When not to get a Pap Test

If you dutifully visit your ob-gyn for a Pap smear every year, you might want to change your routine. There are new government guidelines for the test, which checks for abnormal changes in cells in your cervix that might lead to cervical cancer. Experts now believe that less frequent tests may be safer because getting tested too often can lead to false positives and invasive follow-up diagnostics, such as biopsies and colposcopies – not to mention anxiety and stress. Here’s the latest advice for the U.S. Preventive Services Task Force, a government advisory panel of medical experts:

  • 20 and Younger Skip the Pap smear regardless of sexual history. Cervical cancer is rare in this group, and any abnormal cells often return to normal over time.
  • 21 to 29 Get a Pap test every three years. Skip getting the test for the human papillomavirus (HPV), a sexually transmitted disease that can lead to cervical cancer.
  • 30 to 65 Get a Pap smear every three years or go every five years for both a Pap smear and an HPV test.
  • 66 and Older Skip the Pap test as long as you’re not considered high risk – for example, you’ve had cervical cancer or dysplasia or you have a compromised immune system – and you’ve had three normal Paps or two normal HPV tests in a row in the pas decade, with the most recent one within the past five years.

You can also skip getting a Pap smear if you’ve had a hysterectomy and your cervix removed for reasons other than cancer.

Just keep this in mind: The new guidelines aren’t an excuse to skip your annual appointment with your ob-gyn, according to the American Congress of Obstetricians and Gynecologists. That exam is about a lot more than just a Pap. Depending on your age, it could include a pelvic and breast exam, a discussion about the right birth control for you, or a chat about menopause concerns. It’s also important to keep track of when you had your last Pap smear because that might be a challenge to remember now.

Also keep in mind that you should start getting mammograms every two years once you turn 50, depending on your health and family history. If you have questions or concerns about the recommendations, discuss them with your doctor.

Health Calendar – April Cesarean Awareness Month

SINCE 2009, a third of all births in the U.S. have been by cesarean section—the delivery of a baby through a surgical incision in the mother’s abdomen and uterus. The percentage of cesarean births has been rising steadily for more than a decade; they are up nearly 60 percent since 1996, despite evidence of the increased risk of maternal and neonatal mortality when healthy women agree to a scheduled surgery.

This awareness month was initiated by the International Cesarean Awareness Network (ICAN), a nonprofit organization founded in 1982 primarily to improve mother-child health by preventing unnecessary
cesareans through education about risk and appropriate childbirth decisions.

Cesarean facts from ICAN

  • When a cesarean is necessary, it can be a lifesaving technique for both mother and infant.
  • Many indications for cesarean can and should be questioned.
  • In half of all cesarean births women suffer complications, and the maternal mortality rate is two to four times that of women with vaginal births.
  • Approximately 180 women die annually in the U.S. from elective repeat cesareans.
  • Vaginal birth after cesarean is safer for both mother and infant in most cases than is a repeat cesarean.
  • According to the World Health Organization, “Countries with some of the lowest perinatal mortality rates in the world have cesarean rates of less than 10 percent.”

Hysterectomy

Hysterectomies are among the most common surgical procedures give to women: 600,000 a year are performed in the USA alone. But, are these operations necessary, or simply the easiest option to offer?

A hysterectomy is a surgical procedure in which a surgeon removes some or all of a woman’s reproductive organs. You probably have friends who have had a hysterectomy, but would you know what to do if your doctor recommended one for you? First, the majority of hysterectomies are unnecessary. For example, they are commonly recommended to cure heave periods, fibroids, endometriosis, prolapsed, and pelvic inflammatory disease (PID) – all of which can often be well treated using the natural approach and other forms of conventional medicine. A hysterectomy does provide a permanent solution to all of these problems – but, unless you have uterine or ovarian cancer, or you have given birth and this has led to complications, it’s not always the only solution.

Please consider all the alternatives before you make the radical step of having some or all of your reproductive organs removed. Ask your doctor for justifications, alternatives, and consequences. Ask for a second, third, and fourth opinion. Ask yourself questions, see below, too. Don’t’ take anything at face value and take your time until you’re convinced that a hysterectomy is the right choice for you. In most cases, there’s no immediate hurry to make a decision.

