Women’s health care is ever evolving, with new findings, treatments and recommendations liable for issue at almost any time. With that in mind, Cincy Magazine asked local health care providers to discuss a few topics women should have on their radar to keep current.

Screenings and Annual Exams

The frequency of certain screenings may change, but the physicians at Seven Hills Women’s Health Centers remind women that their annual exams should not be missed.

For instance, while the American College of Obstetricians and Gynecologist Guidelines for Pap tests calls for a screening every three years, from age 21 to 64, doctors caution that the guideline does not suggest a similar break in regular check-ups.

“There’s more to the annual exam than the Pap [test],” says Dr. Navkaran Singh, chief medical information officer at the practice. “We’re trying to educate women on the concept that their exam is about all aspects of their life.”

Yearly pelvic and abdominal examinations also establish a baseline of what’s normal for the individual patient, adds Dr. Gerard Reilly, president of the practice.

In addition to those exams, the annual review includes a breast exam, a thyroid neck exam, age-appropriate blood tests and discussion of such age-relevant topics as sexual health, reproduction and menopause.

At age 30, an HPV (human papillomavirus) test is added to the every-three-year test cycle. The Pap test may be discontinued if, at 65, the patient has had three or more consecutive normal results and no abnormal results in the last 10 years.

Dr. Singh cautions younger women who have been given the HPV vaccine for sexually transmitted infections to not skip getting their Pap tests, mistakenly believing the HPV vaccine has fully reduced their risk of developing cervical cancer.

“One of our biggest fears is that [these HPV-vaccinated women] will stop getting Pap tests,” Dr. Singh says.

While the thinking on mammogram frequency and the age to begin them often changes, Dr. Reilly says, “to make a difference you have to do [the screening every year].

“Breast cancer starts changing quickly,” he adds, and is able to go from undetected to significant in two-years’ time.

And while a Canadian study from the 1980s has raised the idea of starting mammograms at age 50, 40 is the starting age because when breast cancer develops at a younger age, it grows faster and has a more devastating effect than when it develops later in life, Dr. Reilly says.

“Way more 70-year-olds get breast cancer than 40-year-olds, but it is unlikely to affect the 70-year-old woman’s longevity or prognosis,” unlike the 40-year-old woman’s.

Connecting the Dots

Educated health consumers often research their symptoms online, which Dr. Singh appreciates—to a point.

“I like when patients go to the web to look up information, but the flip side is when they trust the web over the doctor,” he says.

The doctor is the one resource who can “connect all the dots together” regarding a specific patient, including the nuances of that person’s condition and malady.

He recommends avoiding chat sites, whose “information is notoriously wrong,” but instead choosing reputable sources like the Mayo Clinic website.

Continuity of Care

Along the lines of the importance of seeing the doctor annually, when it comes to women’s health care, long-term, familiar care is shown to be effective, Dr. Singh says.

“Women bond with their physician and the physician gets to know them,” he says.

But when something like insurance changes cause them to switch doctors, they lose that sense of familiarity.

“It’s a detriment to women’s health care,” he says.

A Game-Changing Therapy in Town

Cincinnati is one of two sites in the country holding a clinical trial to test the effectiveness of a new therapy on symptoms associated with vaginal atrophy.

Dr. Mickey Karram says hundreds of thousands of women experience uncomfortable symptoms when they reach the age of menopause in their early 50s, when ovaries stop producing estrogen on their own. Less estrogen makes vaginal tissues thinner, drier, less elastic and more fragile.

He believes this technology, called MonaLisa Touch, now testing at The Christ Hospital and Stanford School of Medicine, will be game-changing and more efficient than pills and crèmes in treating symptoms that include dryness, itching, burning with urination, discomfort with intercourse, urinary incontinence and increased urinary tract infections.

Other times besides menopause and peri-menopause that these symptoms may occur include:

• During breast-feeding

• After surgical removal of both ovaries (surgical menopause)

• After pelvic radiation therapy for cancer

• After chemotherapy for cancer

• As a side effect of breast cancer hormonal treatment

Fifteen patients are in the trial here in Cincinnati, and Dr. Karram hopes more will be able to use it soon.

The procedure is prized as a non-hormonal solution, which is especially preferred for patients who have had breast cancer. Traditional treatment for these symptoms includes the use of estrogen or hormones.

Previous results of the therapy have resulted within one week and lasted for about a year, with patients having less pain and dryness, Dr. Karram says.

The painless procedure lasts just three-to-five minutes and involves a low wattage laser to stimulate the production of collagen and restore blood flow to the treated area.

The procedure can be administered in-office without anesthetic and is safe, Dr. Karram notes. He likens it to a low-wattage facial skin treatment.

Sarcoma Risk from Surgery

Last spring, the U.S. Food and Drug Administration announced it was discouraging the use of laparoscopic power morcellation for hysterectomies (the removal of the uterus) and myomectomies (the removal of uterine fibroids).

Morcellators are medical devices that core a uterus or uterine fibroids so they can be removed in smaller fragments through a small incision in the abdomen, as in laparoscopy. The problem is there is no reliable way of knowing if the uterine fibroids, or tissue, are cancerous until they are removed.

The dividing process of morcellation, then, can cause cancerous material, or uterine sarcomas, to be left behind in fragments from the surgery, able to grow as tumors in the abdomen and pelvis.

Other treatment options exist, including traditional surgical hysterectomy and myomectomy, and laparoscopic hysterectomy and myomectomy without morcellation, as well as other non-surgical options.

“The bottom line is that [patients and physicians] should be talking about the risk for sarcomas as part of the surgery,” Dr. Reilly says.