Last year I did my first Women’s Health Questions You’re Too Embarrassed to Ask blog post to answer those questions you might not feel comfortable bringing up at your annual exam (or ever!). My fellow OB/GYNs at VPFW and I get these questions all the time – so it’s not nearly as awkward or embarrassing for us to answer them as it is for you to ask. Check out my next round of questions and fill out the form below to (anonymously) submit one you’d like to see answered in the future!
Do women need to get a Pap test every year? When can they stop?
Depends on who you ask! The Pap smear is a cervical cancer screening test, and it is done by collecting cells from your cervix and sending them off to a lab for processing. In the past, these were done on a yearly basis basically as soon as an individual started having intercourse. More recently, the American College of Obstetrics and Gynecology as well as the Society for Gynecologic Oncology endorsed the screening intervals recommended by the United States Preventive Services Task Force (USPSTF). These guidelines recommend that an individual not start getting pap tests until the age of 21.
Between the ages of 21 to 29, a pap test is needed only every three years. From age 30 to 65, they are recommended every five years. After age 65, pap tests can be discontinued if there have been an adequate number of negative pap tests in the past decade.
Some providers prefer to perform pap tests on patients on a yearly basis and, in most cases, insurance will cover the test at that frequency. I would recommend speaking to your gynecologist and coming to an agreement about what testing interval makes the most sense for you.
So…isn’t the whole point of coming to the forsaken annual appointment to get a pap smear? No! In fact, it’s just a tiny facet of what we cover in an annual. It is still very important to come to your gynecologist yearly to review your gynecologic health, receive a comprehensive well-woman exam including breast and pelvic exams, take advantage of STD testing, and to make sure your other preventive health screenings such as mammogram, colonoscopy, and bone density scan are up-to-date.
Curious what else we’re looking for at your annual appointment? See Dr. Santosh’s blog post, What Annual Exams Cover During Every Stage of Life (and Why You Shouldn’t Skip Them!).
Is there anything I can do to support myself through the changes that come with perimenopause?
First of all, what IS perimenopause? What happened to just good old menopause?! Well, perimenopause refers to the menopausal transition. It starts to happen about 4 years before your period stops. The average age of menopause is 51, and so, for most women, perimenopause is expected to start at around age 47. (Check out Dr. Kimberly McMorrow’s blog post, Perimenopause 101: What to Expect, to learn a little more about this transition.)
The usual symptoms are irregular periods, hot flashes, mood changes, and fatigue. The best way to support yourself is to make an appointment with your friendly neighborhood gynecologist! They can help you make sure that the reason for your symptoms is, in fact, perimenopause and not, instead, a thyroid disorder, depression, or other medical issue.
For many patients, your doctor can recommend safe and effective treatments that can help you feel more like yourself during this tumultuous time when it feels like your body (and your brain!) have turned against you. Many ask specifically about the utility of black cohosh and plant-based therapies (isoflavones and phytoestrogens) in reducing hot flashes. Unfortunately, these are no more effective at reducing hot flashes than placebo. As so often happens in medicine, it turns out that regular exercise, a healthy diet, and adequate sleep help far more than most over-the-counter remedies.
How often should I do a self-breast check?
I think we’ve all been in one of those showers that has the placard hanging from the showerhead that demonstrates “proper” self-breast exam (SBE) technique. Personally, I always found it challenging to do the self-breast exam while simultaneously looking up into the blast of shower water to follow the TINY instructions on this placard. Plus, is there actual evidence that performing these exams helps with early detection and survival rates?
In fact, review of the evidence demonstrates that when compared with women who do not perform SBE, women who perform SBE end up with more biopsies for benign masses. It also shows that neither the rate of breast cancer nor the stage at which it is discovered differs significantly between the two groups. Even the Susan G. Komen foundation does not recommend the SBE as a screening tool for breast cancer.
Not giving yourself a SBE every month might feel counter-intuitive, especially if you were raised with the placard lady staring down at you, admonishing you to perform SBE at least once a month! Instead, many of the expert groups now advocate teaching self-breast awareness. Ask your primary care doctor or OB/GYN to teach you about breast health (what else are they going to do now that they aren’t doing a pap every year?!). Ask about how to differentiate between a worrisome lump and a likely normal lump, and what foods, phase in your menstrual cycle, or benign breast conditions can make breast tissue fluctuate in size and tenderness.
