Published on August 21, 2021

Keeping Her Well

Well-woman checkups are one of the most important ways women and girls can stay healthy.

Suzie Lawry-Hall, podcast host: Well-woman checkups are one of the most important ways women and girls can stay healthy. These visits can help prevent and resolve conditions before it’s too late.  Not sure when to start these visits? Or maybe you have questions about your well-woman appointment, what does it involve, and how often should you have one? We will answer these questions and more. 

SLH: I’m Suzie Lawry-Hall, and today I’m speaking with Holly Kralj, a Certified Nurse Midwife from Enloe Women’s Services. She’s here to share on this important topic. So, let’s get started. 

SLH: Thank you so much for being here, Holly. So, we’ll start from the beginning and that is, what does a well-woman checkup entail? What exactly does that mean at Enloe?

Holly Kralj, a Certified Nurse Midwife from Enloe Women’s Services: So, when we talk about well-woman exams, we’re talking about, typically we’re talking about a yearly — we call them an annual exam — where a woman will come in and depending on her age, depending on her risk factors, we’ll look at different concerns, screenings, education etc.  

It really, you know, it’s confusing for women because it really depends. It depends upon how old she is, what the family history is, what her history is, what her needs are, etc. For most women what we’re talking about is starting at age 21 we start to do Pap smears. Obstetrics and gynecology is our background. But you also want to think about an annual exam from the standpoint of preventive care, primary care.  And so part of what we look at are things like dietary issues, weight. Just again, education, counseling, immunization status, risk factors and how we might help that woman to be as healthy as she can.

SLH: And then how often do they have those appointments? Is that every year still?

HK: Well, so here’s where it’s confusing and, and I just want women to know if you’re confused out there it’s not your fault because it’s confusing even to the professionals. 

HK: All of the recommendations have changed. Annual exams mean yearly exams, and we really still want to see women for their yearly exams. But some of what has always been part of the well-woman exam, specifically the Pap smear, the recommendations really have changed. And so, for a low-risk woman, we’re going to start Pap smears — well, for all women we’re going to start at 21. And then we’re going to do them every three years instead of yearly. And women say, “What? I’ve always had a yearly Pap smear.”

HK: But really for most women we’re doing them every three years. And then when we start doing co-testing, and what that means is HPV— Human Papillomavirus —testing with it, we then can extend that out to every five years for the Pap smear with HPV.

SLH: Holly, I would really like it if you could walk us through a woman’s reproductive life cycle and what health care she might need throughout that journey.

HK: So, when I think a woman is starting puberty, (it’s about) understanding her body changes, how to deal with periods, how to take care of herself and understand that.

HK: Breast changes — that can really be tender and confusing. HPV vaccination would be a good piece here. And then also, looking for young women who have problems with their menstrual cycle. By problems, I mean really painful or really heavy, and things that they’re not able to manage with over-the-counter kinds of issues.

HK: In terms of the next phase when women really become sexually active, we need to be thinking about how to prevent pregnancy. And so again, that HPV vaccination we want onboard hopefully before she becomes sexually active. And really, I’d love to be talking with women about how to prevent pregnancy, keep their body healthy and avoid infections prior to them becoming sexually active. So that might be something we would talk at an annual exam for a woman in that age range or in that life phase. When a woman is sexually active regardless of her age, again we’re focusing more on STD screening, and then also looking at birth control methods.

SLH: And then the next phase would be when the woman is starting to (be) childbearing?

HK: Yes, so does she want to have kids or doesn’t she, right? And so, if she wants to have children, then we’re going to be thinking about pregnancy and preconception counseling. Some of the things we would think about are risk factors, again regarding smoking, drug or alcohol use, nutrition. If a woman has a higher BMI going into it, can she bring that BMI down prior to conception? 

HK: Any family risk factors. We talked before about health. And we talked about the family history, you know, looking at any kinds of genetic issues that might be there for screening.

SLH: And then we get into perimenopause and menopause?

HK: Yeah, and so again perimenopause, back to like, puberty where we’re dealing with periods, kind of the same thing, right? Her risk factors (like) sexually transmitted infections don’t go away. So that still can be a risk factor. But many of our women at this stage are more in a settled relationship, you know. And again, we have women who aren’t in a traditional relationship.  

