Scott Webb (Host): As most women know and accept, they're going to need a gynecologist and/or OB-GYN that they can trust in their lifetime. And joining me today is Dr. John Monk. He's a board-certified OB-GYN with Franciscan Health and he's here today to explain what he does, the types of care women will need in their lifetime, and the various services that Franciscan Health offers to patients.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about, for women in particular, about making health their priority, when to check in with their OB-GYN and so forth. And given the sensitive nature of reproductive care, most patients rely on trust, privacy, confidentiality when visiting with their OB-GYN. Would you agree that honoring this patient-physician relationship contributes to building a bridge of trust and respect with patients, allowing an avenue to exist where care can easily be sought out? And can you please elaborate on the importance of the physician-patient relationship within your specialty?

Dr. John Monk: Yeah, I think in women's health terms having a doctor-patient relationship is extremely important. Having a safe space to be able to discuss sensitive health issues, especially when it comes to reproductive health and pregnancy and obstetric and gynecologic care is extremely important. It's important to have a place to safely discuss sensitive issues in terms of sexual health and reproductive health. So, I think promoting a safe environment in both virtual visits and office visits and just the healthcare environment in general is really important for women's health and especially in terms of sharing issues and feeling heard. And it's important for patients and doctors to feel comfortable in an environment where everyone can share issues going on with their overall health.

Host: Sure. Yeah, just being open and honest and feeling, as you say, like they're being listened to and respected and all of that, obviously really important. And I know that one of your clinical interests is women's preventative healthcare. And we know that women are often the caregivers for the family. They sometimes put their health care needs or appointments on hold. How can we help them to really make sure that their health is their priority?

Dr. John Monk: I think we all are living extremely busy lives connected with juggling jobs and raising children and prioritizing our schedules and all the many activities we have going on throughout our daily lives. I think it's easy to put aside our preventative healthcare. In general, mothers and women tend to be the center and the rocks of a lot of families. And women tend to maybe forget about self-care and preventative healthcare. I think it's important that we remember to make ourselves a priority in our lives and have the availability and let people know that you can schedule appointments and always be available.

Host: Yeah, I couldn't agree more, and I'm sure that's true, that a lot of women do put their own care on the back burner in favor of their family, children, spouses, whomever. And as far as reproductive, women's reproductive health goes, maybe you can explain the importance of having an OB-GYN for their entire lifespan and the importance of keeping those regular appointments.

Dr. John Monk: When most women think about obstetrics and gynecology, they think about having children or reproductive health in their 20s and 30s with cervical cancer screening and those things. But having established care throughout a woman's health span in general is important, not just when they're young and having children, but things tend to change in women's 30s, 40s, and 50s. Things that become important like menstrual health, breast cancer, colon cancer screening, cardiovascular risk and lab evaluations; as women get older, menopause issues. So, there are many women's health issues that change over time, not just having children and reproductive health in women's young ages, but also as they get older.

Host: Yeah, right. Like when we hear OB-GYN, right? We think babies, of course, but there's so much more that you all do and so many other reasons, good reasons why they should continue to see you for their entire lifespan, of course. And if we go back and rewind the clock a little bit here, let's talk about the age that it's recommended that a woman start visiting a gynecologist for those routine exams, routine care, and their reproductive systems.

Dr. John Monk: The recommendation for the pelvic examination, Pap smear, cervical cancer screening starts at 21 years of age. We see many women in teenage years with menstrual cycle issues. We see plenty of teenage women with gynecologic issues. And then really, the recommendation is routine annual examination with a women's health expert and most years of adulthood. Most insurance coverages cover once yearly, like women's health examination. And that can be performed by an OB-GYN or many midwives in our hospital system, nurse practitioners, and even a lot of family medicine doctors perform the well woman annual examination. So, I think our hospital system has lots of access to care and it's mostly important just to have someone to come back to over time.

Host: Yeah. And I'm wondering, is there a difference between a gynecologist and an OB-GYN? Is that just a matter of semantics, or is there an actual difference between the two?

Dr. John Monk: There are differences between the different specialties of women health. For example, most midwives take care of pregnancy and babies. A lot of nurse practitioners just perform like well women visits. The difference between OB-GYN and a gynecologist, OB-GYNs focus on pregnancy and women's preventative health, and specific gynecologists usually focus more on menstrual cycle issues and uterus problems and menopause, so more of the non-pregnancy gynecology-related issues.

Host: Yeah. And along those lines, you know, I think we covered this, but maybe go over this again. Besides pregnancy care, when should a woman make an appointment with an OB-GYN?

Dr. John Monk: I think seeing an OB-GYN every year in a woman's life is important. The current recommendation is once yearly women annual examinations in adulthood.

Host: Yeah. And as you say, OB-GYNs do more than just the baby stuff. As we mentioned earlier, a lot of good reasons for women to keep those visits especially if their insurance is cooperative and all that implies. Wondering if you can explain the impact that irregular periods can have on women's health.

