Health and wellness are frequent topics of discussion among women throughout all stages of life. Not surprisingly, they have taken center stage in recent months. The year 2020 has introduced numerous challenges—most, of course, instigated by COVID-19. Women are doing everything possible to keep themselves, their families, and their loved healthy during a pandemic. Their laser focus to stay safe from a single virus has caused many to neglect other critical aspects of their health—a dangerous balancing act. While our news feeds continually remind us that the pandemic is an urgent matter that requires our constant attention, this doesn’t mean other health issues that commonly affect women are taking a break. Dallas area physicians have noticed a decline in women getting their annual medical exams, screenings, and preventive care. They suspect a fear of being in medical offices where they may catch the virus or being too busy caring for and worrying about their loved ones as primary reasons for the decline.
Their prescription? See your doctor, anyway. Get your recommended screenings. Refill your prescriptions. Go to your check-ups. Make time to care for the caretaker. “In my practice, I have seen the fear about COVID-19 being so high, that symptoms that may otherwise bring patients to the doctor get put off,” says Katrina Birdwell, M.D., FACS, of Texas Breast Specialists Methodist Dallas Cancer Center, Mansfield and Waxahachie. “I’ve already seen delayed diagnoses, which means they require a more aggressive treatment or surgery they may not have needed had they seen me sooner. Now, the chance of remaining healthy is lower. I am hopeful more patients will understand how important it is to keep up with medical appointments and recommended screenings, even if they feel perfectly fine.”
“Be proactive! You must advocate for yourself with your doctor. If something doesn’t seem right about your health, get it addressed.”
– Dr. Emily Hebert, Cooper Clinic
If fear isn’t what is keeping women from making it to their annual exams, it’s being too busy. “The most common thing I hear from my female patients is that they don’t have time to take care of themselves because they’re too busy taking care of everyone else,” says. Dr. Emily Hebert, a 24/7 Platinum physician for Cooper Clinic Platinum. “Not all women are mothers, but I think it’s ingrained in us in general that we come second. I try to remind them that a healthy woman will always be better at doing whatever her job is. We only get one body, and if we treat it right, it is much more likely to serve us well.”
Dr. Kimberly Kho, associate chief of gynecology and director of the Fellowship in Minimally Invasive Gynecologic Surgery at UT Southwestern Medical Center, says she worries that patients who have missed an annual exam may decide to push it into the next year “when things calm down.” Although medical guidance today is continually evolving in an ever-changing world, waiting until you are so sick that you need emergency care, rather than preventive care, can be dangerous. “Regular screenings, particularly for cancer, should absolutely continue,” Dr. Kho says. “It doesn’t have to be on the 365-day mark but stay in discussion with your doctor. In fact, many preventive screenings are not required annually but evaluation and counseling, based on age and risk factors, should continue. One positive thing about the pandemic is that we have been able to modify many medical appointments to telemedicine visits. You can still have a meaningful evaluation from wherever you are virtually, then decide what, if anything, is required later during a face-to-face encounter.”
One aspect of a woman’s health that can likely be addressed during a telehealth visit is stress. Dr. Kho says her patients are more frequently reporting an increase in stress-related health issues, even among those who have never sought treatment for depression and anxiety. “The kids are home all the time, and many women are now caring for their parents and other family members, so they have extra responsibilities,” Dr. Kho says. “The mind/body connection is real. We are all feeling anxious now, as there are so many unknowns. Stress can manifest itself in many ways, such as anxiety, extreme fatigue, pain, and menstrual and bowel changes. These symptoms should all be discussed with a doctor, as should any violence or abuse in the home or substance abuse. We have seen an uptick in family violence, which is often connected to social and economic changes. It’s important to be sensitive to these experiences and to know that there are support and resources available.”
Dr. Kho says the No. 1 preventive measure women can take in their pursuit of health and wellness is to continue with their preventive care and necessary screenings. She recommends discussing the following with a doctor in each decade of life:
20s. This is when most women should see their primary care doctor or OB/GYN for cervical cancer screening with a Pap smear, starting at age 21, and is often when birth control options are discussed. “Discussions in the early 20s should be about preventive care and prevention of STI’s for sexually active women, family planning needs, and screening for blood pressure, depression, substance use, interpersonal violence, and counseling about staying healthy with proper nutrition and exercise. Abnormal bleeding or chronic pain absolutely deserve attention during the pandemic, as do refills of contraceptives,” Dr. Kho says.
30s. Continue preventive and general health screenings as well as cervical cancer screening with Pap smear and HPV testing, family planning, and STI screening. “This is often when we will have discussions about pregnancy and starting a family before it possibly becomes an issue, because we know women have more difficulty becoming pregnant as they get older,” Dr. Kho says.
40s. Continue with cervical cancer screenings. Many women think they need an annual “Pap” but the recommendation for cervical cancer screening is now every three to five years for women with no previous abnormalities. Many women in their 40s will start to experience hormonal changes and menstrual abnormalities. This is when the discussion of perimenopause and menopause begins. “For women with no family history of breast cancer, screening for this should be discussed with your doctor starting in your 40s, and earlier for women with a family history of breast cancer or abnormal symptoms,” Dr. Kho says. “Lipid, blood pressure, diabetes, depression, and anxiety screening should also continue in the 40s, as there may be an increase in mood changes associated with hormonal changes.”
50s+. In addition to cervical cancer screenings and mammograms, doctors usually recommend women in their 50s be screened for colon cancer. “Age 50 is when we typically recommend a colonoscopy, unless there have been concerning symptoms or a family history that indicate an earlier screening is needed,” Dr. Kho says. Age 51 is the average age of menopause in women. “At this age, hormone therapies should be discussed as well as counseling around bone health and plans for bone density scans for osteoporosis,” Dr. Kho says. “We also screen for cholesterol and diabetes in the 40s and 50s, and earlier with a family history, or a history of diabetes in pregnancy.”
“Even before the pandemic, women often put others before themselves. Now more than ever, women cannot ignore or defer their own physical and mental health care. This crisis should be a call to arms to try to be as healthy as possible.”
– Dr. Kimberly Kho, UT Southwestern Medical Center
All Ages. “Women should not neglect discussing their mental health throughout their lives,” Dr. Kho says. “Issues with anxiety or depression should definitely be addressed with a healthcare provider, particularly during this stressful time. It could be episodic, but both conditions can impact your quality of life and well-being. About a quarter of women will have experienced anxiety in the past year. The pandemic has been a perfect storm for mood and other health disorders. Women should know that there are resources, they don’t have to suffer alone, and healthcare providers are here to help, even and especially during these times.”
For most healthy women, preventive screenings and annual exams require only a couple of medical appointments each year—a few hours in exchange for peace of mind. Taking a holistic approach to wellness is important for women—pandemic or not. This includes everything from an annual general wellness exam with routine bloodwork and yearly skin cancer screenings to vision exams and twice-yearly dental screenings, Dr. Hebert says. “It’s important for us (physicians) to keep reminding women that they are more than their breasts and uterus,” Dr. Hebert says. “Women get heart disease, hypertension, and many non-female-related cancers as frequently as men. Be proactive! You must advocate for yourself with your doctor. If something doesn’t seem right about your health, get it addressed.”
