Maggie McKay (Host): Welcome to the Kirby Connections Health Podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Maggie McKay. On this episode, we'll talk about women's health visits with Lauren Coovert, Family Practice Physician Assistant. Great to have you here, Lauren. Thank you so much for making the time.

Lauren Coovert, PA-C: Thanks for having me. 

Host: Let's start with what are the key components of a well woman visit and how can patients prepare effectively for this appointment?

Lauren Coovert, PA-C: So a well woman visit is typically just an annual visit to kind of catch up with your provider, but a big focus is on preventative healthcare. So we'll look at some cancer screening options that are available, immunizations, maybe blood work, talk about your mental health, your menstrual health. And any other concerns that you have about your general healthcare as a woman. 

Host: And how have recent updates in clinical guidelines affected the recommended frequency of PAP smears for cervical cancer screening? Because I've heard, different accounts on when you should get one, how often.

Lauren Coovert, PA-C: Yeah. A lot of women used to have to go every year. We would go get our annual PAP and a few years ago those guidelines changed. We had evidence to show that we don't need to do them quite as frequently. So the current guidelines are starting at age 21, women should have at least their first PAP smear at that time and would be done every three years up until age 30.

And then once a woman turns 30, we also do what's called an HPV Co-Test. And that test allows us to look for the virus that we found primarily causes cervical cancer. And then from age 30 until 65, women can either get a co-test every five years or just a PAP every three, or sometimes just an HPV test every five years. 

Host: So do you just check with your doctor basically? 

Lauren Coovert, PA-C: Yep. 

Host: What are the latest advances in STI screening technologies? How do they improve accuracy and patient comfort?

Lauren Coovert, PA-C: So a lot of times we would have to do a pelvic exam to do STD testing. Now we're able to check by urine samples, some blood tests. So that's obviously much more comfortable and less invasive for patients. And we can do more DNA based testing. So it's a lot more specific. The results come back much quicker, which helps to prevent further spread of those infections to their partners, and for the patient to recover quicker. 

Host: Lauren, can you outline the age related guidelines for when women should begin routine mammograms and discuss any recent changes in these recommendations?

Lauren Coovert, PA-C: Yeah, there's a little bit of debate about that right now amongst some of the groups. But in general, the American Cancer Society and ACOG, which is the American Gynecologic Society, they recommend starting at around 40, you would do them every year to two years for most women. And again, there's a case by case basis that you need to talk with your doctor about.

Because if you have a family history or if you've had other changes to your breasts, they may need to do them quicker. You might also need additional types of imaging like MRIs if you're a high risk patient. 

Host: Let's talk about bone density screening. What consideration should be taken into account when deciding on the timing of getting those scans, the bone density scan, DEXA for osteoporosis screening?

Lauren Coovert, PA-C: Yeah, so a lot of women will have to do this by the time they're about 65. Once women go through menopause, they're at much higher risk for loss of bone mass. So for sure by 65 you wanna do that. But women who smoke or who are thinner or are of Asian ethnicity, they have a higher risk in general. If you're on certain medications that can put you at risk, so you may need it sooner than 65. 

Host: Lauren, can you talk about the criteria for when a colonoscopy should be part of a well woman visit and whether non-invasive alternatives like stool tests are viable?

Lauren Coovert, PA-C: So they changed the guidelines for that also, recently. We used to start screening people at age 50, and they dropped that down to 45 within the past five years. So the gold standard is still to do a colonoscopy for screening. We're able to find more. They can do biopsies and remove any polyps that are found, but a lot of patients don't want to do something that invasive.

So we have a couple of stool-based tests. One is the Cologuard test, and that's the commercial you see with the little blue box that they ship to your house and you send them back a sample. And if that's negative, then it's good for three years. There's also the fecal immunochemistry test, that you can do at the hospital, and that's good for one year.

But patients should know that if those two tests are abnormal, then they would still need a colonoscopy. And again, family history plays into that. If you have a family member who had colon cancer at a young age, you probably need to be screened sooner.  

Host: And more often, right?

Lauren Coovert, PA-C: Yep. 

Host: How should a woman decide on the most suitable birth control method? What new options have been developed in recent years? 

Lauren Coovert, PA-C: So there's a lot that goes into that. I think a lot of it has to do with the convenience and then the efficacy and kind of what's your plans or your goals for birth control are. Some women want to use it for birth control, some need to do it to regulate their periods. If you're planning to have a child in the near future, some options are not going be as good of an option for you. So we have long acting reversible contraceptives. So those are things like IUDs, implants, the depo shot, those last longer, so you don't have to take something every day. There's also the standard pill, or patch. And there's even now an over-the-counter birth control that's a non-estrogen pill that you can get at local pharmacies if you want to. So. 

Host: And you mentioned menopause. A big topic for women experiencing it. What symptom management strategies are recommended and what are some emerging treatments? 

Lauren Coovert, PA-C: So menopause is finally getting, I think, the notification that it needs, or, you know, in the media I see a lot of that. I'm in that age group that's heading towards menopause myself. So, hormone replacement was always kind of a taboo. When I graduated, a big study had come out saying that hormones can cause breast cancer and heart disease.

And so a lot of medical providers kind of shied away from them. But I think the pendulum is swinging back. So hormones are the mainstay for most menopausal symptoms like hot flashes and vaginal dryness. But we have a lot of other non-hormonal options. There's new prescription drugs, there's things that can just help with sleep. There's mood stabilizing meds, and all of those, as well as lifestyle can help to manage the symptoms of menopause. 

Host: So hormones are basically just to make it a little easier. Is that right?

Lauren Coovert, PA-C: Yeah, so it's usually due the loss of estrogen that women can have the symptoms that, like I said, range from hot flashes, mood disturbances, brain fog, muscle aches and bone issues. So, kind of every system of our body is dependent on estrogen as a woman, and as we start to lose that, things don't always work as well as they used to.

So replacing some of that estrogen can be very helpful. Progesterone can also help with sleep. There's some evidence that maybe testosterone can be used in women to help with certain conditions. So there's lots of options out there.

Host: Lauren, is there anything else you'd like to add that we didn't cover? 

Lauren Coovert, PA-C: I think it's just important that women know that we're different than men and so the guidelines that we have and the things that affect us, it's important to go to your well woman visit so that you can address those issues and bring any concerns. Because we have lots of ways to treat the various parts of a woman's life.

Host: Right, and like you said, a lot of the guidelines have changed through the years, so you gotta stay current and up to date and do it at least every year. Right?

Lauren Coovert, PA-C: Yep.

Host: Thank you so much for this invaluable information, Lauren. We really appreciate it.

Lauren Coovert, PA-C: All right. Thank you. 

Host: If you'd like to find out more, please visit Kirbyhealth.org/aboutus/communityoutreachservices, or just kirbyhealth.org.

Again, that's Lauren Coovert. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you, Thanks for listening to Kirby Connections Health Podcast.