National Women's Health Week
Motherhood: Obstetrics, fertility and reproductive health
When it comes to reproductive health — whether the aim is to prevent or achieve pregnancy — communication and preparation are key, says Christina Han, MD, director of Maternal-Fetal Medicine at UCLA Health. She recommends every individual consider reproductive planning and discuss those plans with a doctor.
“For anyone with child-bearing potential, especially those with health concerns, being realistic about their current and future timelines will help with reproductive planning. For clinicians providing medical care, assessing every patient with a reproductive lens will help connect them with an obstetrician-gynecologist, or for those at higher risk, with maternal-fetal medicine, in a more timely manner, which can potentially affect how their entire future pregnancy will evolve,” Dr. Han says.
Getting pregnant and maintaining pregnancy are potentially complicated processes that involve anatomical, hormonal and metabolic changes, she adds. “These are things that the lay individual doesn't learn about in school, talk about in the community, and are sometimes even stigmatized — including things like miscarriage and adverse pregnancy outcomes,” Dr. Han says. “So being open and communicating with your obstetrician and finding resources early on can help allay anxiety.”
Gynecologic health: Menstruation, menopause and beyond
A yearly well-woman exam is an important component of overall health care, regardless of a woman’s age or fertility status. From the reproductive years through menopause and beyond, this annual gynecological visit is “an opportunity to make sure any symptoms a woman is experiencing — and findings on the breast and pelvic exam — are normal, says Andrea J. Rapkin, MD. "If they’re not normal, concerns can be addressed at that time or during a future visit.”
While cervical cancer screenings (Pap smears) are no longer recommended annually for women with a history of normal results, a yearly visit to a gynecologist can cover a range of issues, from painful periods and premenstrual syndrome to sexual functioning, screening for sexually transmitted infections and contraceptive needs, Dr. Rapkin says: “Any concerns about overall breast, pelvic, vaginal or vulvar health can be addressed.”
Women should continue these annual exams even after menopause to discuss such potential symptoms as vaginal dryness, urinary urgency, pain during intercourse, mood alterations and sleep problems.
"The well woman exam visit in general does not cover the above issues in depth. Keep in mind that additional visits are often required to ‘take a deeper dive’ into many of the above concerns," Dr. Rapkin says.
Family planning: Contraception services and pre-conception care
For the best pregnancy outcomes, experts recommend optimizing health before trying to conceive, says Amy Stoddard, MD. This can include changing to more pregnancy-friendly prescriptions; getting blood pressure, weight and other health metrics in order; and assessing medical risks and family history.
It’s also important to track menstrual cycles to look for cycle irregularity — longer than 35 days or shorter than 25 days — “because that can mean there might be some underlying medical issue that might make it more difficult for them to conceive,” Dr. Stoddard says.
A person with regular cycles and no other health problems who is planning a pregnancy should consider taking prenatal vitamins at least a month before trying to conceive. “We want to make sure that their folic acid levels are nice and high at the time of conception,” she says.
Even women on birth-control pills who are thinking about getting pregnant can begin taking prenatal vitamins before quitting their contraception. No “wash-out” period is required to return to fertility after using birth control pills or other hormonal contraceptives, Dr. Stoddard says. “A woman can use the contraceptive method of her choice until the month she desires to conceive.” One exception is the Depo-Provera shot, which can delay fertility for up to six months after injection.
Breast health: Mammogram and screening
Breast cancer is second only to skin cancers in prevalence among women. Breast cancer screening is vital for early detection and improved patient outcomes. Screening modalities traditionally include breast self-exams, breast awareness, clinical breast exams and breast imaging.
Routine clinical breast exams by a health care provider are offered starting at age 25. In addition, patients are encouraged to develop "breast awareness at home," rather than practice monthly self-exams, says Jacqueline Fahey, MD. “Essentially, breast awareness is where women have a sense of the normal appearance and feel of their breasts, so they would be aware if they happen to notice a change. Then you would reach out to your OB-GYN provider, so we can do a thorough, systematic exam of the breast and, if needed, order breast imaging.”
The U.S. Preventive Services Task Force is advising that women begin getting mammograms to screen for breast cancer at age 40 and if at average risk continue every two years until age 75.
Bladder health: Specialists in pelvic health
“The biggest risk factor for pelvic floor dysfunction is childbirth,” says Amy Rosenman, MD. “We want women to know that they can have certain problems right after childbirth that can heal without any intervention. Or they might need a minor intervention. Or they may have a significant problem. We’re here for any intervention.”Exacerbating risk factors during childbirth include episiotomy or laceration, pushing for more than two hours and forceps delivery, Dr. Rosenman says.
Pelvic floor disorders include bladder issues, vaginal prolapse and problems with defecation. For younger patients, conservative and non-surgical interventions are the first option and may include pelvic floor physical therapy or a pessary device. Corrective surgery is possible for more serious cases and for women after menopause.
One obstacle to treatment is the embarrassment factor, Dr. Rosenman says, adding that she encourages her medical trainees to facilitate the conversation with women. “Patients should be empowered to bring it up, because there are specialists who are trained in helping them,” she says. “And there are a lot of things that can be done.”
Gynecologic cancer: Care and prevention
Beyond a healthy lifestyle — which includes avoiding smoking and alcohol, eating a balanced diet, getting regular exercise and maintaining a healthy weight — one of the best ways to reduce risk of cervical and endometrial cancers is with HPV vaccination, typically given between age 9 and 26, says Ritu Salani, MD. “It’s not a replacement for Pap testing or HPV screening, but it significantly reduces risk,” she says.
There are no screening tests for ovarian or uterine cancers, so it’s important to know your family history and whether any first-degree relatives (parents, siblings or children) have received cancer diagnoses. “If you have a significant family history, genetic testing may be important,” Dr. Salani says, to identify potential interventions.
Symptoms of gynecologic cancers include abnormal bleeding, particularly postmenopausal bleeding, as well as abdominal bloating or persistent pelvic pain or pressure.
“A lot of women attribute these symptoms to age, weight gain or changes in diet, but one of the things about ovarian cancer, particularly, is it has vague symptoms,” Dr. Salani says.
Gynecologic oncologists are available at UCLA Health to treat these cancers, along with a survivorship program to support patients through their recovery and ongoing wellness.
Surgery for women's health: Minimally invasive gynecologic surgery
Minimally invasive gynecologic surgeries for such conditions as abnormal bleeding, fibroids, endometriosis and ovarian cysts lead to faster recovery times, less need for narcotics and less time in the hospital.
“Generally, you should always strive to accomplish a patient’s surgery via minimally invasive techniques,” says Valentina Rodriguez-Triana, MD. “For a lot of our procedures, the patients can even leave the same day.”
Minimally invasive surgical techniques are also used for pregnancy prevention (sterilization) and gender affirmation for transgender patients, she says. Even hysterectomies can be accomplished through laparoscopy and robotics.
“It’s a really broad spectrum of surgical techniques that are utilized to handle different pathologies,” Dr. Rodriquez-Triana says. “And while not everybody would be a good candidate for these types of techniques, every woman should ask if this is the surgical route she should take. Because we know the recoveries are safer and faster for women to get back on their feet.”