WOMEN’S HEALTH DOCTORS.

Who should I see for Women’s Health issues?

womens health in general practice

Women’s Health Doctors

There are special women’s health needs that are delivered or arranged by your GP. In The UK, it is difficult to get an appointment with a doctor at all. In Australia, patients can obviously choose their doctor. Younger women tend to prefer to see female doctors for women’s health issues. So most women’s health doctors are female just as most men’s health doctors are male.

A central area of women’s health is screening for breast, cervical & ovarian cancer. Examinations and Pap smears are provided in the practice for screening and/or diagnosis. Contraception & STD testing are important services. It is a good idea to seek advice before thinking about getting pregnant. A pre-pregnancy appointment will ensure that potential risks are uncovered and managed & this usually includes a blood test. Other key areas of women’s health are Infertility, The Menopause,  and managing gynaecological symptoms such as pain and heavy periods.

Recurrent Urinary Tract Infections & Premenstrual Syndrome (PMS) are other common women’s health issue for which there is effective medication and strategies.

Your GP may refer you to a Gynaecologist for specialist input, particularly if you may benefit from a surgical procedure.

Pre-Pregnancy Counselling

A healthy pregnancy and baby begin prior to conception. If you are planning on a baby, this is the time to get counselling at a women’s health appointment on nutrition, exercise, and lifestyle issues. The doctor will be covering your vaccination history and arrange a blood test for immunity to a variety of different infections that can be dangerous in pregnancy. Other blood work is usually recommended. In addition, a family history may suggest increased risk of genetic conditions. You should take a pre-pregnancy supplement for at least 3 months prior to conception and your doctor will advise you on the best one to take. There is the opportunity to discuss which antenatal clinic to attend.

GP Contraceptive advice for womenContraceptive advice

Contraception is a lot more than a script for the pill. It is common that the the pill should not be prescribed for safety reasons, and there are other reasons why other methods of contraception should be explored. A long acting progestogen implant (implanon) can be inserted in the medical centre. Other options are the progestogen-only pill, three-monthly progestogen injection, and you may be referred for either The Intrauterine device or vaginal ring.

women health issues in general practiceWell Woman Health Screenings

Any Women’s health clinic should include regular, periodic screenings to catch diseases early. When incorporated into wellness programmes, preventative health screenings can save lives. Because women have unique health care needs, it is important that a well woman exam and health screening be conducted apart from any visit to a medical centre regarding symptoms or illness. Women’s health screenings are important to staying healthy and leading an active and full life.

Breast Cancer Screening in general practiceBreast Cancer Screening

Breast cancer is highly treatable and survivable when caught in its earliest stages. Unfortunately, breast cancer is the most common form of cancer found in women in Australia.¹ Breast cancer screening as part of a well woman health screening is made up of a clinical breast exam and a mammogram provided by BreastScreen Australia, a National Programme for Breast Screening.

Clinical Breast Exam.

As part of this exam, your doctor will ask you about any changes you have noticed in your breasts since your last well woman health screening. Your breasts will be visually examined while you are sitting up and physically examined while you are lying down. This examination includes not only the breast area but also under the arms as part of the lymph node examination. If you aren’t performing regular breast exams at home, you should be! Your doctor can show you how to perform this very important examination every month. If you are performing regular self-exams at home, the clinical breast exam can be performed yearly at your local medical centre as part of your annual well woman exam.

Mammogram.

BreastScreen Australia, the national programme for breast screening in Australia, provides free mammograms every 2 years for breast cancer screening. If you are a woman between the ages of 50 and 74 and have no signs of breast cancer then you should be screened every two years. This is because most breast cancer occurs in women over the age of 50. If you are between the ages of 40 and 49 or over the age of 75 then you should discuss the need for breast screening mammogram with your doctor. Based on your personal and family history your doctor will be able to make a determination about your breast cancer screening schedule with a radiology or clinic referral.

[1] Australian Institute of Health and Welfare: AIHW Breast Cancer

Cervical Cancer Screening in general practice

Cervical Cancer Screening

Cervical cancer rarely has symptoms in its early stages. Yet catching cancer early is crucial to survival. Cervical cancer rates in Australia have been cut in half since the introduction of the National Cervical Cancer Screening Program began in 1991.¹ Unfortunately, 80% of the women in Australia with cervical cancer did not undergo regular screening.²

Who Should Get Screened for Cervical Cancer?

