Well Woman Gynecology
Cancer Screening Guidelines
Breast Cancer
- Yearly mammograms starting at age 40 and continuing as long as a woman is in good health.
- Clinical breast exams (CBE) should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women age 40 or over.
- Women should report any breast change promptly to their health care providers. Breast self-exams (BSE) is an option for women starting in their 20s.
- Women at increased risk (e.g. family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (e.g. breast ultrasound or MRI) or having more frequent exams.
Cervical Cancer
- All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with a regular Pap test or every two years with the newer liquid-based Pap test.
- Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years with either the regular or liquid-based Pap test. Women who have certain risk factors such as DES exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or a chronic steroid use should continue to be screened annually.
- Another reasonable option for women over 30 is to get screened every three years (but not more frequently) with either the regular Pap or liquid-based Pap test, plus the HPV DNA test.
- Women over 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
- Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.
Endometrial (Uterine) Cancer
- The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer, and strongly encourages to report any unexpected bleeding or spotting to their healthcare provider. For women with or at high risk for hereditary nonpolyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy at age 35.
Colon and Rectal Cancer
Beginning at age 50, women at average risk for developing colorectal cancer should follow one of these five testing schedules:
- yearly fecal occult blood test (FOBT)* or fecal immunochemical test (FIT)
- flexible sigmoidoscopy every 5 years
- yearly FOBT* or FIT plus flexible sigmoidoscopy every 5 years**
- double-contrast barium enema every 5 years
- colonoscopy every 10 years
* For FOBT, the take-home multiple sample method should be used.
** The combination for yearly FOBT or FIT plus flexible sigmoidoscopy every 5 years is preferred over either of these options alone.
All positive tests should be followed up with a colonoscopy.
People should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors:
- a personal history of colorectal cancer or adenomatous polyps
- a strong family history of colorectal cancer or polyps in a first degree relative younger than age 60 or in two first degree relatives of any age
Note: a first degree relative is defined as a parent, sibling, or child. - a personal history of chronic inflammatory bowel disease
- a family history of an hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon cancer)
Source: The American Cancer Society Cancer Detection Guidelines
Well Woman Gynecology
The nurse-midwives provide gynecologic care for well women of all ages.
Menarche: The first menstrual cycle - is the dawn of the transition from maidenhood to motherhood. It will happen, on average, between the ages of 11-13 (ranging from as much as ages 9-15). After that first cycle of bleeding, it may take as long as a year or so before she reaches a predictable 28-30 day pattern.
This time is marked by many physical changes but there are also emotional changes - likened to a rollercoaster of emotions caused by the surges of hormones. The rollercoaster ride doesn’t look so bad from steady ground, but once you’re on it, your opinion changes. Young women face up to 4-5 years of these hormonal tidal waves or roller coasters. The ebbing or flowing of estrogen in a woman’s body is synonymous with mood swings, alternating periods of energy and fatigue, and spiritual highs and lows.
The midwifery service provides well woman care to adolescents. We are happy to meet with young women to discuss the physical and emotional changes that occur during menarche. We can discuss and educate based on individual needs. Some women will want to learn about birth control options, others may want to discuss heavy menses and cramping, others may be struggling with emotional or social concerns with family or friends. A first pap smear is recommended after a young woman becomes sexually active. Meeting with a healthcare provider before that happens is helpful, so that she feels the importance of her new power to procreate.
Childbearing Years
The years of fertility are many, and yet most women chose to only cultivate that fertility by bearing children a few times. The Midwifery Service provides supportive, educative, individualized care for women during these years. A woman’s needs may vary but birth 
control options, healthy lifestyle education, and health screening (pap smears, cholesterol levels, mammograms, etc) are all basic to our health care at this time. A woman’s emotional needs also change as her roles change with her partner, with work, with her aging parents. We understand this and are happy to discuss and support women as they may need counseling referrals, support with PMS symptoms, or libido changes. Yearly annual exams are recommended during this time to screen, support and educate women before and during perimenopause.
Perimenopause - is the year(s) leading up to menopause. Menopause is marked by a woman’s last menstrual period. However, she can not know for sure what is her last period until she has been period free for 1 year.
Menopause is a normal part of life. It is one step in a long slow process of aging. For most women it begins silently somewhere around the age of 40 when menstrual periods may start to become less regular. Declining levels of hormones, estrogen and progesterone cause changes in your periods. These hormones are important for keeping the vagina and uterus healthy, for normal menstrual cycles and for a successful pregnancy. Estrogen also helps keep bones healthy. It helps women keep good cholesterol in their blood.
Symptoms of perimenopause start 2-4 years before the last period. When a woman notices her menstrual cycles are less regular, she may also feel such symptoms as hot flashes or night sweats. Changing hormone levels can cause a variety of symptoms that may last from a few months to a few years or longer. Some women have slight discomfort or worse. Others have little or no trouble. If any of these changes bother you, check with your nurse-midwife.
The most common symptoms are:
- changes in your period
- hot flashes
- problems with your vagina or bladder
- sexual changes
- mood changes
- changes in your body
How Can I Stay Healthy After Menopause?
Staying healthy after menopause may mean making some changes in the way you live.
- Don't smoke. If you do use any type of tobacco, stop - it's never too late to benefit from quitting smoking.
- Eat a healthy diet - one low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
- Make sure you get enough calcium and vitamin D - in your diet or in vitamin/mineral supplements.
- Learn what your healthy weight is, and try to stay there.
- Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.
Other things to remember:
- Take medicine to lower your blood pressure if your doctor prescribes it for you.
- Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
- Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.
Are you bothered by hot flashes? Menopause is not a disease that has to be treated. But you might need help with symptoms like hot flashes. Here are some ideas that have helped some women:
Try to keep track of when hot flashes happen - a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid it.
- When a hot flash starts, go somewhere cool.
- If night sweats wake you, try sleeping in a cool room or with a fan on.
- Dress in layers that you can take off if you get too warm.
- Use sheets and clothing that let your skin “breathe.”
- Have a cold drink (water or juice) when a flash is starting.
Healthy living information from National Institute on Aging “age pages” publication.
