What happens during an OB/GYN visit at each stage of life?

By Donald Monteiro, MD, gynecologist
Tufts Medical Center Community Care

Women – from teens to seniors – need an annual visit with their OB/GYN. Just as women’s healthcare needs change as they age, their annual OB/GYN appointments change, too. Throughout the course of a woman’s life, we’ll discuss a variety of topics from contraception to menopause.

Here’s a breakdown of what to expect during your next annual visit with your OB/GYN.

The early years: Ages 15 to 21

We recommend that young women start having an annual visit with an OB/GYN around age 15. Sometimes parents don’t think it’s necessary, and occasionally the young woman will be nervous about it. But these years are important for a young woman to get comfortable with an OB/GYN they can trust.

From ages 15 to 21, the annual visit is usually more of a conversation than an exam. In most cases, a pelvic exam is not necessary, and we really want to get to know our patients.

We’ll talk with young women in this age group about contraception and sexually transmitted infections (STIs). Regardless if the patient is sexually active or not. It’s important to arm young women with the knowledge they need to protect themselves from infections and unplanned pregnancy. We will also discuss the HPV vaccine and home breast exams.

At age 21, we recommend that women have their first Pap test. The Pap test is recommended every three years between ages 21 and 30 to test for cervical cancer and HPV.

The “family planning” years: Ages 22 to 44

Starting at this stage in life, the annual exam includes a breast exam, an abdominal exam, and a pelvic exam. We’ll check for abnormalities, such as lumps or painful areas, and talk with you about your concerns.

At the annual visit, we’ll check your blood pressure and body mass index (BMI). We’ll also talk about family medical history, nutrition, exercise, and weight management to help reduce your risk for Type 2 diabetes and certain cancers down the line.

The majority of my patients in this age group are interested in pregnancy prevention or becoming pregnant. At the annual visit, we’ll talk about contraception options, fertility options, preconception counseling, and what may work best for them in their lifestyle and stage of life. We usually will perform an exam during the visit.

For women who are planning on becoming pregnant, we will also take a collaborative approach to see if genetic counseling or screenings are indicated. If there are medical issues to consider, such as high blood pressure or diabetes, we can try to correct or improve those issues prior to pregnancy.

Starting at age 30, it’s recommended that women start getting tested for human papillomavirus (HPV). HPV is common among this age group and often has no symptoms.

Some strains of HPV can cause cervical cancer, genital warts, or oral and neck cancer if left untreated. There is now an HPV vaccine that children should begin to receive at a younger age, typically around age nine, but many women in their 30s have not received it as a child. The vaccine is now suggested up to the age of 45 and may be covered by insurance.

The HPV test can be done at the same time and from the same sample as the Pap test. Under current guidelines, the test can be done every three to five years as long as the Pap testis normal and HPV is not present. If there are any abnormalities with the Pap test, the doctor will determine how often the patient should come back for testing.

Most women this age have a menstrual cycle (a period), and many women develop ovarian cysts that come and go with their periods. If we feel a cyst or lump in your abdomen during your pelvic exam, we can do an ultrasound to determine what it is. Ultrasounds can be done abdominally (outside the body) or transvaginally (inside the vagina with an ultrasound wand).

Often we’ll wait until after the patient’s period to do an ultrasound – if we do it before her period, they may be functional cysts which may go away after a cycle. If we do it after her period and find a cyst, it could signal a more significant problem.

Starting menopause: Ages 45 to 54

The average age of menopause is 50 to 52. At this stage in life, many women are having irregular or heavy periods. Their hormones may be fluctuating, leading to typical menopause symptoms, such as night sweats, mood swings, and hot flashes.

We’ll talk through all those issues at your annual visit and determine next steps. There are many options to treat these symptoms, including:

• Lifestyle changes (diet and exercise)
• Medication
• Hormone replacement therapy
• Alternative, complementary approaches, such as meditation and acupuncture

This is also the age when most women should be having regular screenings for a number of other potential issues. Tests like mammograms, bone density screenings and colonoscopies can help women keep a clean bill of health as they get older.

The 2015 American Cancer Society (ACS) guidelines suggest that women start getting annual mammograms at age 45 instead of age 40. This change is controversial among doctors and patients, so talk with your doctor to determine what you’re comfortable with and at what age you should start getting mammograms. The American Congress of Obstetrics and Gynecology (ACOG) recommends that women start mammograms at age 40.

In my own practice, if a woman doesn’t have a strong family history of breast cancer, we usually recommend starting mammograms at age 40. If there’s a strong family history of breast cancer, such as a mother or sibling, the recommendation is to start mammograms roughly 10 years prior to the age the relative had breast cancer. For example, if your mother had breast cancer at age 45, the recommendation for you would be to start annual mammograms at age 35.

The other issue at this age is bone health. While a woman is still having her period and producing hormones, estrogen protects the bones. Once a woman stops having her period, the ovaries decrease the amount of estrogen being produced and there is some bone loss, which can lead to osteoporosis, which can put you at risk of fracture.

At the annual visit, we’ll talk about exercise and diet strategies to help protect your bones. Many women will do a baseline bone density test at this age to see where they stand, especially if they have a strong family history of osteoporosis.

Age 55 and onward

In this age range, women often encounter more issues with hormone changes. Vaginal dryness and decreased sexual desire often become concerns, so we discuss the treatment for these issues, including counseling, if needed.

As a woman enters her 60s and 70s, there is more concern about the vulva – the outside of the vagina. Aging changes can cause irritating or painful symptoms. One such condition, lichen sclerosis, causes skin changes related to decreased estrogen production. The condition can cause a lot of itching and irritation, and also can be pre-cancerous. The vulva should be examined closely during the annual visit, particularly after age 55, to treat and manage skin conditions and potentially detect early-stage cancer.

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Donald Monteiro, MD, practices at a Tufts Medical Center Community Care office in Melrose. For more information or to make an appointment, call 781-662-4390.

Last updated April 8, 2019.