HK: We also have women who are partnered with women. So all of those different pieces factor into the individualized risk factors of who we need to be screening. But again, I think most of our focus at that point, we’re looking more at breast cancer risks, we’re looking at ovarian cancer risks, we’re looking at fibroids. Things where the periods are doing weird things again, and again moods are doing weird things again and how to manage those kinds of challenges that come up for us, speaking personally. And then in the menopausal period, again we’re looking more at cancer risks. We’re looking more at bone density issues, again screening etc., and how it is that a woman is navigating that period of her life.

SLH: All this information has been so great, Holly. Can you now tell me what the health screenings are? What do well-women checkups look like when we start to enter into our 40s?

HK: Sure and, and 40 is kind of a big age because —

SLH: I’m almost there.

HK: Well, so that’s when we start to offer mammograms in term of breast cancer screening. Some women start later; some women start earlier based on family history. And again there are different recommendations out there. 

HK: But at an annual exam for a woman who is 40 and older, we’re going to be doing the breast exam. In terms of the pelvic exam, that’s how we’re going to be checking her ovaries to screen for any ovarian cancer. In terms of, again we talked about Pap smears, but we would be looking for any bleeding between periods for women over 40. That becomes significant for uterine cancer. 

HK: When women turn 50 that’s the general time where we would start doing colorectal cancer screening. There are some screens that we can do earlier, but most women will get a colonoscopy at 50. And again I’m generalizing because there are women who need it earlier based on family history or symptoms. And again, the importance of the annual exam doesn’t go away. We begin to focus more on, again screenings for cancer, screening for other kinds of reproductive health issues, primarily cancers. And then (we’re) looking at helping women transition through the perimenopausal period. All of the symptoms that may be coming up as a woman starts to get closer to menopause. 

SLH: My next question is about how to keep a woman’s body healthy. Like, what are some general tips that you would recommend to our viewers? You know of course get your well-woman exam.

HK: Yes, come in.

SLH: It sounds like you need to go talk to your family if you haven’t already, (to) understand some of your family history. But what are some other recommendations?

HK: So, we always want to talk about diet and exercise. We really recommend that everybody should be getting, you know, the recommendations now are saying that we should be getting 30 minutes of aerobic exercise every day. I’m not doing that, but we should be. And for weight loss, it should be more. And so that’s the other thing is looking at people’s weight and height and BMI, which is what we use, although BMI’s can be deceiving. 

HK: So again, kind of looking at a woman’s health and wellness, but looking at eating more plant-based diets. Less animal fats tends to be really helpful in terms of disease prevention. Decreasing certainly refined carbohydrates and carbohydrates in general. Trying to keep lower carb, more complex carbs is going to be important.  We want to be looking at not smoking. We want to be looking at having our immunizations up to date and preventing the diseases that we can. 

HK: We want to be looking at our women in safe situations. So again, intimate partner violence, looking at those kinds of issues, substance abuse issues, all of those things are so crucial. Again, we are not just breasts and uteruses and vaginas. We are a whole woman. And so part of it is looking at all those different pieces.

SLH: Those are all of my questions for today. You answered them so well. Anything you want to say before we sign off?

HK: Many of the recommendations have changed for women over 75, and so they’re saying now for Pap smears that you don’t have to do it if a woman is 65 and older.  Most of my women aren’t comfortable with that yet. But that’s what, again, the recommendations are showing in terms of risk benefit. 

HK: One of the things that to me as a woman and as a consumer that can get confusing again is like is it based on best practice? Is it based on insurance reimbursement? All of those things have to get teased out. Other things that I would like to mention in terms of immunizations for women who are older: The shingles vaccine is recommended. It is recommended certainly for women over 60. It’s available to women over 50, best practices over 60. I say people get to choose what they want to do. 

HK: Again mammograms, they’re saying over 75, you don’t need them anymore. Again, I let women kind of choose that at this point. As long as women are making decisions and know what’s paid for by their insurance and know what the risks and benefits are from different screenings, then I kind of leave it to women and their providers to choose what is the appropriate screen. 

HK: You know, again I feel like I can come with the best evidence that I have. And I can come with what the recommendations are, but again it’s really the woman’s body.  And so I hold that very strongly. That’s kind of her choice about what is the right choice for her.

SLH: Thank you, Holly, and thank you all for watching. We hope you found this information helpful. If you want to hear more about embracing menopause, check out Enloe’s new podcast Health Matters: Getting Real About Wellness. We’ve placed a link in the comments field.  And if you haven’t already, please schedule your well-woman appointment today. 

SLH: Join me next month for our Facebook discussion on joint health. Goodbye for now.