Baby bumps, lady lumps and mental slumps: a health checklist for women.
As a GP, I have people coming in for “a bit of a check-up” on a weekly basis. It’s great that patients recognise the importance of preventative health. From my experience however, I have come to realise that doctors and patients often have differing ideas of what sort of “check-ups” are most important, especially women given that their health needs differ depending on their age.
As Women’s Health Week kicks off next week, I thought it quite timely to list the top 10 topics that I suggest women (at varying stages of their lives) explore when they’re at their next GP appointment.
If you don’t have the time to read every subject, below is a summarised list in order of priority…but I really encourage you to read the content as it will help you understand the importance of each from a GPs perspective.
- Pap smears
- Breast checks
- Pregnancy and pregnancy planning
- Mental health check
- Heart health check
- Bowel cancer
I cannot stress how important it is to get regular papanicolaou (PAP) smears.
Did you know that 85% of women in Australia who develop cervical cancer have either not had a pap smear or have been inadequately screened?
I know it can be a bit embarrassing for women, but it’s no big deal for GP’s. We can actually PREVENT cervical cancer by doing regular pap smears.
Who should have a PAP smear? All women who have EVER been sexually active (including women who have had sex with only women) should be having pap smears every two years. PAP smears should start from the age of 18, or two years after they became sexually active (whichever is later), and continue until they are 70 years old.
I recommend women ‘get to know their own breasts.’ If you think there have been any changes to them, it is important that you discuss it with your GP as soon as you can. Your GP will perform a breast check themselves and may order an ultrasound and/or mammogram.
Women from the age of 50, until at least 69, and have no breast symptoms, should be having free mammograms via a breast screen every two years. If you have a family history of breast cancer you should discuss this with your GP and they can help decide if you need to start having mammograms earlier.
This is often a reason why younger women come in to see me. It is important to discuss early and come in with an open mind. There are so many alternatives to ‘the pill’ and they may be a better option for you. There are some options that are much more reliable then ‘the pill’ and some can last for up to 10 years! SHine SA has an excellent website that discusses the different types of contraception available.
Having a baby is such an exciting and nerve-wracking time. I recommend all women come in to see their GP before trying to get pregnant.
Prior to getting pregnant, it is important to start taking certain vitamins (folic acid and iodine), review the medications they may be on and perform blood tests to check their immunity levels to Rubella (German Measles) and Varicella (Chicken Pox). Unfortunately, women cannot have these vaccines while pregnant and if not immune can put their baby’s health at risk if they were to pick up these diseases, so its worth a discussion with your GP first. When women do fall pregnant – they should make an appointment to see their GP early on and ask the practice if there are any GP’s at the clinic who specialise in the care of pregnant women.
Difficulty getting pregnant is more common then people realise. It is rare that people get pregnant in the first month of trying, although we all know stories of this happening!
For healthy couples in their 20’s having regular unprotected sex, the chance of becoming pregnant each month is only 25%. It can be considered normal to not get pregnant for months and months.
I suggest that if under the age of 35 women see their GP after 12 months of trying for some additional testing, it is important that their partner also sees their GP as well. If women are older than 35, we recommend seeing their GP after six months of trying.
Mental health is often something people are afraid to bring up with their GP or mention at the end of their consult. It is so important to recognise the symptoms of anxiety and depression. Some symptoms of concern are:
- low mood
- withdrawing from social situations
- not finding happiness in previously enjoyable activities
- increased or decreased sleeping and appetite
- suicidal thoughts
A GP is often a great starting point. People should book a double appointment so your GP has time to go through things properly. Individuals may be eligible for a Mental Health Plan which will allow them to see a psychologist (specialised counsellor) at a reduced fee (subsidised by Medicare).
If you are having suicidal thoughts, Lifeline can offer someone to talk to over the phone on 13 11 14 and please see your GP as soon as possible. If you are having strong suicidal thoughts or a mental health emergency please call Mental Health Triage on 13 14 65, it is like the 000 for mental health problems.
Some great references for people who may be having difficulties with mental health or their friends and family include:
Heart disease is the number one cause of death in Australian women.
Women’s blood pressure is normally measured from the age of 18, aiming for a reading of 120/80. Cholesterol readings are generally first performed at the age of 45, however may start earlier in people with certain risk factors for heart disease.
Although medications may be required, there are lots of lifestyle changes that can lower blood pressure and cholesterol naturally:
- Ensuring a healthy diet that is varied, but low in salt and low in saturated and trans fats.
- Limit alcohol intake to one standard drink per day with a few alcohol free days per week.
- Regular exercise is a very important part of maintaining heart health; I recommend 30-60 minutes of exercise per day (mostly moderate intensity, but also including vigorous intensity and weight bearing exercise).
- Limit or quit smoking. Smoking is a major risk factor for heart disease and there are so many things GP’s can offer to assist with the quitting process in their patients:
I know it’s a bit icky but at the age of 50 the government send everyone a poo sample kit in the mail. Please, please, please do it! It’s free and easy to do. It can detect bowel cancer and pre-cancerous tumours (polyps) well before people develop symptoms. We all know that the key to beating cancer is to pick it up early, or even better detect pre-cancerous polyps and have them removed before they cause any problems. Poo tests should be done every two years until the age of at least 75.
Did you know that the average age of menopause is 51? Many women experience hot flushes, mood changes, joint pains, itchy skin and dry vaginal area. Although these are perfectly normal, I encourage women talk with their GP if it is bothering them or interfering with their lives.
There are lots of mistruths about hormone replacement therapy (HRT) floating around in the general population, but it can be quite life changing for a lot of women. There are also lots of other non-hormone treatments for menopause related symptoms that can be offered. Regardless of which option may be selected, it’s important to discuss any concerns that they may have with their GP.
Osteoporosis refers to a thinning of the bones. Thin bones mean increased risk of fractures (broken bones). Osteoporosis is far more common in women than in men and after menopause women’s risk increases significantly.
Generally, it is a good idea to get a baseline scan (called a bone density scan) done when women go through menopause and then depending on the result every 2-5 years after this. Making sure women have enough calcium in their diet and get appropriate sun exposure to give adequate vitamin D levels are important steps towards preventing osteoporosis.
So there you have it – the top 10 topics that I recommend women check when consulting with their GP. How many have you discussed with your GP? Are there any others that you like to ask?