance.
Having a period & ovulating, but am not getting pregnant…when should I see a specialist? Generally you should give yourself a year. If you are a more than 35 years old you should see someone soon after 6 months of trying. You can start with your regular ob/gyn. They can do a workup and give you some treatment options. They can also discuss when and if you need to see a REI specialist: Reproductive Endocrinology & Infertility. If you are having irregular cycles, do not think you are ovulating, having pain with sex, have been diagnosed with endometriosis you should see your doctor sooner. If your partner has had genital surgery, trauma, chemotherapy, radiation, or problems with erection or ejaculation, he should see a urologist.
Anything else women need to remember about our health? “Just because it is natural does not mean it is good.” “The vagina does not need to be washed – please do not use cleaners inside!” “Birth control does not cause infertility.”
So, I hope these topics can be talked about more casually in our society. The more we know, the better we can be. We are here for you! Remember, through it all – breathe + maintain!