Part of the Age-Friendly Health Care Special Report
(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)
Older people may be less likely to receive regular gynecological care because of factors like insurance coverage, belief among women that they no longer need gynecologic care after menopause, access barriers, competing health issues and professional, family and caregiving demands.
But there are times people 50 and older should visit a gynecologist or a primary care provider who can examine gynecological problems. Urinary issues, new sex partners or symptoms in the pelvic area are all reasons to go in, says Dr. Stacy Tessler Lindau, an OB-GYN and professor at the University of Chicago.
Here’s what you need to know about when and how to get gynecological care:
Screenings and Exams: What to Expect and Ask
As changes associated with aging and estrogen deficiency happen, among the common gynecologic problems are urinary issues like itching and burning, postmenopausal vaginal bleeding and pelvic symptoms like vaginal fullness.
It’s important that you receive an annual physical with the recommended screenings, Lindau says, but full pelvic exams may not always be necessary. Practitioners should examine the vulva, Lindau says, but pelvic exams are usually not needed unless there are certain concerns, according to the American College of Obstetrics and Gynecology.
“[People] 55 and older tend to be silent about things happening in their pelvis area,” Lindau says. “It is important to empower patients to be comfortable speaking about these issues.”
Older patients will no longer need a pap smear or cervical cancer screening unless they haven’t had a screening in the past 10 years, says Dr. Melissa Simon of the OB-GYN department at Northwestern University Feinberg School of Medicine. Simon is a member of the U.S. Preventive Services Task Force, a panel of national experts who make evidence-based recommendations about clinical preventive services.
“If your doctor doesn’t ask you about sex or partners, don’t be afraid to mention it.”
“What we’re looking for is having had two negative exams in a row,” she says. According to Health in Aging, cervical cancer is rare in older people who have been screened in the past.
While the risk of ovarian, breast and uterine cancers increases with age, there is not enough evidence suggesting annual gynecologic exams are effective at preventing or detecting noncervical cancers, Lindau says. “If a woman has post-menopausal bleeding, this could be a sign of a uterine abnormality or cancer, and she should see a gynecologist or other clinician who can perform a gynecologic exam and possibly an endometrial biopsy, an ultrasound or other testing,” she notes.
Simon says clinical breast exams should still happen yearly, and mammography screenings should also be done yearly or every two years.
“Mammography screenings vary for individual [people],” Simon says. “We still recommend annual screenings up to age 75, but you might stretch them to [every] two years.”
For those who have had sex with a new partner, getting tested for sexually transmitted infections is also important. HIV screenings are an essential area of gynecological care for older adults.
“We do tend to under-address the risk of HIV and can sometimes be late at diagnosing it,” Lindau says. “We tend to regard older people as asexual people. Doctors are sometimes not comfortable talking to older patients about sex.”
If your doctor doesn’t ask you about sex or partners, don’t be afraid to mention it, Lindau says.
In an article for Tufts Medical Center, Dr. Donald Monteiro says older patients may experience vaginal dryness and decreased sexual desire. Your provider can discuss possible treatments.
There are a handful of primary health care screenings that your primary care physician — whether that’s a gynecologist, nurse practitioner or family medicine doctor — can and should perform.
“Even in a gynecology visit, I have to make sure they’ve had all these screenings up to date,” Simon says. “It’s important to frame it as: This is the set of screenings you need, and you can get most of them from primary care provider, but you can also get most from a gynecologist.”
For a person dealing with minimal health concerns, the screenings include bone density screenings typically starting at age 65, cholesterol panels at least every five years, diabetes testing at least every three years, thyroid disease every five years and blood pressure at least once a year for those with normal blood pressure.
Fecal immunochemical tests for colon cancer should happen yearly, and a colorectal screening for cancer should be done every 10 years. Providers should screen for hepatitis C if a person was born between 1945 and 1965.
“The bottom line is encouraging a healthy lifestyle, good nutrition and exercise for older patients,” Simon says.
Search For an ‘Age-Friendly’ Doctor
People 65 and older can benefit significantly from seeing a geriatrician — a doctor with specialized training and experience working with older patients, says Dr. Melissa Simon of the OB-GYN department at Northwestern University Feinberg School of Medicine.
A search on WebMD’s portal or Health in Aging can help you find a geriatrician in your area, but locating a nearby and available geriatrician isn’t always possible. There are only around 7,000 geriatricians in the United States.
If seeing a geriatrician isn’t feasible, gynecologists, family medicine doctors and nurse practitioners typically have the ability, knowledge and experience to perform gynecological exams as well. If you get primary care through a nurse practitioner or doctor at a family medicine clinic, you likely don’t need a separate visit to a gynecologist. Primary care providers can perform most routine exams and you might even feel more comfortable with a doctor with whom you’re familiar.
If you want to make sure your doctor has experience working with older patients — or even better, practices “age-friendly” care — call the clinic’s office to ask. Your health insurance provider should also be able to provide you with your best options.
Seeing a health care provider for gynecological exams and a wellness check-up is as important in your 50s, 60s and beyond as it is in your 20s. Visit a gynecologist or talk to your primary care provider about performing gynecological exams according to clinical guidelines or when you experience symptoms.
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