WOMEN’S HEALTH.

Who should I see for Women’s Health issues?

womens health in general practice

Women’s Health Doctors

There are special women’s health needs that are delivered or arranged by your GP.

A central area of women’s health is screening for breast, cervical & ovarian cancer. Cervical Screening Tests are performed in the practice or self-taken. Contraception & STD testing are important services. It is a good idea to seek advice before thinking about getting pregnant. Make an appointment for pre-pregnancy care to ensure that potential risks are uncovered and managed & this usually includes a blood test. Other key areas of women’s health are Infertility, The Menopause, and managing gynaecological symptoms such as pain and heavy periods.

Recurrent Urinary Tract Infections & Premenstrual Syndrome (PMS) are other common women’s health issue for which there is effective medication and strategies.

Your GP may refer you to a Gynaecologist for specialist input, particularly if you may benefit from a surgical procedure.

Endocrinology and Women

Women are more likely than men to experience an underactive thyroid.

Polycystic Ovarian Syndrome may lead to problems with weight, hirsutism.

Low dose Testosterone Therapy may be considered in women.

Care before pregnancy

A healthy pregnancy and baby begin prior to conception. Talk over your plans before you get pregnant. This is the time to get advice on nutrition, exercise, and lifestyle issues. The doctor will be covering your vaccination history and arrange a blood test for immunity to a variety of different infections that can be dangerous in pregnancy. Other blood work is usually recommended.

You should take a pre-pregnancy supplement for at least 3 months prior to conception and your doctor will advise you on the best one to take. Requirements for iodine, folic acid, iron, vitamin d and calcium vary from woman to woman.

Your doctor will also discuss genetic carrier screening. You may consider testing for conditions such as cystic fibrosis, fragile x syndrome and spinal muscular atrophy. The female would normally be tested first, and their partner tested if the female is a carrier. The goal is carrier screening is to find couples who are both carriers because there is a 1 in 4 chance of a baby being affected. Affected couples may consider pre-implantation diagnosis through IVF, or diagnosis in early pregnancy with a view to termination of pregnancy. As you can see, this is a very personal choice for each couple and decisions should not be rushed.

There are a myriad of optional tests in early pregnancy including non invasive prenatal testing. Your GP will guide you through the myriad of first trimester screening options including Non Invasive Prenatal Testing.

There is the opportunity to discuss which hospital antenatal clinic to attend.

Contraception

Contraception is a lot more than a script for the pill. It is common that the the pill should not be prescribed for safety reasons, and there are other reasons why other methods of contraception should be explored. A long acting progestogen implant (implanon) can be inserted in the medical centre. Other options are the progestogen-only pill, three-monthly progestogen injection, and you may be referred for either The Intrauterine device or vaginal ring. Finally your partner may consider vasectomy.

Well Woman Health Screenings

Any Women’s health clinic should include regular, periodic screenings to catch diseases early. When incorporated into wellness programmes, preventative health screenings can save lives. Because women have unique health care needs, it is important that a well woman exam and health screening be conducted apart from any visit to a medical centre regarding symptoms or illness. Women’s health screenings are important to staying healthy and leading an active and full life.

Breast Cancer Screening

Breast cancer is highly treatable and survivable when caught in its earliest stages. Unfortunately, breast cancer is the most common form of cancer found in women in Australia. Breast cancer screening as part of a well woman health screening is made up of a clinical breast exam and a mammogram provided by BreastScreen Australia, a National Programme for Breast Screening.

Clinical Breast Exam.

As part of this exam, your doctor will ask you about any changes you have noticed in your breasts since your last well woman health screening. Your breasts will be visually examined while you are sitting up and physically examined while you are lying down. This examination includes not only the breast area but also under the arms as part of the lymph node examination. If you aren’t performing regular breast exams at home, you should be! Your doctor can show you how to perform this very important examination every month. If you are performing regular self-exams at home, the clinical breast exam can be performed yearly at your local medical centre as part of your annual well woman exam.

Mammogram.

