Health Guidelines For Women

News From The American College Of Obstetrics And Gynecology

If you view your obstetrician-gynecologist as your primary-care physician, make certain to let him or her know this, or you may not get all the medical attention you need and deserve, say experts at the American College of Obstetricians and Gynecologists (ACOG).

Some physicians are concerned that too many women are slipping through the health-care cracks by relying on a specialist as the gatekeeper of their primary and preventive care, without letting that specialist know they are in charge.

"When, a number of years ago, managed care decided to allow women to see their OB/GYN without a referral from a primary-care doctor, it was supposed to make the act of obtaining reproductive and gynecological care easier," says Dr. Steve Goldstein, a professor of obstetrics and gynecology at New York University Medical Center.

But over time, Dr. Goldstein says, this arrangement "morphed" into an unofficial "subspecialty,” and the OB/GYN became the primary-care physician, at least in the minds of many women.

"The problem with this concept is that too often women don't tell their OB/GYNs that they do consider them as their primary-care physicians,” Dr. Goldstein says. “So the doctor continues to believe someone else is in charge."

Experts say many women are less aware of what primary screenings and evaluations they are missing when it comes to general health and preventive care.

"The woman thinks her gynecologist is providing primary care while her gynecologist thinks an internist is providing primary care,” Dr. Goldstein adds. “And in reality, no one is doing it."

Who Is Your Primary Caregiver, ACOG Asks

To help close that knowledge gap, the ACOG has just published an updated set of primary and preventive care guidelines, the most comprehensive to date. Reporting in the medical journal Obstetrics and Gynecology, ACOG experts detail exactly what a woman should expect in the way of screenings and preventive care, regardless of who is caring for her.

"We feel it's important that both women and their doctors have a clear understanding of what constitutes primary care, and the kind of screenings and evaluations every woman should have at various stages of her life, beginning in her teens through her senior years," says Dr. Bryan R. Hecht. He is chairman of the ACOG Committee on Gynecologic Practice, and he helped draft the new guidelines.

However, Dr. Hecht adds that what women may really need most is to have a heart-to-heart with their OB/GYN and establish whether he or she will be the one providing that essential primary care.

"It is very important that a woman let her OB/GYN know that she views him or her as the primary-care specialist, in order to ensure that she is getting all the care she needs," Dr. Hecht says.

More important, Dr. Goldstein says, is to give your physician the choice about what role he or she feels most comfortable playing in your overall health care, since not all OB/GYNs believe they are qualified to act as the mainstay of your health care.

"The truth is, not all OB/GYNs feel equally confident about providing primary care, and many are not even really qualified to do so," Dr. Goldstein says. "So if your doctor says he or she would prefer that you see an internist for your non-gynecological needs, pay attention, and realize that this suggestion is being made in the best interest of your health."

Regardless of who is providing your primary care, both Drs. Goldstein and Hecht say it is still vital to see your gynecologist for a yearly visit, even if you are not due for a regular screening, such as a Pap test.

Always consult your physician for a diagnosis.

Live Longer, Healthier

The National Women's Health Information Center offers the following 10 things you can do to help live longer, live better, and live happier:

Be Informed. Learn about health promotion and disease prevention and ask your physician for specific information regarding your needs.

Be Good To Your Bones. For healthy bones, be sure to replenish your stock of calcium every day with plenty of foods such as milk and dairy products, tofu, leafy, green vegetables, canned salmon or sardines, and calcium-fortified juices or breads. Speak with your physician about calcium supplements.

Avoid Illegal Drugs and Alcohol. For women, the definition of moderate drinking stops at one glass. And, where illicit drugs are concerned, there is no such thing as "moderate" use.

Take Medicine Wisely. Read the labels, follow the instructions carefully, and remind your physician or pharmacist about any other medicines or supplements you might be taking that could interact with your medication. If you have any questions about possible side effects, call your physician or pharmacist.

Play It Safe. Avoid injuries. Buckle up. Wear a bike helmet. Use smoke and carbon monoxide detectors. Wear sunscreen and UV protected sunglasses. Use street smarts and common sense. Practice safe sex.

Get Checked. Get regular checkups, preventive examinations, and immunizations. Do not forget self-examinations, too.

Do Not Smoke. Smoking is the leading preventable cause of death in our country.

Eat Smart. It is the secret to good health. Eat plenty of fruits, vegetables, and grains. Enjoy a variety of foods, balance foods from each food group, and exercise moderation.

Get Moving. The other secret to good health: just 30 minutes of physical activity, accumulated over the course of each day, can radically improve the way you look and feel, both physically and mentally.

Be Happy. Take time for yourself. Get connected with family, friends, and community. Do things you enjoy!

Online Resources

(Our Organization is not responsible for the content of Internet sites.)    

American College of Obstericians and Gynecologists

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Institutes of Health (NIH)

National Women's Health Information Center

Office of Research on Women's Health

February 2004

Health Guidelines For Women

Who Is Your Primary Caregiver, ACOG Asks

Live Longer, Healthier

ACOG Recommendations

ACOG Recommendations

Highlights from the recommendations of American College of Obstetricians and Gynecologists (ACOG) experts include:

Ages 19 to 39

• An initial health screening at 19, featuring a complete health history, including your health status; dietary/nutrition assessment; level of physical activity; use of complementary or alternative medicines; tobacco, alcohol or drug use; sexual practices; abuse or neglect; and urinary or fecal incontinence. This screening should then be updated annually.

• An annual physical exam, including height, weight, blood pressure, mouth/dental; check of the neck for swelling/thyroid problems; and examination of breasts, abdomen, pelvis, and skin.

• Yearly evaluation and counseling on issues concerning sexual activity; fitness and nutrition (including folic acid and calcium intake); interpersonal and family relationships; domestic violence; work satisfaction and lifestyle stress; cardiovascular risk factors (including family history, cholesterol profiles, obesity, diabetes); personal hygiene; high-risk behaviors, including occupational and recreational hazards; breast self-exams; skin exposure to ultraviolet rays; suicidal thoughts; depressive symptoms; and drug or alcohol use.

• Lab testing should include Pap test (annually, beginning no later than age 21; after age 30, every two to three years after three consecutive negative tests and no signs of disease); and a tetanus booster every 10 years.

• High-risk groups (or those with symptoms) may also need: hemoglobin (red blood cell) assessment; bacteriuria testing; mammograms; a fasting blood sugar test; sexually transmitted disease testing; HIV testing; genetic testing/counseling; rubella assessment; tuberculosis skin testing; lipid profiles (for cholesterol); thyroid stimulating hormone testing; hepatitis C testing; colorectal screening; and bone density screening.

• High-risk groups may also need the following vaccines: Hepatitis A and B, pneumonia, varicella and measles, mumps, and rubella.

Ages 40 to 64

All of the above, plus:

• Mammography every one to two years beginning at age 40; yearly at age 50.

• Lipid (cholesterol) assessment every five years beginning at age 45.

• Yearly fecal occult blood testing for colorectal cancer or flexible sigmoidoscopy every five years, or yearly fecal occult blood testing plus sigmoidoscopy every five years, or double contrast barium enema every five years or colonoscopy every 10 years beginning at age 50.

• Fasting glucose testing every three years beginning at age 45.

• Thyroid stimulating hormone screening every five years beginning at age 50.

• Counseling and evaluation on hormone therapy.

• Influenza vaccine annually beginning at age 50.

Ages 65 and over

All of the above from both groups, plus:

• Yearly urine analysis, mammogram, bone density screening.

• Evaluation and counseling on visual acuity, hearing, depression.

Always consult your physician for more information.