Women’s health from top to bottom


In this article:

  • Women are sometimes too embarrassed to report problems to their primary care provider.

  • When you don’t fix a problem right away, it can turn into a much bigger health issue.

  • Start a list of questions or issues a week or so before your appointment, then use it to guide your conversation.

It happens more often than you might think: A middle-aged woman schedules an annual checkup with her primary care physician, dutifully answers all of her doctor’s questions, and performs the appropriate blood tests. Then, a few months later, she struggles with a recurring problem that never showed up on a routine checkup. As a result, she may need to undergo further medical treatment which could have been avoided if treated earlier.

Building a relationship with their primary care provider is important for all women — and especially those in their 50s (50-70s) — says Melanie Santos, MD, FACOG, FPMRS, Medical Director of Health pelvis from St. Jude Medical Center in Fullerton, California. Santos is a urogynecologist who specializes in treating women with incontinence and other pelvic floor disorders. “I see most patients more often than an annual checkup, so sometimes they feel more comfortable with me than with their primary care physician,” she said. “I often find myself recommending that they see their primary care physician about certain medical conditions that they have kept secret.”

In some cases, women are too embarrassed to bring up personal concerns with their doctor, such as leaking urine or other pelvic problems. For others, they simply feel that they don’t have time to seek treatment. “Women tend to take care of everyone else in their lives before managing their own health,” Dr. Santos said. “They wait for the dust to settle with everything else, when in reality their problem may have a quick and easy solution.”

For women past childbearing age, it’s especially important to be honest with their primary care physician, as they may have treatable conditions related to menopause, heart health, bone health, or pelvic health.

Perimenopause and menopause

During menopause (when a woman’s sex hormone levels drop, causing her menstrual cycle to stop) and perimenopause (the time leading up to this point), the body goes through several hormonal changes that can cause a variety unpleasant symptoms. Although some women think it’s just part of getting older and they “have to go through it,” there are many ways a primary care physician can help.

Hormone replacement therapy is considered a safe and effective choice for women whose hot flashes and night sweats are intolerable. However, this is not the only option. Other medications that treat hot flashes and night sweats include gabapentin, an anti-epileptic drug, and antidepressants. Doctors also recommend that women avoid hot flash triggers, including alcohol, caffeine, stress, tobacco, and spicy foods. Additionally, there are other natural ways to manage symptoms that doctors can help recommend and manage.

The main thing is for a woman to tell about this in detail and describe what is happening so that the doctor can determine how best to help her. “So many people are suffering when they don’t need it,” said Dr Santos. “That, in turn, can affect mental health and create a cascade of other issues.”

Heart health

Heart disease is the leading cause of death for women in America and leads to almost as many deaths in women as in men. Symptoms of heart disease in women are different from those in men and can include (but are not limited to):

  • Chest pain or discomfort
  • Neck, jaw or throat pain
  • Pain in the upper abdomen or in the back

Dr. Santos said women should not hesitate to report any new or unusual symptoms to their doctor. Even if a patient suspects that her symptoms are probably just acid reflux, she should still tell her primary care provider. “Telemedicine has become a big part of what some providers are offering,” Dr. Santos said. “It’s very easy to have a quick virtual appointment with your doctor to discuss your concerns.”

Bone health

The Centers for Disease Control and Prevention recommends women 65 and older get a bone density test to find out if they have osteoporosis. However, if a woman has a relative with a broken hip or other risk factors for osteoporosis, she should have her first bone density test between the ages of 50 and 64.

Fragile bones can be especially dangerous for women as they age, as they are at high risk of sustaining a debilitating fracture. Early symptoms may include:

  • Receding gums
  • Brittle nails
  • Height loss
  • Lower back pain
  • A curved shape at the spine

Pelvic health

There are three main types of pelvic floor disorders: urinary dysfunction or incontinence, or lack of bladder control; bowel dysfunction or fecal incontinence, or lack of bowel control; and pelvic organ prolapse, a condition in which the uterus, bladder, and intestines can “fall” into the vagina. According to Dr. Santos, women with these conditions, such as urinary incontinence, often wait an average of seven years before seeking treatment. It’s living a long time in discomfort!!

Incontinence can be a difficult subject to discuss with a primary care physician, but it is an important topic. Some women think leaking urine or feces is just part of aging they will have to live with, but that’s not true. There are many treatment options, and some are very simple solutions. “If a problem worries you, it doesn’t matter if it’s part of aging,” Dr. Santos said. “You shouldn’t have to ‘just live with it’.”

make a list

Dr. Santos suggests compiling a list of questions before an appointment so you don’t forget anything. “When you go grocery shopping, you don’t just improvise it,” she said. “You make a list and use it to guide your shopping. It’s the same with a doctor’s appointment.

A strong relationship with a primary care physician can lead to better overall health and a better quality of life. There’s nothing they haven’t heard before, and no problem is cause for embarrassment. Communication is the key to treatment.

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Related Resources

Women’s Health Resources

How heart disease affects women

Pelvic floor therapy

This information is not intended to replace professional medical care. Always follow the instructions of your healthcare professional

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