The COVID-19 pandemic disrupted many women’s preventative care schedules, and you may wonder what recommendations have changed since your last regular visit to the OB/GYN. Dr. Huh is joined by Ashely Wright, MD, who leads the ultrasound service at UAB Medicine. She discusses the current guidelines by age range for the Well Woman Alabama initiative and clears up misconceptions about how often to have pelvic exams, pap smears, and other services that are part of good preventative care for women.
Submitted By: Kate Hiden
Selected Podcast
Well Women Care
Featuring:
Learn more about Ashley Wright, MD
Ashley Wright, MD
Ashley Wright, MD is a GYN Ultrasound Director.Learn more about Ashley Wright, MD
Transcription:
Dr Huh (Host): Hello everyone. This is Dr. Warner Huh, the chair of such gynecology at the University of Alabama Birmingham, and like to welcome you to this monthly episode of Women's Health with Dr. Huh. So today we, have important topic. It's a timely one. It's the topic of new updates with well, women preventative care, you know, as we particularly come out of COVID, we can argue that preventative care has taken a little bit of a backseat through the COVID pandemic. I know a lot of our listeners have questions about updates related to, well woman care. And with me today, is, Dr. Ashley Wright, who is an associate professor in the Division of Women's Health in the Department of OBGYN here at UAB. Importantly, she also leads our gynecology ultrasound service here in the department and has enormous expertise in this area. So welcome Dr. Wright to this monthly podcast.
Dr Ashley Wright: Great. Thanks for having me.
Dr Huh (Host): So let's talk about preventative care for women. As I mentioned earlier, I think a lot of women, millions of women perhaps, have put, preventative care on the back burner during the COVID Pandemic, and we're just starting to see a reemergence of women seeking, preventative care services like they did pre COVID. But more importantly, that there have been some pretty market changes in terms of the preventative care that we provide, to women overall. Mostly really important. Really good. I thought it might be helpful for you to kind of overview some of those recommendations, including important changes or updates maybe by age range, if that sounds good for you.
Dr Ashley Wright: Sure. There are three main questions that I get a lot of times that I think will help get us started with this. the first that I get is when does my daughter need to come see a gynecologist? a second question is, what? I don't need a pap smear every year. and then a third question is, what do you mean I need a colonoscopy? I'm 45. So that just kind of highlights some of the things that I think are important per age range. So first are really the adolescents. And so there's a couple of things that we can think about here. Of course, if an adolescent is sexually active, if they need contraception, then that's important for them to be able to talk to their gynecologist about.
If they have abnormal cycles, abnormal bleeding, or if certainly haven't started their cycles by age 16. But a common area here, is that a 16 year old does not need a pap smear, which I think, is one of the main questions that moms wanna know is, if I bring my daughter in here, is she gonna have to have a pap smear? And the answer to that is no. As far as the reproductive years goes, and this is where I think a lot of, women are really catching up from the Covid pandemic is what about contraception? They might not have been able to get into the doctor for a couple of years even.
What about pap smears? What about, hey, I'm thinking about getting pregnant now. What do I need to know about? And then certainly family history especially as genetic testing becomes more readily available and less expensive as well. I think that's important, that a lot of women also don't know about. And then as far as later on, so maybe after reproductive years and into menopause, colonoscopies are actually now recommended at age 45. So that's been a recent change that I think happened right before the pandemic, but a lot of patients are not up to date of that as well.
Dr Huh (Host): Yeah, so it's interesting. So a question I think probably you and I get all the time is women come in saying, Do I really need to come in yearly? And to the point that you were bringing up about pap smears or cervical cancer screening is the often asked, do I need a pap every year? And more importantly, do I need a pelvic exam every year? So I would love to know what you think about that.
Dr Ashley Wright: Sure. So it's been interesting since the pap smear guidelines changed 10, 11 years ago. Now a lot of women don't understand what we do quote down there, so they just think we're just doing something and they really don't know. So I found, it interesting to just talk about what we actually do when we're doing the stuff down there, so to speak. So, the short answer is that women don't have to necessarily have pelvic exams every year. They're uncomfortable sometimes they don't give us enough information and we end up needing to do additional tests, for example.
And so it is not true that you have to have a pelvic exam every year. There are certain circumstances where it's important. So of course we're gonna be needing to look at the cervix. If we're doing a pap smear, we're gonna be needing to look, and do a pelvic exam. If there's abnormal bleeding, if there's a history of GYN malignancy. anything along those lines, is important for us to be able to evaluate.
And then of course, with pap smears, You definitely don't need one every year if you're have a normal history and don't have a history of abnormal pap smears in the past either. So I do think it's important for women to, at least touch base with their gynecologist every year, or a primary care doctor if maybe childbearing is done and they're up to date with other screenings, I think that makes the most sense.