BreastScreen Australia, the national programme for breast screening in Australia, provides free mammograms every 2 years for breast cancer screening. If you are a woman between the ages of 50 and 74 and have no signs of breast cancer then you should be screened every two years. This is because most breast cancer occurs in women over the age of 50. If you are between the ages of 40 and 49 or over the age of 75 then you should discuss the need for breast screening mammogram with your doctor. Based on your personal and family history your doctor will be able to make a determination about your breast cancer screening schedule with a radiology or clinic referral.

Cervical Cancer Screening

Cervical cancer rarely has symptoms in its early stages. Yet catching cancer early is crucial to survival. Cervical cancer rates in Australia have been cut in half since the introduction of the National Cervical Cancer Screening Program began in 1991.¹ Unfortunately, 80% of the women in Australia with cervical cancer did not undergo regular screening.

Who Should Get Screened for Cervical Cancer?

The recommendations for cervical cancer screenings as part of the well woman health screenings are undergoing some pretty big changes. The population that should be screened and the method of cervical cancer screening are both changing. Here is a quick summary of who should currently be screened:

We’re all familiar with the old 2-yearly Pap smears.

The new cervical screening test was enacted in December 2017 with a 5 yearly test between the ages of 25 and 74.

Research has shown that screening women under the age of 25 has had no change in the number of cases diagnosed or the number of cases resulting in the death of women in that age group.

How Do You Screen for Cervical Cancer?

The new screening will take place in much the same manner as the old PAP test screening. The sample is taken from your cervix by a clinician and tested by the lab for The Human Papilloma Virus (HPV). Various high-risk types of HPV are tested for. HPV types 16 and 18 are ‘automatically’ high risk and these women will require a referral for a colposcopy examination. Other types of HPV will automatically involve a further test of the sample for ‘abnormal cells’, and the result of this further test will determine the level of risk.

It takes over 10 years for cervical cancer to develop from persistent HPV infection. For this reason, Cervical Cancer Tests only need to be routinely performed every 5 years.

Women over 30 years of age who do not want a clinical examination may opt for a ‘self taken‘ sample. Your GP will need to request this.

The Role of HPV in Cervical Cancer

The new cervical screening programme recognizes that cervical cancer can be detected prior to the development of actual cancerous cells. That is because cervical cancer is strongly linked to HPV infection, particularly HPV types 16 and 18.

Persistent HPV infections can lead to the abnormal cells that eventually develop into cervical cancer. By identifying and treating the HPV infection early, the abnormal cells and cancer can be avoided.

Just because you have received the HPV vaccination does not mean that you can skip HPV screening for cervical cancer. Unfortunately, the HPV vaccination does not protect against all strains of HPV that can cause cervical cancer. So, both vaccinated and unvaccinated women need to participate in screening. Fortunately, HPV screening only needs to be performed every 5 years

[1] Cancer Council of Australia: Cervical Cancer

Ovarian Cancer diagnosis.

Currently there are no general screenings for ovarian cancer. This is because as of now, there is no effective test for the early detection of ovarian cancer. That doesn’t mean that you shouldn’t be concerned about this sort of cancer, particularly if you have a family history in a close relative of ovarian, breast, or bowel cancer. Signs to watch out for are:

Abdominal pain or feeling bloated
Frequent urination
Back or pelvic pain
Irregular menstrual cycle or flow
Pain during sexual intercourse

These symptoms do not mean that you have ovarian cancer, but they do mean that you need to be assessed by your doctor at your local medical centre. A CA125 blood test may be performed. This looks for the presence of a protein (CA125) in your blood. This protein can be caused by ovarian cancer cells. Unfortunately, there are other normal causes of a raised CA125, which is why it cannot be used alone to diagnose ovarian cancer. However, it may be used in conjunction with other tests (such as a transvaginal ultrasound) to confirm or exclude ovarian cancer.

Good health is important to you and those who depend on you. Whether you are a partner, mother, spouse, or valued employee the people in your life depend on you. You owe it to them and yourself to take care of your body, participate in yearly well woman exams, and cancer screenings on a regular basis. You will get peace of mind and in the event disease is detected, you’ve already started on the road to recovery by getting the diagnosis.

There is no one like you. Take care of yourself!

WRITTEN BY: Richard Beatty
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