Of course, make an appointment for a breast check with your OB/GYN if you feel that something just isn’t right. And once you turn 40, it’s recommended to add a screening mammogram to your annual women’s health routine. (We offer mammography services at 4 VPFW locations in the Richmond area!) Dr. Stone has a great blog post on the subject: Screening Mammograms: When To Start, Odds Of Getting “Called Back,” And How They Can Save Your Life.
When should I go off birth control if I am hoping to become pregnant?
Think about it this way – aren’t you worried about getting pregnant if you miss a pill? Yes! In fact, if you miss two or more consecutive pills, or don’t start your new pack right after the placebo week of the previous pack has finished, we advise you to use back up protection or emergency contraception if you have had sex. So you should anticipate a quick return to your baseline fertility once stopping the pills. (In case you want a refresher, I covered what to do if you miss a birth control pill in my last round of Q&A.)
If you aren’t planning to try right away, it is sometimes helpful to stop the pills approximately 3 months prior to getting pregnant (right at the same time when it’s a good idea to start taking prenatal vitamins). This helps you learn to track your cycles and predict your fertile window during each month. Overachievers may choose to use ovulation predictor kits during these months to ensure you are ovulating.
If you notice an abnormal cycle length (i.e. less than every 21 days or longer than every 35 days) or your ovulation predictor kits are not positive, make an appointment so we can help troubleshoot the process.
Of course, not all birth control comes in the form of a little pack of pills. Here’s a guide to some other birth control options and how long the return to fertility can take once you stop using them:
- The Nexplanon device is similar to birth control pills. The hormone is undetectable in the bloodstream about 1 week after its removal, and 90% of its users will ovulate within 3-4 weeks after it has been removed.
- IUDs are different from birth control pills in that they do not stop ovulation. Therefore, you have an immediate return to fertility and can conceive at any time after the IUD has been removed. Because the progesterone IUDs (Kyleena and Mirena) also thin the lining of the uterus, it may take a month, or sometimes a bit longer, to get your period back. This does NOT mean that you are not ovulating, however, and it should be assumed that you could get pregnant as soon as the IUD is removed.
- Depo is also different. 50% of depo users who wish to become pregnant do so in the first 10 months after discontinuation of the medication. However, there is a small proportion of women whose return to baseline fertility can take up to 18 months. If you are thinking about conceiving in the next 1-2 years, talk with your OB/GYN about an alternative to depo.
If you’ve decided it’s time to start trying, you might also want to schedule a preconception visit with your doctor to talk about optimizing your fertility health and how to identify your optimal times for conception. Here’s Dr. Olsen’s list of 14 questions to ask to get the most out of your preconception visit!
What should I do if a tampon gets stuck?
Many–if not all–women who use tampons have experienced the heart dropping panic of getting a tampon stuck or realizing that there’s a tampon in there that has long been forgotten. While you may feel that this is the height of embarrassment, all OB/GYNs can assure you that it is not. We are happy to cite HIPAA-approved examples, if asked.
One of the main causes of consternation in these situations is that you have to ask for help to get it out. PLEASE do not try to retrieve it by yourself (beyond a reasonable effort, of course), and for goodness sake don’t enlist a friend–no matter how close you think you are to them. Allow the professionals to handle it. You can usually schedule a same-day appointment. The whole ordeal will be over in less than a minute and then we can all pretend it never happened.
Have a Question for Dr. Giles?
You can anonymously submit a question for Dr. Giles to answer in a future “Women’s Health Questions You’re Too Embarrassed to Ask” blog post on the VPFW blog. To make an appointment with a VPFW provider, call 804-897-2100 or schedule online at vpfw.com.
About Dr. Allison Giles
Dr. Allison Giles is an OB/GYN at Virginia Physicians for Women. She sees patients at VPFW’s Henrico Doctors’, St. Mary’s, and West Creek locations.