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Adult Care

Well Woman Exam

Annual well-woman exams are important for women at every age to maintain wellness and health and to detect early diseases. If your healthcare practitioner finds any problems early, he or she may be able to treat them, which could less likely pose serious health risks.

In addition to a physical exam that assesses overall health, a well-woman exam includes breast and pelvic physical exams, a Pap smear, and other laboratory and imaging studies, as needed.

Starting at age 21, women should get annual pelvic exams, which include an external inspection and an internal speculum exam. Younger women do not need internal exams unless they experience a menstrual disorder, vaginal discharge, pelvic pain, or other reproductive-related symptoms.

Another important part of the well-woman visit is the breast exam. These should be done every year for women ages 21 to 39. Women ages 40 and older should have annual clinical breast exams and annual mammograms.


Menopause is reached one year after the end of a woman’s last menstrual period, which typically happens between ages 45 and 55. However, you may start experiencing hot flashes and other symptoms two to eight years before your last period.

Menstrual changes are often the first sign of approaching menopause. In the years before menopause, a woman’s ovaries naturally begin to produce less estrogen. As a result, you may skip periods or have heavier or lighter periods than usual.

Declining estrogen levels may also cause the following:

  • Hot flashes, which cause hot, flushed skin and sweating
  • Nighttime hot flashes, known as night sweats
  • Difficulty falling or staying asleep, which may be related to night sweats
  • Vaginal dryness and/or irritation
  • Urinary incontinence and/or urinary tract infections
  • Moodiness, which may be related to sleep problems or stress

Some of these symptoms may last for several years after a woman’s last period.

Exercise and Fitness

For women older than 50, regular physical activity may help tame some of the symptoms of menopause such as hot flashes, joint pain, anxiety, depression, and sleep problems. Exercise also reduces heart disease, osteoporosis, and diabetes risk, and helps control weight. American Heart Association experts recommend 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity each week, such as:

  • Strength training: Lifting hand weights improves your strength and posture, reduces the risk of lower back injury, and helps you tone muscles. Start with a hand weight that you can comfortably handle for ten repetitions. You need to feel your muscles are getting tired, but no pain.
  • Aerobic exercise: Walking, jogging, and dance-exercise are good forms of aerobic exercise. They work the large muscles in your body, which benefits your cardiovascular system and your weight. Work up to 20 to 45 minutes per session, three or four days a week.
  • Stretching: Helps maintain flexibility and range of motion in joints. They also reduce the risk of injury and muscle soreness. Pilates and yoga are good forms of stretching exercise because they build core body strength and increase stability and good posture.
  • Balance: Pilates and yoga are great ways to stay strong and flexible beyond 50 because both can be easily modified. Bands can help you stretch, and ten minutes of stretching after a workout is wise.

Please consult your physician before beginning an exercise program.

Detecting and Treating Breast Problems

The processes of puberty, menstruation, pregnancy, breastfeeding, and menopause result in unique changes in your breasts. These changes sometimes cause problems with your breasts, although usually minor. However, properly performed monthly self-breast exams and regular visits to the doctor will improve detection of problems that might not be so minor and can save your life. Many women with breast pain or breast lumps worry about breast cancer.

There are three common methods of early detection:

  • Mammogram: A mammogram is an X-ray of the breast that can often find tumors that are too small for you or your doctor to feel. We recommend that you begin screening at age 40. Your doctor may suggest that you have a screening mammogram at a younger age if you have risk factors for breast cancer.
  • Clinical breast examination: During your routine physical exam, your doctor may do a clinical breast exam. During the exam, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.
  • Breast self-examination: This involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror. Your healthcare practitioner should evaluate any new lump or change in appearance. Most breast problems or changes are not caused by cancer.

Early breast cancer is often seen on a mammogram before you experience any symptoms. The most common symptom of breast cancer is a painless lump, but sometimes painful lumps are cancerous. Other symptoms of breast cancer include:

  • Skin changes, such as dimpling or puckering
  • Nipple discharge
  • Darkening of the area around the nipple
  • A nipple being drawn inward
  • Any breast problem that lasts more than two weeks

PMS Counseling and Treatment

Most women have tender breasts, bloating, and muscle aches a few days before they start their menstrual periods, which are normal premenstrual symptoms. But when they disrupt your daily life, they are called premenstrual syndrome (PMS). PMS can affect your body, your mood, and how you act in the days leading up to your menstrual period.

Common physical signs include the following:

  • Bloating
  • Swollen and tender breasts
  • Lack of energy
  • Headaches
  • Cramps and low back pain
  • Feelings of sadness, anger, irritability, or anxiousness
  • Trouble focusing on tasks
  • Withdrawal from family and friends

PMS symptoms may be mild or strong and vary from month to month. When PMS symptoms are severe, the condition is called premenstrual dysphoric disorder (PMDD).

These lifestyle changes can help you feel better.

  • Eat a variety of healthy foods, especially foods rich in calcium. Include whole grains, protein, low-fat dairy, fruits, and vegetables.
  • Get plenty of exercise.
  • Cut back on caffeine, alcohol, chocolate, and salt.
  • For pain, try aspirin, ibuprofen (such as Advil or Motrin), or another anti-inflammatory medicine.

Talk to your healthcare practitioner if these changes don’t provide some relief from your symptoms after a few menstrual cycles. He or she can prescribe medicine for problems such as bloating or for more severe PMS symptoms.

HPV Testing and Prevention

A human papillomavirus (HPV) test checks for a high-risk HPV infection in women. HPV is a sexually transmitted infection (STI). An HPV test checks for the genetic material of the human papillomavirus. Like a Pap test, an HPV test is done on a sample of cells collected from the cervix. There are many types of HPV. Some types cause warts that you can see or feel. Other types do not cause any symptoms. Most people do not know they have an HPV infection. This test will show whether a high-risk type of HPV is present. In women, high-risk types of HPV (such as types 16, 18, 31, and 45) cause changes in the cells of the cervix that can be seen as abnormal changes on a Pap test. Abnormal cervical cell changes may resolve on their own without treatment; however, some untreated cervical cell changes can progress to serious abnormalities and may lead to cervical cancer over time if they are not treated.

STI Testing and Treatment

Most sexually transmitted infections (STIs) have no symptoms, so it is difficult to know if you have been infected. Periodic testing is recommended for anyone with multiple sexual partners, even if they are using condoms. Ask your partner(s) if they have or have ever had an STI. We offer safe and confidential STI testing and treatment.

If you are diagnosed with an STI, most can be treated effectively. Many, however, cannot be cured. Antibiotics are prescribed for gonorrhea, chlamydia, and syphilis, and patients usually respond well. There is no cure for genital herpes, but outbreaks can be shortened with antiviral medications.

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