Dr Huh (Host): Yeah. So I wanna sort of, unpack that a little bit further because there are multiple really important points for our listeners. So first off, You know, I think both OB GYNS and patients were led to believe that they needed to come in, have a p and a pelvic exam every single year. And we can understand how that started, but I think contemporarily, it's probably not necessary. But more importantly, I just wanna make sure our listeners understand that there are many other health preventative, things that are dressed in the gynecologist's office above and beyond just the pelvic examination, that's really important to review. It's not all about the pap smear. Whenever a woman gets a pelvic exam, they think they're automatically getting a pap and that's not the case.
So it's important that if you think you're getting a pap and you're getting a pelvic gastro doctorate, did you do a pap psin or not? Because the two of them are not equated, although I could totally understand, why that is. I think one area, albeit an area of controversy is, breast cancer screening, particularly with mammography. And this is an area just like Pap smear screening that is constantly on the move and changing based on growing evidence. I thought we could just take maybe a couple moments for the listeners to understand what are the current recommendations for breast cancer screening, particularly the mammography.
Dr Ashley Wright: So there was something great that happened called the Women's Preventive Service Initiative that combine multiple different organizations, including ACOG, that kind of give. Updates and recommendations as far as what is important for well woman care. And so I like that because it summarizes multiple different bodies, that we can use. And that's I think, part of the confusion with women these days and even providers too. But really and truly, some of it depends on family history.
So if you have a family history that is significant, let's say for multiple members of the maternal side of your family with breast cancer, then that may mean you need screening earlier. So that is important, and that's part of what we talk about when you come in, to the gynecologist, is really try to delve further into your family history. Saying that if you're at average risk and don't have significant family history, then the recommendation is to initiate screening no earlier than age 40, and no later than age 50.
After 50, it is recommended that you have a mammogram every year. Before 50 it's really a decision a patient and the doctor because there's some downsides to mammography, higher rate of false positives, which means we're more likely to find something that really is not accurate and we need to do further testing. Also, they're not the most comfortable exams in the world, and so, that's important too.
Dr Huh (Host): One thing that I think a lot of, the public doesn't understand about screening is that, unfortunately screening is not perfect, but what people often don't understand is, why don't we do the test every month or every six months? And the reason for that is that there are real potential harms with being over screened, including having undergone multiple procedures or biopsies that probably were totally unnecessary. So I think just for our listeners to recognize that, I think there's a lot of consternation that we're spacing out intervals and the people say, Oh, this is too far.
And there arguments on both sides. But to also recognize getting screened too often doesn't translate necessarily into a better outcome or picking up the problem earlier. So I just think that's something really important for our listeners to understand something that's misunderstood, but also to recognize that screening is not ideally perfect either. So I don't know if you have any thoughts about that.
Dr Ashley Wright: Yeah, absolutely. And I get a lot of questions about that with mammography specifically because I think there is so much advertisement these days about breast cancer and celebrities talking about breast cancer and getting screening, and so I think it makes people more nervous and they think they should get screening more frequently, but it's on the flip side of that is. But if you do have that mammogram, there's something that comes back and you're waiting for a phone call to get further mammograms and ultrasounds and breast biopsies.
And those are also, again, uncomfortable and they may be completely benign. So there's definitely a balance between really trying to get screened and making sure you're staying up to date with that, but also not over screening.
Dr Huh (Host): I couldn't agree more. And there's one additional thing that I think you brought up that is really important, which is really contraceptive counseling and care, which I know for a fact that very much was tabled and put on the back burner during the COVID pandemic. And I think a lot of women actually had problems refilling their contraception and having some challenges with that. But to recognize that when women who are seeking contraception, there are so many different options that are available to patients, but you need to have that discussion with your OB GYN.
And so for millions of women, that's an really important one-on-one conversation that could be had at this yearly, well woman preventative visit. So, I dunno if you have Anything further to add beyond that, Dr. Wright?
Dr Ashley Wright: Yeah, absolutely. So in a perfect world, we would want women to get pregnant when they wanted to get pregnant and if they wanted to get pregnant, right? So we want women to be able to have that choice to choose a pregnancy or not whenever they want. And so, you're right that it was difficult for a lot of women, and still maybe in certain circumstances if there aren't physicians available in their areas to be able to provide contraception. But it's really important. and that's a conversation that we definitely try to have of, Hey, what's your plan as far as future children goes? And what's your plan about having pregnancies, because there may be other factors involved, in the healthcare that could be optimized prior to getting pregnant.
Dr Huh (Host): Couldn't agree more. This was a truly brilliant conversation and again, I very much would like to thank Dr. Wright for updating us on contemporary updates on well woman care, including all the different types of screening. there are lots of changes, and this changes obviously need to be communicated to the broader community. So I really appreciate you doing that. So as always, please rate this podcast and we welcome any comments, particularly on topics that you're interested in.
