At every stage in a woman’s life, an OB-GYN can provide a wide range of services that meet her health needs — from puberty through her child-bearing years, menopause and beyond. Obstetricians and gynecologists — or OB-GYNs — specialize in women’s health.
In this video, Dale Mitchell, MD, chairman of the department of obstetrics and gynecology at Scripps Clinic, joins San Diego Health host Susan Taylor to discuss the role OB-GYNs play helping women at various stages throughout their lives.
When it comes to a woman’s health, “every question is important,” Dr. Mitchell says.
The American College of Obstetricians and Gynecologists (ACOG) recommends the first gynecologic visit take place between the ages of 13 and 15 years old. The initial visit offers the opportunity for the start of a long relationship between the patient and her OB-GYN.
The first visit could just be an age-appropriate discussion about reproductive health topics, including menstruation period and sexual activities, and a review of medical history. Most often a general exam and an external genital exam are performed. An internal pelvic exam, which is a check of the reproductive organs, is not required unless there is a health issue involved.
The ACOG recommends women get a Pap test (also known as a Pap smear) to screen for cervical cancer beginning at age 21.
Dr. Mitchell says OB-GYNs tend to see many of their patients when they are in their late teens or early 20s and cover many areas. “Most importantly, we provide education on safe sex, birth control and vaccination for HPV (human papillomavirus), which is the most common sexually transmitted disease,” he says. HPV can cause cervical disease, including cervical cancer.
Many young women share the same health concerns, including birth control or prevention of pregnancy.
Dr. Mitchell says birth control methods are safer today and offer many options. “We look at the risk factors, but, in general, most young women are going to be healthy and appropriate for any form of birth control,” he notes.
Birth control options range from hormonal — birth control pills, patches, vaginal rings, injections and IUDs — to non-hormonal, such as natural family planning and condoms.
When pregnancy occurs and motherhood is the goal, an OB-GYN monitors for high-risk pregnancy conditions that could affect the mother, the baby or both.
“We advise women who are planning to get pregnant to see an obstetrician in advance of conception to discuss any risk factors and a plan of management, especially in the early stages of pregnancy,” Dr. Mitchell says.
“We like to make sure they take prenatal vitamins or a folic acid supplement that reduces the risks of certain birth defects, and see if they’re interested in doing a carrier screening (testing for genetic disorders),” he adds.
Age and weight are risk factors, "especially for women in their 40s and above,” Dr. Mitchell says. “We see more problems, such as higher rates of high blood pressure, (gestational) diabetes and C-section rates.”
OB-GYNs treat infertility, where age is often a factor.
“For someone in their 20s without any risk factors, most of us recommend they continue trying for up to one year before any intervention is done,” Dr. Mitchell says. “For someone in their 40s who’s getting toward the end of the reproductive age group, I might take that down to three or four months,” he says.
An infertility evaluation is done to find the reason why pregnancy has not occurred.
“Probably 80 percent of the time, just through simple testing, we can identify something. About half the time it's a male factor; half the time it's on the woman's side. And there are things we can do at that point,” Dr. Mitchell says.
“Those 20 percent that we can't figure out are usually referred to a reproductive endocrinologist or a fertility subspecialist. And their focus these days is to consider things like intrauterine insemination (artificial insemination) or in-vitro fertilization,” he says.
In-vitro fertilization is a process through which eggs are removed from the woman’s body and fertilized with sperm in a lab, then placed back into the uterus with the hope that the woman will become pregnant. “The younger the woman, the healthier the woman, the higher chance of success,” Dr. Mitchell says.
Menopause marks a period of changes for every woman. Symptoms related to this transition may arise either just before or after she stops menstruating.
“For some people, the only thing that changes is their period stops, while for others it’s worse and they are just miserable with hot flashes and other symptoms. Most patients are going to be within those two extremes,” Dr. Mitchell says.
Hormone replacement therapy can be used to relieve symptoms. However, “it’s something that you should talk to your doctor about,” Dr. Mitchell says.
Breast exams become more important as women age.
The American Cancer Society recommends women with an average risk of breast cancer should get an annual mammogram beginning at age 45, and, if they choose to, as early as 40. “As OB-GYNs we tend to be a little conservative, so I still recommend a baseline mammogram around age 40,” Dr. Mitchell says.
Scripps offers an advanced form of mammography called breast tomosynthesis or 3-D mammography, which uses low-dose X-rays to detect cancer early.
Medical screenings continue to be important as women get older. Their risk for heart disease, breast cancer, colon cancer and osteoporosis increases with age. Dr. Mitchell recommends they continue to see their OB-GYN well after menopause, but that they include an internal medicine specialist as part of their health team.
Most important is that they continue to see their physician on a regular basis and feel comfortable talking about any health issue that is important to them, he says.