The recommendations for cervical cancer screenings as part of the well woman health screenings are undergoing some pretty big changes. The population that should be screened and the method of cervical cancer screening are both changing. Here is a quick summary of who should currently be screened:

Recommendations up to 2016. When the National Cervical Cancer Screening Program was first launched, it was recommended that all women between the ages of 18 – 70 that have ever been sexually active be screened via a PAP test every 2 years. Until the new screening programme is fully implemented in 2017, it is important that women continue to participate in PAP tests every 2 years.

New Recommendations from 2016/17. The cervical cancer screening changes will be fully enacted May 2017. The screening population will be changed to women between the ages of 25 to 74. Research has shown that screening women under the age of 25 has had no change in the number of cases diagnosed or the number of cases resulting in the death of women in that age group. Women that are 70 to 74 should have a final screening before exiting the screening programme. Women over the age of 69 that have never been screened or were screened infrequently should be screened under the new programme.

How Do You Screen for Cervical Cancer?

Just like the screening population, the method of cervical cancer screening is also undergoing a change. The new screening will be more effective in saving lives and will not need to be performed as often. The existing screening focuses on the presence of cancer cells or abnormal cells. The new protocol recognizes the role of the human papilloma virus (HPV) in cervical cancer. Both screening types can be easily performed at your local medical centre.

PAP Test. During the present cervical screening exam, the physician inserts a speculum in the vagina to open the vagina walls and allow for a visual inspection of the cervix. A brush is used to gently scrape the walls of the cervix and collect cells for inspection. This is generally the most awkward part of the exam and may feel a bit uncomfortable. The sample will then be dispatched to a laboratory for examination.

HPV Screening. The new screening will take place in much the same manner as the old PAP test screening. You will still have to disrobe and lie on your back with your knees up on your chest. However, instead of swabbing to look for abnormal cells, the sample will be examined for the presence of the human papilloma virus (HPV). In addition to being a superior method of early screening for cervical cancer, the HPV test only needs to be performed every 5 years. It usually takes a long time – over 10 years – for cervical cancer to develop from persistent HPV infection, and this is the reason that a 5-yearly test is safe.

The Role of HPV in Cervical Cancer

The new cervical screening programme recognizes that cervical cancer can be detected prior to the development of actual cancerous cells. That is because cervical cancer has been positively linked to HPV infection. Persistent HPV infections can lead to the abnormal cells that eventually develop into cervical cancer. By identifying and treating the HPV infection early, the abnormal cells and cancer can be avoided.

Just because you have received the HPV vaccination does not mean that you can skip HPV screening for cervical cancer. Unfortunately, the HPV vaccination does not protect against all strains of HPV that can cause cervical cancer. So, both vaccinated and unvaccinated women need to participate in screening. Fortunately, HPV screening only needs to be performed every 5 years

[1] Cancer Council of Australia: Cervical Cancer

[2] Australian Government – Department of Health changes to cervical cancer screening

Ovarian Cancer early diagnosis in general practiceOvarian Cancer diagnosis.

Currently there are no general screenings for ovarian cancer. This is because as of now, there is no effective test for the early detection of ovarian cancer. That doesn’t mean that you shouldn’t be concerned about this sort of cancer, particularly if you have a family history in a close relative of ovarian, breast, or bowel cancer. Signs to watch out for are:

  • Abdominal pain or feeling bloated
  • Frequent urination
  • Back or pelvic pain
  • Irregular menstrual cycle or flow
  • Pain during sexual intercourse

These symptoms do not mean that you have ovarian cancer, but they do mean that you need to be assessed by your doctor at your local medical centre. A CA125 blood test may be performed. This looks for the presence of a protein (CA125) in your blood. This protein can be caused by ovarian cancer cells. Unfortunately, there are other normal causes of a raised CA125, which is why it cannot be used alone to diagnose ovarian cancer. However, it may be used in conjunction with other tests (such as a transvaginal ultrasound) to confirm or exclude ovarian cancer.

Good health is important to you and those who depend on you. Whether you are a partner, mother, spouse, or valued employee the people in your life depend on you. You owe it to them and yourself to take care of your body, participate in yearly well woman exams, and cancer screenings on a regular basis. You will get peace of mind and in the event disease is detected, you’ve already started on the road to recovery by getting the diagnosis.

There is no one like you. Take care of yourself!

WRITTEN BY: Dr Richard Beatty
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