If you want information on, our OBGYN services and expertise at UAB. Please check out uabmedicine.org and I'm very proud to announce that the department was highly ranked as number five in US News and report, which just speaks to the Austin care that Dr. Wright and her colleagues provide to our, many, many patients. So, until next time, we'll talk to you, at the next podcast and, take care. Peace out. Bye-bye. .
Dr Huh (Host): Hello everyone. This is Dr. Warner Huh, the chair of such gynecology at the University of Alabama Birmingham, and like to welcome you to this monthly episode of Women's Health with Dr. Huh. So today we, have important topic. It's a timely one. It's the topic of new updates with well, women preventative care, you know, as we particularly come out of COVID, we can argue that preventative care has taken a little bit of a backseat through the COVID pandemic. I know a lot of our listeners have questions about updates related to, well woman care. And with me today, is, Dr. Ashley Wright, who is an associate professor in the Division of Women's Health in the Department of OBGYN here at UAB. Importantly, she also leads our gynecology ultrasound service here in the department and has enormous expertise in this area. So welcome Dr. Wright to this monthly podcast.
Dr Ashley Wright: Great. Thanks for having me.
Dr Huh (Host): So let's talk about preventative care for women. As I mentioned earlier, I think a lot of women, millions of women perhaps, have put, preventative care on the back burner during the COVID Pandemic, and we're just starting to see a reemergence of women seeking, preventative care services like they did pre COVID. But more importantly, that there have been some pretty market changes in terms of the preventative care that we provide, to women overall. Mostly really important. Really good. I thought it might be helpful for you to kind of overview some of those recommendations, including important changes or updates maybe by age range, if that sounds good for you.
Dr Ashley Wright: Sure. There are three main questions that I get a lot of times that I think will help get us started with this. the first that I get is when does my daughter need to come see a gynecologist? a second question is, what? I don't need a pap smear every year. and then a third question is, what do you mean I need a colonoscopy? I'm 45. So that just kind of highlights some of the things that I think are important per age range. So first are really the adolescents. And so there's a couple of things that we can think about here. Of course, if an adolescent is sexually active, if they need contraception, then that's important for them to be able to talk to their gynecologist about.
If they have abnormal cycles, abnormal bleeding, or if certainly haven't started their cycles by age 16. But a common area here, is that a 16 year old does not need a pap smear, which I think, is one of the main questions that moms wanna know is, if I bring my daughter in here, is she gonna have to have a pap smear? And the answer to that is no. As far as the reproductive years goes, and this is where I think a lot of, women are really catching up from the Covid pandemic is what about contraception? They might not have been able to get into the doctor for a couple of years even.
What about pap smears? What about, hey, I'm thinking about getting pregnant now. What do I need to know about? And then certainly family history especially as genetic testing becomes more readily available and less expensive as well. I think that's important, that a lot of women also don't know about. And then as far as later on, so maybe after reproductive years and into menopause, colonoscopies are actually now recommended at age 45. So that's been a recent change that I think happened right before the pandemic, but a lot of patients are not up to date of that as well.
Dr Huh (Host): Yeah, so it's interesting. So a question I think probably you and I get all the time is women come in saying, Do I really need to come in yearly? And to the point that you were bringing up about pap smears or cervical cancer screening is the often asked, do I need a pap every year? And more importantly, do I need a pelvic exam every year? So I would love to know what you think about that.
Dr Ashley Wright: Sure. So it's been interesting since the pap smear guidelines changed 10, 11 years ago. Now a lot of women don't understand what we do quote down there, so they just think we're just doing something and they really don't know. So I found, it interesting to just talk about what we actually do when we're doing the stuff down there, so to speak. So, the short answer is that women don't have to necessarily have pelvic exams every year. They're uncomfortable sometimes they don't give us enough information and we end up needing to do additional tests, for example.
And so it is not true that you have to have a pelvic exam every year. There are certain circumstances where it's important. So of course we're gonna be needing to look at the cervix. If we're doing a pap smear, we're gonna be needing to look, and do a pelvic exam. If there's abnormal bleeding, if there's a history of GYN malignancy. anything along those lines, is important for us to be able to evaluate.
And then of course, with pap smears, You definitely don't need one every year if you're have a normal history and don't have a history of abnormal pap smears in the past either. So I do think it's important for women to, at least touch base with their gynecologist every year, or a primary care doctor if maybe childbearing is done and they're up to date with other screenings, I think that makes the most sense.
Dr Huh (Host): Yeah. So I wanna sort of, unpack that a little bit further because there are multiple really important points for our listeners. So first off, You know, I think both OB GYNS and patients were led to believe that they needed to come in, have a p and a pelvic exam every single year. And we can understand how that started, but I think contemporarily, it's probably not necessary. But more importantly, I just wanna make sure our listeners understand that there are many other health preventative, things that are dressed in the gynecologist's office above and beyond just the pelvic examination, that's really important to review. It's not all about the pap smear. Whenever a woman gets a pelvic exam, they think they're automatically getting a pap and that's not the case.
