Q: I am postmenopausal and I have had a hysterectomy. Do I really still need to see the gynecologist?
A: The short answer is YES. In fact, there is really no time when a woman should stop seeing her gynecologist. Whether you’ve had a hysterectomy, are menopausal or post-menopausal, or even if you’re no longer sexually active, you should still see your gynecologist every year. Annual gynecological exams can save lives.
After a hysterectomy or menopause, there are still so many aspects of women’s health to be evaluated. The likelihood of cancers increase with age and problems are often first found through annual exams. Whether you are postmenopausal or have had a hysterectomy, we check every year for palpable masses in the pelvis, and we assess vulvar and vaginal tissues (especially for women with a history of HPV). In post-menopausal women who have had nothing removed, we need to evaluate for postmenopausal bleeding, or evidence of masses on the uterus, cervix, and ovaries.
Even if you are menopausal or post menopausal, this does not mark an end to Pap smears for cervical cancer screening. Based on your age and the cervical cancer screening guidelines, Pap smears should be continued as determined by your doctor.
Pap smears may be discontinued after a total hysterectomy unless the surgery was performed for cervical cancer or other uterine cancers. In these high risk situations, Pap smears should be continued as determined by your doctor. Pap smears may be discontinued for women who have had a hysterectomy with no significance of prior abnormal Pap smears, but should continue to have routine pelvic exams performed by their doctor.
But, again, remember that even if your pap smear days are done, an annual gynecological exam is still so important. In addition to the evaluations described earlier, we will address other issues that become more prevalent with age. These might include managing menopausal symptoms, urinary incontinence, prolapse of pelvic tissues and organs, and more. We’ll also talk about the continuing necessity of practicing safe sex. (Did you know that the older population is one of the fastest growing age groups for sexually transmitted infections?)
Lastly, seeing a gynecologist after menopause or a hysterectomy is not just about the reproductive system. We will discuss preventive screenings and tests such as osteoporosis screening, mammography, colon cancer screening and your risk for diabetes, just to name a few. A Dexa scan, known as an osteoporosis test, will assess bone strength and a colonoscopy can search for colon masses. And, of course, all woman above the age of 40 should perform monthly breast exams and schedule screening mammograms. Vaccines may also be discussed during an annual gynecological visit as well as a discussion about your hormones, menopause management and other health issues.
So, yes, you should have a routine gynecological exam once a year, even if you are menopausal, postmenopausal or have had a hysterectomy. The annual gynecological exam helps provide guidance and encourages preventive care that will promote positive health habits and wellness for all women in this category.