Your Decision Checklist

Ask yourself the following questions. If you answer no to any, could it be time to reconsider?

  • Have I had my last child?
  • Do my symptoms affect my daily life?
  • Have I tried all the natural alternatives?
  • Am I ready to deal with the symptoms of sudden, early menopause?
  • Is my life at risk without this procedure?

About the Procedure

A hysterectomy is major surgery that requires a lengthy stay in the hospital, incisions, general anaesthetic, and painful days and weeks afterwards. It can also trigger sudden and unexpected physical, sexual, and psychological changes. You’ll no longer be able to have children. If you have your ovaries removed (and sometimes even if you don’t), you’ll have to deal overnight with the symptoms of menopause. You may also experience urinary incontinence and weight gain. All these changes are the result of declining estrogen levels.

If a hysterectomy is the option that’s right for you, consider what type you should have. The following are the four types of surgery available. As a rule of thumb, try to have as little removed as possible.

Sub-total abdominal hysterectomy

This represents the least invasive version of a hysterectomy, as it removes only your uterus, allowing you to keep the rest of your reproductive organs. As your cervix is left in place, you’ll have a reduced risk of vaginal prolapsed (here the inside of the vagina moves outside the body – sort of turning itself inside out). Intercourse is likely to continue to be pleasurable.

Total abdominal hysterectomy

For this type of hysterectomy, surgeons remove both your uterus and cervix. It will take you at least three months to recover. The surgery may make it harder for you to reach orgasm. As your cervix is removed during this procedure, you won’t need to continue to have Pap smears, and you’re less likely to get any immediate menopausal symptoms because your ovaries will have been left intact.

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

In this technical sounding version of the abdominal hysterectomy, you’ll have not only your uterus and cervix removed, but your ovaries and Fallopian tubes, too. If you hadn’t already reached menopause, you’ll be given hormone replacement therapy (HRT) immediately after your operation, and you’ll need to take it in the long term. This is because removing your ovaries plunges you suddenly into menopause. So, the younger you are when you have the surgery, the longer you’ll have to take HRT. You should expect to stay on HRT until you’re around 50 years old.

Radical abdominal hysterectomy

The most extensive form of hysterectomy, this removes not only all your reproductive organs, but also your cervix, the tissue at the top of your vagina and your pelvic lymph nodes. A doctor should offer it only to treat a condition such as cervical cancer. The surgery can damage your bladder, urinary tract, and bowels. You’ll need at least three months to recover.

Non-surgical procedures

Some kinds of hysterectomy can be performed without the need to make an incision in your abdomen.

Vaginal hysterectomy Unless your uterus is large, your surgeon may be able to remove your uterus and cervix through an incision inside your vagina, rather than in your abdomen. The procedure and recovery time are quicker than in abdominal hysterectomy.

Laparascopically assisted vaginal hysterectomy In this highly complex procedure, a kehhole surgeon uses a laparascope to look into your pelvic cavity and then cuts away your uterus and cervicx, removing them through your vagina.

Menopause Naturally

Since 2002, when the National Institutes of Health halted a hormone-therapy (HT) trial for safety reasons, women have been worried about HT use. In fact, over half the women surveyed in one study attempted to stop using HT after the find were releases. Although further analysis of the trial revealed that some risks may have been overstated, particularly for women in their 50s, concerns remain. Perhaps not coincidentally, the use of herbal supplements for menopause symptoms is one the rise. The problem? Research is limited and often conflicting, and quality is questionable since supplements aren’t FDA regulated. Plus, herbs can interact with certain drugs and cause side effects. Below are commonly recommended HT alternatives (all are over-the-counter, and you’ll find most in natural-food stores), but talk to your physician before trying them.

Black Cohosh Study findings are mixed, but this is the alternative remedy that physicians (even mainstream doctors most often suggest for hot flashes. The most popular preparation is a tablet called Remifemin.