So it's important that if you think you're getting a pap and you're getting a pelvic gastro doctorate, did you do a pap psin or not? Because the two of them are not equated, although I could totally understand, why that is. I think one area, albeit an area of controversy is, breast cancer screening, particularly with mammography. And this is an area just like Pap smear screening that is constantly on the move and changing based on growing evidence. I thought we could just take maybe a couple moments for the listeners to understand what are the current recommendations for breast cancer screening, particularly the mammography.
Dr Ashley Wright: So there was something great that happened called the Women's Preventive Service Initiative that combine multiple different organizations, including ACOG, that kind of give. Updates and recommendations as far as what is important for well woman care. And so I like that because it summarizes multiple different bodies, that we can use. And that's I think, part of the confusion with women these days and even providers too. But really and truly, some of it depends on family history.
So if you have a family history that is significant, let's say for multiple members of the maternal side of your family with breast cancer, then that may mean you need screening earlier. So that is important, and that's part of what we talk about when you come in, to the gynecologist, is really try to delve further into your family history. Saying that if you're at average risk and don't have significant family history, then the recommendation is to initiate screening no earlier than age 40, and no later than age 50.
After 50, it is recommended that you have a mammogram every year. Before 50 it's really a decision a patient and the doctor because there's some downsides to mammography, higher rate of false positives, which means we're more likely to find something that really is not accurate and we need to do further testing. Also, they're not the most comfortable exams in the world, and so, that's important too.
Dr Huh (Host): One thing that I think a lot of, the public doesn't understand about screening is that, unfortunately screening is not perfect, but what people often don't understand is, why don't we do the test every month or every six months? And the reason for that is that there are real potential harms with being over screened, including having undergone multiple procedures or biopsies that probably were totally unnecessary. So I think just for our listeners to recognize that, I think there's a lot of consternation that we're spacing out intervals and the people say, Oh, this is too far.
And there arguments on both sides. But to also recognize getting screened too often doesn't translate necessarily into a better outcome or picking up the problem earlier. So I just think that's something really important for our listeners to understand something that's misunderstood, but also to recognize that screening is not ideally perfect either. So I don't know if you have any thoughts about that.
Dr Ashley Wright: Yeah, absolutely. And I get a lot of questions about that with mammography specifically because I think there is so much advertisement these days about breast cancer and celebrities talking about breast cancer and getting screening, and so I think it makes people more nervous and they think they should get screening more frequently, but it's on the flip side of that is. But if you do have that mammogram, there's something that comes back and you're waiting for a phone call to get further mammograms and ultrasounds and breast biopsies.
And those are also, again, uncomfortable and they may be completely benign. So there's definitely a balance between really trying to get screened and making sure you're staying up to date with that, but also not over screening.
Dr Huh (Host): I couldn't agree more. And there's one additional thing that I think you brought up that is really important, which is really contraceptive counseling and care, which I know for a fact that very much was tabled and put on the back burner during the COVID pandemic. And I think a lot of women actually had problems refilling their contraception and having some challenges with that. But to recognize that when women who are seeking contraception, there are so many different options that are available to patients, but you need to have that discussion with your OB GYN.
And so for millions of women, that's an really important one-on-one conversation that could be had at this yearly, well woman preventative visit. So, I dunno if you have Anything further to add beyond that, Dr. Wright?
Dr Ashley Wright: Yeah, absolutely. So in a perfect world, we would want women to get pregnant when they wanted to get pregnant and if they wanted to get pregnant, right? So we want women to be able to have that choice to choose a pregnancy or not whenever they want. And so, you're right that it was difficult for a lot of women, and still maybe in certain circumstances if there aren't physicians available in their areas to be able to provide contraception. But it's really important. and that's a conversation that we definitely try to have of, Hey, what's your plan as far as future children goes? And what's your plan about having pregnancies, because there may be other factors involved, in the healthcare that could be optimized prior to getting pregnant.
Dr Huh (Host): Couldn't agree more. This was a truly brilliant conversation and again, I very much would like to thank Dr. Wright for updating us on contemporary updates on well woman care, including all the different types of screening. there are lots of changes, and this changes obviously need to be communicated to the broader community. So I really appreciate you doing that. So as always, please rate this podcast and we welcome any comments, particularly on topics that you're interested in.
If you want information on, our OBGYN services and expertise at UAB. Please check out uabmedicine.org and I'm very proud to announce that the department was highly ranked as number five in US News and report, which just speaks to the Austin care that Dr. Wright and her colleagues provide to our, many, many patients. So, until next time, we'll talk to you, at the next podcast and, take care. Peace out. Bye-bye. .