When you’re no longer having menstrual periods or symptoms associated with menopause, you might think you’re done with the gynecologist. Not so fast: While your reproductive years may be over, your reproductive organs still need care, whether that comes from a gynecologist or a primary care provider in family medicine or internal medicine.
“Everybody needs primary care to make sure that they’re getting all the preventive services they are eligible for,” says UNC Health OB-GYN Rachel Urrutia, MD. “As part of that, make sure your gynecologic health is addressed.”
We talked to Dr. Urrutia about common gynecologic concerns postmenopause.
Gynecologic and Breast Cancer Screening After Menopause
Menopause typically happens in a woman’s early 50s, but women continue to need a Pap test to screen for cervical cancer until they are 65. This test should be done every five years, unless you’ve had abnormal test results or have other risk factors for cervical cancer.
“Once a woman is 65, and there haven’t been problems with her Pap tests before, she has a very low risk of cervical cancer, so Pap tests are no longer needed,” Dr. Urrutia says. “But the risk of other cancers—ovarian, uterine, breast—goes up as you age.”
When you no longer need a Pap test, you should discuss with your provider whether you still need a routine pelvic exam or if you’ll have one only if you notice a problem. There is no screening test for uterine or ovarian cancers, so it’s important to be aware of potential symptoms and your relative risk.
There’s one red-flag symptom that postmenopausal women always need to have evaluated.
“Any vaginal bleeding after menopause is abnormal,” Dr. Urrutia says. “It’s important to have an evaluation in case it’s due to a growth or cancer in the uterus.”
Keep in mind that the majority of the time, the cause of the bleeding isn’t cancer, but it is the symptom that helps women get an early diagnosis of uterine cancer, when it’s easiest to treat, Dr. Urrutia says.
Other symptoms of ovarian or uterine cancer include abdominal or pelvic pain, changes in bowel or urinary habits, or feeling full quickly when eating. If you notice any changes to the skin of your labia or growths on your vulva, call your doctor.
You should discuss your risk factors for these gynecologic cancers with your provider; if you have a family history of cancer, are overweight, or have a history of other conditions, you may be at a higher risk. If you have had a hysterectomy, be sure to understand what is removed; you may have had your uterus removed but still have your ovaries or your cervix, which means you can still get cancer in those organs.
You should get mammograms at least every other year from the age of 40 to the age of 74 (women at higher risk may need screening more often). At the age of 75, discuss with your provider about whether to continue screening, based on your personal risk.
Sexual Health After Menopause
The days of birth control and babies may be over, but your sex life doesn’t have to be. Still, some changes associated with menopause and this stage of life can make sex more difficult. If you’re not happy with your sex life, talk to your provider.
“During the transition to menopause, the vaginal tissue gets thinner, and that can lead to pain and irritation,” Dr. Urrutia says. “Pain during sex is not normal, and a lot can be done to help the issue, depending on what’s causing it, including pelvic floor physical therapy, hormone treatment or other medications.”
You may not even be in the mood to have sex.
“You might have a low libido and be fine with it, and that’s OK, because there’s no normal libido,” Dr. Urrutia says. “But a lot of women complain about decreased libido, and if it’s bothering you, know that there are things that can help.”
Again, treatment will depend on what might be causing your issues. Dr. Urrutia notes that caregiving demands are often at their highest for women at menopause and in the years afterward, as they’re typically taking care of both children and aging parents, while also working, so it may take time to untangle issues like stress, fatigue, hormonal changes and other factors.
If you’re dating or having sex with multiple partners, remember you’re still at risk for sexually transmitted infections, so use condoms and get screened regularly.
Pelvic Floor Disorders After Menopause
As you age, you’re at greater risk of a pelvic floor disorder such as urinary incontinence or pelvic organ prolapse.
“Urinary incontinence is very common, and if it’s interfering with quality of life, there are treatment options,” Dr. Urrutia says. “We can offer different strategies depending on cause and patient goals—physical therapy, behavioral changes, medications or surgeries.”
Pelvic organ prolapse occurs when pelvic organs such as the uterus, bladder, vagina or rectum drop down into the pelvis because the muscles of the pelvic floor can no longer support them. Those muscles can weaken because of pregnancy, vaginal birth, chronic coughing caused by asthma or smoking, extra weight or repeated heavy lifting. The severity of symptoms, which include a feeling of pressure or heaviness, the sense that something might be falling out of your vagina, a bulge, urinary issues and pain, varies.
“This is something we can evaluate and discuss possible treatment options,” Dr. Urrutia says. “If you want treatment, there are options, such as pessaries, physical therapy or surgery.”
While your gynecologist or primary care provider can do an evaluation for these issues, you may be referred to a urogynecologist, a gynecologist who specializes in pelvic floor disorders.
Other Health Concerns for Postmenopausal Women
Postmenopausal women will have the same health issues and risks that affect any aging person—mood disorders, heart conditions, sleep concerns and cancer. That’s why it’s important to continue to see a primary care provider regularly so that you can get all of the screenings and support you need.
If you’ve just reached menopause, Dr. Urrutia notes that the transition affects two areas of general health that you should be aware of.
“Women tend to gain weight in menopause, and it can be harder to lose that weight,” she says. “It’s usually central adipose fat—fat around the abdomen—which can put you at high risk of diabetes, high blood pressure or stroke.”
Because being at a healthy weight will help you decrease your risk of other health concerns, Dr. Urrutia recommends talking to your doctor if you need assistance with weight loss.
The drop in hormones caused by menopause also affects your bone health, so ask your provider about screening for osteoporosis.
“You’re at a high risk for osteoporosis as you age,” Dr. Urrutia says. “Weight-bearing exercise can reduce your risk of falls and injuries. Make sure you’re supporting bone health by staying active.”
Concerned about health risks as you age? Talk to your doctor. If you need a doctor, find one near you.