Pap smears to bone density tests: What your gynaecologist wants you to check in your 20s, 30s and beyond

Pap smears to bone density tests: What your gynaecologist wants you to check in your 20s, 30s and beyond Your gynaecological health priorities change with age. Experts explain which checks are important at every stage of life and the symptoms you shouldn't ignore. Imagine trying to get pregnant and not knowing when you should seek specialist medical advice. Or perhaps you’re becoming sexually active but not aware of how to ensure optimal sexual health. You could also be older and grappling with the daunting arrival of menopause and its associated symptoms. Your gynaecologist is your best bet in all these scenarios. They can also advise you on the scans and screening tests you may need, some of which help to prevent more serious issues, such as osteoporosis and gynaecological cancers. Here’s a guide to what you need at every age. YOUR 20S: PERIODS, CONTRACEPTION AND SEXUAL HEALTH For young women, it’s mostly about getting periods under control, so see a gynaecologist if you suffer from pain, irregular cycles or heavy bleeding, said Dr Seet Meei Jiun, head of the Department of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH). Your 20s is also when cervical screening begins. Dr Freda Khoo, consultant obstetrician and gynaecologist at Freda Khoo Clinic for Women, said all women who have ever had sex are recommended to have their first Pap smear at the age of 25. According to the Ministry of Health’s cervical screening guidelines, women aged 25 to 29 should get a Pap smear once every three years. Women over 30 should get a human papillomavirus (HPV) test every five years. Dr Khoo explained that the Pap smear checks for abnormal cells and the HPV test looks for the virus infecting the cells. From age 30, HPV testing becomes the recommended routine cervical screening test. Dr Khoo said the rationale for not doing the HPV test earlier is that, in your younger years when you might be more sexually active, HPV infection would be more prevalent. As such, doing the test in the younger age group would mean picking up a lot of HPV. “The body’s own immune system clears the HPV on its own most of the time, especially if you are young and healthy. Thus, many times, the HPV infection in the younger age group might be transient,” Dr Khoo told CNA Women. Both tests are performed in the same manner – using a small pliable brush to pick up a sample from the cervix. The HPV vaccine is also recommended, ideally before your first sexual encounter as HPV is usually transmitted sexually. Currently, under the Singapore National Childhood Immunisation Schedule, females aged 13 receive two doses of the HPV vaccine in school. The vaccine is designed to protect women from certain high-risk strains of HPV. However, Dr Khoo noted it’s important to understand there are more than 200 types of HPV and the vaccine only offers protection from four to nine of the most high-risk types. Therefore, Pap smears and HPV tests should still be undertaken. Women who are sexually active and not planning for pregnancy should also consider contraception. Your gynaecologist will be able to advise on which method is best for you. This is also when you should be more aware of sexually transmitted infections (STIs). Dr Robin Edwards, specialist in obstetrics and gynaecology at Raffles Women’s Centre, said STIs are common and the risk of passing infections between sexual partners can be reduced significantly by using barrier contraception (for example, condoms) and by undergoing screening for infections when starting a new relationship. “Not all STIs cause symptoms but some can cause damage to the internal pelvic organs that are critical for fertility, such as the fallopian tubes,” he said. “Most common STIs are treatable, usually curable.” He added: “Therefore, STI testing is important and should be seen as a positive action for any sexually active person. You should feel comfortable to discuss with your doctor any concerns you have about sexual health without fear of judgement or embarrassment.” YOUR 30S & 40S: FERTILITY AND PERIMENOPAUSE Dr Seet said women at this age could be trying to get pregnant or dealing with conditions like polyendocrine metabolic ovarian syndrome (PMOS, formerly known as PCOS, or polycystic ovary syndrome) or endometriosis, which make conception harder. Dr Seet said a fertility assessment is recommended for couples who have been trying to conceive for 12 months without success. However, for women over 35, it is worth seeking this