Written by Corey Whelan
“I can't wait to put on a flattering surgical gown and pop my feet into freezing cold stirrups, for my annual gynecological exam,” said no woman, ever.
That annual visit to the gynecologist isn’t fun, and lots of women procrastinate about making their appointment. In fact, data indicates that gynecological visits have declined significantly among women in the U.S. since 2000.1 There’s no specific age breakdown data associated with that troubling statistic, but anecdotal evidence tends to suggest that a significant percentage of postmenopausal women are eliminating gynecological visits from their healthcare routine.
The drivers of this behavior in postmenopausal women are manifold. Some women may think they don’t need a gynecologist after their reproductive years have passed. Others may be confused about conflicting guidelines for Pap smears. And many women may decide they just “don’t have time to go,” which stops them from getting the healthcare they need.
You may not want to, but that annual visit with your gynecologist is essential, especially for postmenopausal women. The next time you find yourself wondering, “Do I need to see a gynecologist after menopause?” we hope you’ll realize the answer is ‘yes’. Read on to find out why.
Why You Still Need a Gynecologist After Menopause
There’s a common misconception among postmenopausal women that gynecological care isn’t necessary once your period has stopped for good.2 A quick look around a typical gynecologist’s waiting room may solidify that thought. According to Dr. Brooke Faught, DNP there are many drivers for this, including confusion about guidelines, reduction in sexual activity, and an assumption that seeing a primary care physician when postmenopausal, is enough.
Pelvic Exams Are About More Than Just Pap Smears
Many postmenopausal women are confused about how often they need gynecological care, which can be due to conflicting opinions from professionals in the field. “The guidelines on how often postmenopausal women should see their gynecologist change continuously, and there is no clear consensus. This confusion keeps many women out of their doctor’s offices,” Dr. Faught explains.
This may be especially true for women over 65. Confusion exists because screening options vary, so that any of the following are acceptable for those aged 30-65, according to the American College of Obstetricians and Gynecologists (ACOG) – an FDA approved HPV test every five years, co-testing (Pap smear and HPV) testing every five years or a Pap alone every three years. Of course, individual situations may alter this. After 65, they state that Pap smears may no longer be needed.3
ACOG has also issued caveats for the over-65 guideline that may negate Pap smears for some postmenopausal women.4 Their reasons for not needing this test include having normal Pap screenings in prior years. In other words, your body and health history should be taken into consideration when determining how often a Pap smear or any gynecological tests are needed during postmenopause.
How often you need gynecological care, is best determined by a healthcare provider who knows your health history. This relationship is a key reason why postmenopausal women need to see their gynecologist regularly. A healthcare provider who knows you and your chart can pick up on changes quickly. It’s never too late to establish this relationship. For postmenopausal women, maintaining that relationship is essential.
It’s important to remember that the risk of cancers, including those affecting reproductive organs, increases with age.5 But, Pap smears are also only one part of a gynecological exam. Regular pelvic examinations can support early detection of malignancies and other conditions that may affect postmenopausal women.6
Why Seeing a Primary Care Physician May Not Be Enough
Many young women see a gynecologist for all their healthcare needs, instead of relying on a primary care physician (PCP). Dr. Faught has noticed that this trend tends to flip in postmenopausal women, who often forgo the gynecologist and instead, rely on their PCP for everything. “You may not need both a PCP and a gynecologist. However, if you have specific concerns such as abnormal breast changes, or pain during sex, a gynecologist may be your better bet,” says Dr. Faught, who stresses the need to have someone knowledgeable reading your mammogram. “Gynecologists are best trained to manage abnormal mammograms, and in some instances, guide you to next steps,” she adds. “They’re also more likely than a PCP to ask you questions about sex, based upon what they notice during your exam. This can open up the door to much-needed conversations about pain during intercourse, changes in desire, and issues that are common during perimenopause and menopause, such as vaginal dryness.”
Another concern which may be best handled by your gynecologist is vaginal atrophy, also known as atrophic vaginitis and genitourinary syndrome of menopause (GSM). It’s caused by declining levels of estrogen and is most commonly experienced during peri- and postmenopause. Vaginal atrophy causes the vulvar and vaginal tissue to become thin, dry, and inflamed. Since it shortens and tightens the vagina, it’s no surprise that this condition causes pain during vaginal sex. It can also lead to symptoms such as burning with urination, and urinary frequency as well as urgency.7
Vaginal atrophy can diminish quality of life for many postmenopausal women. It can also be ignored or misunderstood by primary care physicians. A survey of medical professionals found that gynecologists were significantly more likely to be knowledgeable about vaginal atrophy than primary care physicians. Gynecologists were also more likely to assess postmenopausal women for vaginal atrophy, and to counsel them on treatment options.8
“There are a host of conditions that a gynecologist is more likely than a primary care physician to pick up on. In addition to vaginal atrophy, these include vulvar skin disorders such as Lichen Sclerosis, a precancerous condition,” says Dr. Faught. When it comes to your vulvovaginal health, your gynecologist can provide helpful and precise advice and treatment recommendations as they’re specifically trained in this area.
And then, of course, there’s sexual desire. “Lack of sex drive is the most prevalent sexual complaint voiced to gynecologists from women of all ages. Since the reasons behind it are so individualized, a conversation is always warranted. There are many causes, and many treatments that can uptick desire and libido [specifically] in postmenopausal women,” adds Dr. Faught.
How Often to See Your Gynecologist After Menopause?
Dr. Faught recommends that postmenopausal women see their gynecologist once a year, especially if they don’t have a primary care physician. She also advises that seeing a gynecologist after menopause can help with routine care, such as thyroid exams, cholesterol and blood pressure checks, and preventive care, as needed.
Pelvic examinations should be done annually. Dr. Faught’s broad-based rule of thumb for Pap tests in postmenopausal women is once every three to five years for women with no recent history of abnormal Pap results. It’s also a good idea to check in with your healthcare provider to discuss their recommendations on visit frequency based on your health history.
What to Expect During Your Gynecologist Exam Postmenopause
Your gynecologist will likely do a routine physical exam, which includes a breast and pelvic examination. The pelvic exam looks for signs of:
- Ovarian cysts
- Uterine fibroids
- Early-stage gynecological cancer
- Sexually transmitted infections
- Vaginal bleeding
- Vulvar/vaginal skin changes
- Abnormal vaginal discharge/infections
- Urinary issues9
You may get a blood test and give a urine sample. These tests can provide information about kidney health and detect any underlying or silent infections you may have.
Based on age and risk factor, and if your healthcare provider deems it necessary, they may order a bone density scan. This test can help to detect osteoporosis, a condition which affects nearly 19% of women over 50.10 If your gynecologist doesn’t offer this test but suggests it, they’ll likely provide you with a recommendation for a radiologist or imaging center.
Additionally, the American College of Gastroenterology recommends a colonoscopy every 10 years beginning at the age of 45,11 so, your gynecologist may provide you with a recommendation for this test as well.
Lastly, they’ll talk to you. A good gynecologist will take the time to hear your concerns and provide information and answers that can help you live your healthiest, most beautiful postmenopausal life.