Gynecologic Care in your 40s
What is different about an annual visit after a woman turns 40?
We have an enhanced emphasis on wellness and prevention, providing individualized counsel on diet as well as supplements to maintain bone density and manage menopausal symptoms. Of course, we start ordering mammograms at age 40 and bone density screenings at 50. We can take care of everything—blood work, sonograms, urodynamic testing for incontinence, mammograms and bone density screenings—in one visit, under one roof.
What preventive treatment do you recommend for a woman in her 40s?
Many women are deficient in vitamin D and that’s very important to stay ahead of in your 40s if you want to maintain bone density. As you experience menopause and its associated lower estrogen support, you can lose over 20% of your bone density. If you are deficient in vitamin D and calcium in your 40s, you increase the risk of developing osteoporosis in your 50s. Don’t wait until you are in a menopausal place to increase your intake of these essential vitamins.
Why does an OB/GYN track weight, BMI and dietary habits?
Because of hormonal changes in midlife, women can gain weight around the midsection that may contribute to chronic health problems like diabetes, heart disease and cancer. At this time we may want to test hormones secreted from your thyroid, the butterfly-shaped gland at the front of your neck. Weight gain from thyroid imbalances can happen suddenly and medications can help you get back to normal. We will also watch your testosterone levels. Adding a supplement can help you retain lean muscle mass.
When should a woman begin hormone testing?
I tend to begin testing in a woman’s early 40s so she has the tools to regulate symptoms before they become bothersome. Not everyone needs “hormones” for menopausal symptoms, though. A soy or herbal supplement can help relieve hot flashes and melatonin may relieve sleep disturbances. If a woman decides to incorporate hormones, we talk about delivery methods—a patch, pills, cream or bio-identical hormones. Many of my patients are surprised to learn that insurance benefits include coverage for hormone therapy, including bio-identicals, and they are relieved to have a board certified OB/GYN to turn to for counsel, testing and affordable treatments.
How do I start a conversation with my OB/GYN about painful intercourse?
Actually, your OB/GYN should be the one to initiate a conversation about sexual health and function. I always ask before the exam so that I can look for physical causes. We may discuss decreased libido, issues with sexuality and therapy and options to treat painful intercourse. For decreased libido, common in a woman’s 40s and 50s, I am certified to prescribe the new female arousal medication Addyi, and we can also discuss androgen therapy. I am excited to now offer the MonaLisa Touch procedure that treats vaginal dryness and painful intercourse in the office without surgery or hormones.
Speaking of uncomfortable topics…what about incontinence or prolapse?
As many as 50% of women will experience prolapse, the relaxation of the bladder, uterus or bowel, and nearly 45 million Americans have incontinence issues. It’s common, but not normal to leak urine, so talk to your OB/GYN. You can restore your quality of life with physical therapy, medications and, as a last resort, minimally invasive surgery.
Why are my periods so heavy and unpredictable after 40?
The median age for menopause is 51, and every woman is unique in the transition, but periods do tend to become problematic in a woman’s 40s. I counsel my patients through this phase, testing for underlying causes and offering suggestions for permanent solutions such as in-office ablation and single incision hysterectomy.
I utilize the daVinci robot to perform complex surgeries in a minimally invasive fashion with less downtime and discomfort. I have personally performed over 400 robotic surgeries and in my role as a certified proctor training other surgeons have assisted on many more. Focusing on gynecology helps me provide the most up-to- date treatments for bothersome midlife menstrual issues.
How often should an over-40 woman see her OB/GYN?
If your paps are normal, you may space out testing for up to five years. However, there is still a need to come in every year for a pelvic exam. The idea that a pap smear is the sole reason for a well woman visit is a misconception, so don’t forget to schedule an annual exam. Without a pap smear, it just gives us more time to talk about other issues.