assessment before the 12-month mark. As women hit their late 40s and approach perimenopause, they might experience hot flushes, mood swings, poor sleep and unpredictable periods. Sex drive may dip and vaginal dryness can become an issue too, said Dr Seet. Do you really need a gynaecologist to help manage your perimenopause symptoms? Dr Edwards said women can consult a general practitioner or family doctor. You may also see a gynaecologist, either as your primary doctor for menopause or for specialist input, if required. “What is most important is finding a doctor who can discuss your symptoms, address any underlying causes and restore your quality of life, whether through hormone replacement or complementary treatments,” he added. In some cases, your doctor might order blood tests to check for thyroid dysfunction, said Dr Seet. Thyroid symptoms such as fatigue, weight changes, hair loss, mood changes or irregular menses can closely mimic hormonal changes, she added. “It is particularly worth checking in the perimenopausal years.” HOW TO DO BREAST SELF-EXAMINATION Breast cancer should be on your radar once you hit your 40s, although it can affect women at any age. The Singapore Cancer Society recommends that women aged 40 to 49 get a mammogram once a year. Once you hit 50, get one every two years. Dr Freda Khoo, consultant obstetrician and gynaecologist at Freda Khoo Clinic for Women, said all women should learn to perform breast self-examination (BSE) once they’re out of puberty as this is when their breasts have fully developed. The best time is seven to 10 days after the start of your period, when your breasts are least tender and swollen. If you’re no longer having periods, choose a date that’s easy to remember. Dr Khoo outlined the two steps of BSE: - Look: Stand in front of the mirror and place your hands on your hips. Look at your breasts in the mirror and look for any changes in shape, skin appearance and nipple appearance. Raise your arms above your head and look for any dimpling in the skin underneath the breasts. - Feel: This is best done lying down. Using your middle three fingers, go in a systematic circular direction from the outer aspect of the breast to the inner aspect towards the nipple. Feel for any lumps or irregularities. Gently squeeze the nipple for any discharge. Feel in the armpits for any lumps or hardness. Dr Robin Edwards, specialist in obstetrics and gynaecology at Raffles Women’s Centre, added that, during early adulthood, women may notice changes in their breasts that coincide with their menstrual cycle. This is common and normal. However, symptoms that are not linked with your cycle may be more significant and should be checked. YOUR 50s AND BEYOND: BOWEL HEALTH, BONE DENSITY AND POST-MENOPAUSE When a woman hasn’t had a menstrual bleed for 12 consecutive months, she has reached menopause. This is when new concerns come into the picture. “Bladder leakage and a weakened pelvic floor become more common and vaginal dryness often gets worse,” said KKH’s Dr Seet. “Bone health becomes a real priority, as the risk of thinning bones increases significantly. Heart health also needs more attention, since the body loses some of the natural protection that oestrogen previously provided.” From age 65, women should get a bone mineral density (BMD) test. This simple procedure uses low-dose X-rays and a camera to measure bone mineral content, which estimates bone strength and the risk of bone fractures. Dr Khoo said a BMD test should be done earlier if you are postmenopausal and possess risk factors for osteoporosis. This includes a family history of osteoporosis or hip fractures, a previous fracture after a minor fall and those who reached menopause before 45. The test can be repeated every five years, more often if there are signs of bone loss or osteoporosis. Dr Khoo suggested consulting your GP or gynaecologist on when you should do a BMD test. Screening for bowel cancer, via a colonoscopy, is crucial too. Raffles Women’s Centre’s Dr Edwards explained this involves passing a flexible camera via the anus into the large bowel to look directly inside. This test can identify abnormalities of the bowel and allow biopsy of any polyps or growths. While Singapore guidelines recommend a colonoscopy every five to 10 years from age 50, Dr Edwards said individuals with additional risk factors for cancer – such as a family history, prior bowel cancer treatment or certain conditions that predispose to cancer – may be advised to do it earlier and more frequently. CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.