A well woman exam is more than just a pap smear and a mammogram. It is an opportunity to bring up any health concerns you may have and a chance for your provider to screen for any health problems that could develop. Every annual exam will cover the basics; medical history, surgical history, family history, allergies, and current medications, but depending on the patient's age a variety of other topics may be discussed. Some gynecologic topics that may be covered include contraception, sexually transmitted infections, menstrual cycles, menopausal symptoms, sexual health and family planning. Other topics that are commonly discussed are depression screening, vaccinations, healthy and safe relationships, weight loss, urinary concerns, and cancer screening. Because well woman exams cover such a range, they are recommended annually for all women 13 years and older.
Age 13-17: Young women in this group are experiencing a variety of changes physically, emotionally and socially. Puberty is a great time to initiate regular GYN care as it provides a safe and reliable place for the patient to ask questions or share concerns.
- Depending on the patient, parents sometimes stay in the room for the majority of the visit but are often asked to leave just for a few minutes. This empowers the patient to start to take responsibility for her own healthcare, ask questions or bring up concerns she may find too embarrassing to mention with her parents in the room
- A significant health risk in this age group is reckless behavior therefore it is important to discuss topics such as driving, seatbelt use, alcohol, tobacco, and drugs. Another priority for these patients is mental health so screening for anxiety, depression, healthy self-image and healthy relationships is performed.
- Discussing normal menstrual cycles can alleviate any anxiety and correct any misperceptions young women have about menses. Establishing an understanding of contraception along with safe and healthy sexual practices is critical. A pelvic exam is not required for these patients unless they have a concern such as a sexually transmitted infection. Age 11-12i s the ideal time to receive the HPV vaccine however if given prior to age 15, only two doses are required. After age 15, three doses are required.
- As with any annual visit, screening for common medical concerns such as high blood pressure and obesity is necessary. With young women it is especially important to talk about healthy weight goals and promote good self-body image.
Age 18-21: Women in this group may be living on their own for the first time, are legally allowed to partake in alcohol and tobacco and may be sexually active. This new independence makes this the ideal time to transition the responsibility for the patient's health from her parents to herself.
- Unintentional injuries and psychiatric disorders are not uncommon in this age group therefore screening for unsafe behaviors such as not using seatbelts, driving recklessly, using tobacco, drugs or excessive alcohol continues to be imperative. Equally important is screening for depression, anxiety, unhealthy self-image or unhealthy relationships.
- Pap smears are recommended starting at age 21 however all sexually active women in this group should be screened for sexually transmitted infections. An annual visit a good place to discuss safe sexual practices, menstrual concerns, contraceptive options and the HPV vaccine if it was not received earlier in life.
- Women in this group may be considering starting a family and should consider preconception counseling to optimize their health prior to conceiving.
- In addition to routine screening for high blood pressure and obesity, additional screening for high cholesterol, diabetes, breast cancer or colon cancer may be initiated depending on personal and family risk factors.
Age 22-39: The prime reproductive years are when women see their OBGYNs most frequently however well woman visits sometimes are forgotten in lieu of OB visits or simply forgotten in the hustle of a busy life.
- As women age the risks to their health change. From ages 22-34, injury due to accidents continues to be the most common risk to health therefore discussing alcohol, drug and tobacco use, and seatbelts continues to be a high priority. Mental health continues to be a priority therefore screening is done for depression, anxiety and healthy relationships.
- Heart disease becomes a prominent health risk for women starting as young as age 35. In addition to routine screening for high blood pressure and obesity, additional screening for high cholesterol, diabetes, breast or colon cancer may be recommended depending on family and personal risk factors.
- Many women in this age group are considering having children, are in the process of expanding their family or have completed their family and wish to avoid having more children. Preconception counseling is recommended for those who are planning to have children and contraceptive counseling is recommended for those who wish to avoid having more children.
- An annual visit is useful to discuss safe sexual practices, discuss menstrual concerns and for routine screening for cervical cancer with a pap smear.
Age 40-49: As women transition out of the reproductive years, they may start to develop menopausal symptoms or other medical concerns that arise with age.
- Perimenopause can be an emotional time for women with the fluctuation of hormone levels therefore it continues to be important to screen for depression, anxiety, healthy relationships in addition to excessive alcohol, tobacco and drug use.
- Cancer emerges as a major health risk during the 5th decade of life therefore in addition to continuing routine pap smears, screening mammograms are recommended to be started at age 40. Menstrual concerns, perimenopausal symptoms, urinary incontinence, uterine prolapse, safe sexual practices and contraceptive options or preconception counseling are all topics to be reviewed at well women visits.
- Heart disease continues to be a major risk to women’s health consequently in addition to routine screening for high blood pressure and obesity, routine screening for high cholesterol, diabetes and colon cancer is recommended at age 45.
Ages 50-64: Similar to puberty, women in this age group may have recently undergone or will be going through a large change in their hormones. The average age of menopause is 51 years old.
- Ensuring healthy social habits and mental health remains a priority. This is done through screening questions regarding the use of alcohol, tobacco and drugs in addition to inquiring about depression, anxiety and healthy relationships.
- Cancer and heart disease remain risks to women’s health. Risk factors for these diseases is elicited through review of family and personal history. Falls also pose a risk to health so a discussion of fall prevention is warranted.
- As women go through menopause, routine well woman exams are a good place to ask questions regarding menopause and safe sexual practices. Routine pap smears are recommended to age 65. Mammograms are recommended annually.
- Routine screening for high blood pressure, obesity, high cholesterol, diabetes and colon cancer are continued. Heart disease, lung cancer and osteoporosis may be screened for based on family and personal risk factors.
Over 75: In general, patients in this group no longer require routine pap smears however they can still benefit from regular well woman exams.
- In addition to routine screening regarding the use of alcohol, tobacco and drugs, it is imperative to ensure a safe living environment and screen for elder abuse, depression, anxiety and health relationships.
- While most women no longer have menopausal symptoms, some still may therefore discussion of menopausal symptoms and review of safe sexual practices is important.
- Routine screening for high blood pressure, obesity, osteoporosis, colonoscopies, and fall risk continue to be a priority. Depending on personal and family history, mammograms and screening for lung cancer may be recommended.
Author
Dr. Kathryn Gottschalk
OBGYN