St. John’s Wort This plant (used to make teas and tablets) acts as a natural antidepressant. A review in the Journal of Women’s Health reported that it may help with menopausal mood swings.

Ginseng According to the National Institutes of Health, this root (available in teas, tablets, and extracts) may ease moodiness and sleep disturbances.

Flaxseed You know this seed is good for your heart, but it may ease hot flashes too. In one study, women who are 4 tablespoons daily halved their number of hot flashes in 6 weeks.

Check your Label

Since the FDA doesn’t regulate herbs, look for a seal of approval from a certifying organizations, such as U.S. Pharmacopeia (USP). The USP Verified Dietary Supplements seal ensures that a product contains only the listed ingredients and no contaminants.


Soy Good? Researchers have flip-flopped on whether the soybean can ease hot flashes and slow menopause-related bone loss. One recent study found that eating ½ cup of soy nuts daily reduced hot flashes by 45 percent in 8 weeks, but more research is needed. Don’t want to go nuts? Try other soy sources: tofu, soy milk, soy cheese, soy yogurt, or edamame. One caveat: Talk to your physician if you have or have had breast or another hormone-related cancer. Although soy may lower breast-cancer risk in healthy women, some experts think the plant estrogens in this bean could stimulate estrogen receptors in women who already have the cancer.

The New Pap Rules

Whether you’re 25 or 40-plus, cervical-cancer screening can save your life. What to know before you step into the stirrups.

20s

Being getting annual PAP tests 3 years after you start having intercourse or at age 21. A cell sample is taken from your cervix during a Pap to detect changes that could signal cancer. Also, approximately 70 percent of cervical-cancer cases are caused by the human papillomavirus (HPV). If you’re under 26, ask your doctor about the new HPV vaccine. Researchers recently made an exciting discovery: The vaccine may guard against additional cancer-causing strains – not just two of them, as previously thought. Whether you get the vaccine or not, you need an annual Pap. For best results, do not douche or use tampons for at least 48 hours before.

30s

Some doctors think it’s best to keep getting annual Pap tests. The guidelines change once you turn 30, however, so annual tests may not be necessary. If you’ve had normal Pap results 3 years in a row, you can have the test every 2 to 3 years. Also, consider getting screened for HPV. It’s easy: Your doctor can use the same sample of cells that he or she collected for your Pap. In fact, the HPV test may be even more crucial than the Pap. One study found that for women age 30 to 69 it was nearly 40 percent more effective than the Pap at detecting precancerous cells. It’s crucial to be vigilant now, because most cases of cervical cancer are detected after age 35.

40+

Turning 40 doesn’t mean you should stop getting Paps. You should continue the tests at least until you are 70 – because 20 percent of cervical-cancer cases are diagnosed after age 65. Here’s another reason not to skip the stirrups: Women in this age group may have been exposed to diethylstilbestrol (DES, a hormone widely used from 1938 to 1971 to prevent miscarriage). Ask your mom – if she took DES when she was pregnant, you could be at increased risk for cervical cancer.

Q&A


I’m 44 and have had three normal Paps. Do I really need a yearly ob-gyn visit?
Definitely. You still need an annual pelvic exam, which is not the same as a Pap test. During a pelvic exam, your doctor examines your reproductive organs to look for problems, including signs of ovarian and endometrial cancer.

Endometriosis

Approximately 5 million women in the USA and 1.5 million women in the UK suffer from endometriosis.

Endometriosis is characterized by cells from the endometrium (the lining of the uterus) that have migrated to form endometrial patches in other parts of the body – most commonly in the pelvic cavity (on the ovaries and cervix), but also more rarely in the bladder and bowel, lungs, heart, eyes, armpits, knees, or nasal passages. A serious condition, it’s most common in women aged over 30. Up to half these women will have fertility problems because of it.

Symptoms

Pain in the pelvic region is the most striking and debilitating symptom of endometriosis and is not always confined to the lead up to and during your period. Some women experience pain all month. If the endometrial patches have migrated to your bowel or bladder, you may experience pain when you have a bowel movement or urinate. If you suspect you have endometriosis, keep a record of any pain you experience and see if it is cyclical – patterns of pain can help establish a diagnosis. You may also experience pain during intercourse (known as dyspareunia). This is one of the most common symptoms of endometriosis, so it’s worth visiting your doctor if it applies to you.