Dr. John Monk: Menstrual cycle health is extremely important. And I think it tends to not be discussed frequently enough. I see a lot of women in my practice who have heavy, irregular, unexpected menstrual cycles throughout their lives. They're either bleeding heavily with associated problems like anemia, fatigue, losing work days really affecting their activities of daily living. And a lot of women I see in the office with just unexpected menstrual cycles, those problems really affect everyday life and activities of daily living. All too often women tend to think these are normal or put off addressing issues because they don't think there's anywhere to discuss these problems or adequate treatment options.

And I would just encourage women, if you're having heavy, unwanted, irregular menstrual cycles that are affecting your activities of daily living to seek care. There's a lot of diagnostic and treatment options. There's medical and surgical options, diagnostic evaluations to see what's going on in terms of menstrual health.

Host: Yeah. As you say, there's a lot of things, not just women, but men and women, a lot of things that we just chalk up to age or whatever and just assume that what are you going to do? These things happen. But a lot of the things come to find out in my line of work here and speaking with providers and experts is a lot of these things are not just to be expected. They're not just normal part of aging. And as you say, irregular periods, that's a good time to reach out. Maybe you could tell us about some of the gynecological issues that women face, some of the symptoms, causes, solutions, and so on.

Dr. John Monk: Sure. As I discussed earlier, most women's issues tend to gradually change over time. So in women's 20s and 30s, it tends to be irregular periods, fertility health and family planning issues. Sexual health issues like STD screening, vaginitis, bacterial vaginosis, yeast infections, those kinds of issues in women's 20s and 30s.

 When I see women in middle ages, 40s and 50s, it tends to be menopausal issues, perimenopausal issues, heavy menstrual bleeding in women in their 40s. There are multiple postmenopausal elderly women issues as well, such as urinary incontinence, pelvic organ prolapse and variety of other postmenopausal issues that go along with declining estrogen levels as women age. Breast health is always extremely important in decreasing breast cancer risk and those things so routine mammogram screening and breast examinations are extremely important, especially as women get older.

Host: Yeah. As the women in my life, mom, wife, even my 16-year-old daughter, they always want to tell me and want me to know it's not easy to be a woman. There's a lot of issues all throughout life. Thankfully, they have OB-GYNs or gynecologists to help them.

And I have my thoughts on this next question, but we'll hear from an expert here. Maybe you could describe paramenopause symptoms and what can be done for a healthy transition prior to menopause. And I referenced that because it's always freezing in my house because my wife thinks it's always too warm in the house, in the car. And my daughter and I are always shivering whereas she's sweating. So, I'll leave it to you, in an expert's words.

Dr. John Monk: Yeah. The average age of menopause is 51.5 and perimenopause is the several years prior to this transitional period. And the symptoms hallmarked, as you stated, are hot flashes, night sweats, mood swings, dryness. There's a multiple constellation of symptoms that can bother women throughout perimenopausal period.

For most women, it's a normal transition. You know, a period of one to two years where they get some hot flashes and then they slowly resolve over time. But about 50% of women have significant debilitating menopause symptoms that don't resolve over time. There's lots of treatment options for perimenopause symptoms. There's lifestyle modifications and there are some good herbal and soy supplementations that can help mitigate symptoms. Recently, multiple good prescription medications for menopause symptoms, including non-hormonal and hormonal treatment options. Menopause definitely affects quality of life and can sometimes be quite debilitating. So, I'd encourage women who it's really affecting relationships and quality of life to seek some consultation to discuss options that can improve their lives.

Host: Yeah. And hopefully, some of those options work for folks. In my home, we just basically turn the heat off in the winter, and everybody just has to deal with it. But you are so right, it really has affected my wife's quality of life. And so, we try to find a happy middle ground somewhere, 68, 69, where we're not quite freezing, but we're close to it.

Doctor, this has been great today. Just want to give you a chance as we wrap up here, final thoughts, takeaways, whether it's your clinical interests or what you just do on a daily basis in the office and how you can help folks, how you can help women.

Dr. John Monk: Thanks for having me today. Appreciate you taking the time to speak with me. Yeah, I spend most of my days hanging out with patients and discussing their everyday lives and clinical problems. And a lot of what we do at Franciscan is counseling patients about what's going on in their lives and what kind of treatment options are available for patients to try to optimize their health and improve their quality of life.

And I'd encourage anybody who isn't getting routine care if they need an annual examination or having problems in their female health life to look us up and schedule an appointment. And we have a lot of midwives and family medicine doctors and nurse practitioners and OB-GYNs on our medical staff to give us a call and let us know what's going on. And hopefully, we can help you have a better life here.

Host: Yeah. Yeah. That sounds good. And for more information, visit franciscanhealth.org and search When It's Time To See A Gynecologist. Doctor, thanks so much for your time. You stay well.

Dr. John Monk: Thank you, sir.

Host: And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.