Although pelvic and intercourse pain are the most identifiable symptoms, there are a number of others that in isolation may mean nothing , but together can indicate an endometriosis problem. Sadly, many women with endometriosis experience all of them, making this a truly debilitating condition. They include irregular and/or heavy periods, tiredness, lower back pain, digestive problems (such as bloating, diarrhea, and nausea) and difficulty in getting pregnant.

Causes

Doctors remain unclear as to exactly what causes endometriosis. Theories range from “retrograde menstruation”, when endometrial blood sheds into the Fallopian tubes instead of out of the vagina, to problems with the immune system. No one has been able to say definitively which of the many theories is right, although probably, as with most things, a combination of factors lies at the root of the problem. We do know that the condition seems to run in families, and perhaps the most widely accepted explanation is that endometriosis is estrogen sensitive: The more estrogen you have in your system, the more susceptible you are. This would certainly explain an increasing trend for the condition in the modern world – if you delay having babies (as many women now do), you have more periods, so are exposed to more estrogen.

Diagnosis

Doctors commonly under-diagnose endometriosis. For this reason, if your symptoms are cyclical and especially if you suffer from pain during intercourse and painful periods, insist your doctor tests you for the condition. The following are the most common methods of diagnosis your doctor will use.

Ultrasound Although an ultrasound scan is useful, it can’t actually diagnose endometriosis. What it can show, however, is any abnormalities in the pelvic cavity, including any adhesions and cysts, which may be caused by endometriosis. An ultrasound can also pick up a condition called adenomyosis, in which patches of endometrium (uterine lining) are present in the myometrium, the uterus’s layer of muscle tissue. Having adenomyosis is a strong sign that you have full-blown endometriosis and your doctor will probably send you for a laparoscopy.

Laparoscopy This is the gold-standard test for diagnosing endometriosis. You’ll be given a general anaesthetic so that your doctor can use a harmless gas to “inflate” your abdominal cavity. Once your abdomen is inflated, your pelvic organs can be viewed easily using a laparoscope. This is a thin viewing tube your doctor inserts through an incision just below your navel. Using the laparoscope, he or she can see whether or not any endometrial patches exist in your abdominal cavity. If they do, the doctor can laser them off during the same procedure.

Conventional Treatments

The conventional way to endometriosis is to shut down your reproductive hormones using medication. This stops your periods, reducing the levels of estrogen in your body. Endometriosis is a complex condition and if anything your doctor sys to you doesn’t fit your experience or just doesn’t make sense to you, don’t be afraid to ask for a second opinion.

Danazol Because endometriosis grows in the presence of estrogen, giving you a weak, male hormone to take effectively stops ovulation altogether, shutting off your body’s estrogen supply. Bear in mind that nay male hormone may have the effect of giving you “male” symptoms, notably acne, facial hair, weight gain, and a deeper voice. Nausea, rashes, headaches, and moodiness may also occur.

The contraceptive pill If you take the Pill “back to back”, without breaking for a withdrawal bleed, you can reduce the impact of endometriosis.

Gonadotrophin-releasing hormone (GnRH) analogues These drugs put you in a temporary state of menopause, shutting down your estrogen supply. Your doctor will prescribe them as an injection, nasal spray, or implant (which goes just under the skin).

Diathermy or laser surgery If drug treatments aren’t successful, your doctor may advise you to have diathermy (the use of intense heat) or laser surgery to burn off the endometrial patches. A doctor performs the procedure during a laparoscopy with the aim of removing as much endometriosis as possible and freeing up any organs that have fused together with adhesions (endometrial scar tissue).

Hysterectomy As an absolute last resort, your doctor may offer you a hysterectomy. However, unless your ovaries are removed as well as your uterus, the patches are likely to grow back elsewhere in your body because your ovaries will continue to make estrogen. Most doctors agree that, although endometriosis affects the uterus, the uterus itself isn’t the problem.