Q: How long have you been a gynecologist?
A: For over 35 years. I graduated from medical school in 1980.
Q: I bet that adds up to a lot of well-woman visits. Why do you think women should get annual checkups?
A: It gives you an opportunity to build a relationship with your doctor and learn what preventive health steps you can take for your short- and long-term health. Having a relationship with your gynecologist can really offer you the kind of education you need about what's appropriate at every stage in your life.
Q: What should women do to prepare for their well-woman visits?
A: Write down a list of questions. Sometimes patients are embarrassed to bring out their list, but I love a list. With a list, you won't walk out worrying about what you forgot to ask. If it's long, sometimes I'll say, "We'll only get through a certain number of things today, but let's schedule a follow-up appointment." Follow-up visits may not be free or without a copay.
Also, make sure you write down the name and dosage of all your medicines. We even want to know about the medicines that don't require a prescription (such as supplements, herbal products, energy boosters, vitamins, or cold medicines).
Keep in mind that when you book a well-woman visit, it's just a check-in for a "well" woman, so we've only put aside enough time for a checkup.
However, if you have a complaint or concern, such as pain, abnormal bleeding, or recurring urinary infections, write it down and think about the answers to these questions:
- How long have you noticed it? What's the pattern?
- What makes it worse or better — activity, diet, position, sleep, sex, foods? Have you tried heat, rest, or over-the-counter medicines?
- What else has changed during this time? Did you start a new job, try to lose weight, take a new dietary supplement? New soap or shampoo? New partner?
Q: What would you say to women who are embarrassed to go to the gynecologist?
A: Yes, it's embarrassing. That being said, we do a lot of uncomfortable and embarrassing things that are good for us. At the end of the day, most women will realize that it's not as bad as they thought it would be and they feel better knowing everything is fine.
I even pat myself on the back after I go to the gynecologist. Mammograms, too. I hate doing it, but I think "Phew. I've taken care of myself."
Q: What about asking questions that make them uncomfortable?
A: We've seen it all. We don't take it home. If you feel nervous about asking something, write it down before you come in. If you put it in writing, you've already faced it and you can just read it to me. I learn the most from listening to the patient and getting her history, which can then help inform the physical exam.
Q: What are the topics you think all women should cover with their gynecologists?
A: It depends on your life stage, but bleeding patterns are important at every age. For anyone menstruating, keep a menstrual calendar. When we ask for your LMP or last menstrual period, we want to know the first day and not the last day. Know that answer before you walk in the door. If you're menopausal, let us know if you've had any bleeding, spotting, or brown or bloody discharge.
Tell us about any changes that are out of the ordinary. Keep in mind that it may be different for you, but it can still be normal. Our bodies change as we age, so patterns may change. Something may be different for you, but it's up to me to figure out if it's abnormal. If you're concerned about something, make an appointment.
Q: What do you tell your patients who are going through perimenopause and menopause?
A: Hopefully, your mom tells you about your first menstrual period, but unfortunately, she may not tell you about the last. Menopause shares commonalities with adolescence — the irregular cycles and the mood swings. But instead of teenage acne, there are hot flashes, wrinkles, and changes in body shape. No wonder we have so many questions.
Menopause is officially one year after the last menstrual period and typically happens between 40 and 55 years old. Perimenopause is the time leading up to the last period.
My first suggestion is, again, keep good menstrual records. There are apps available. Then get educated. I recommend The North American Menopause Society's website. Most women tolerate the changes with nothing more than reassurance. But for some women, hormone replacement therapy may be a safe and very helpful option, or non-hormonal options may be better. A trip to the gynecologist can help you decide whether treatment of menopausal symptoms is right for you.
Q: What questions do you wish women would ask you?
A: It depends on her age, but if someone wants to be a mom, we should talk about the things she needs to consider. If she doesn't want to be a parent anytime soon, same thing. Let's talk about the things she needs to consider, so she can get pregnant when she wants, instead of getting pregnant and then deciding what to do. Planned pregnancies are healthier pregnancies.
If there is any chance you could get pregnant, no matter how unlikely, you should consider yourself at high risk for pregnancy. This means choosing a modern, safe, effective birth control method that is right for you. You also need to take multivitamins with folic acid and refrain from using alcohol and other toxins and environmental hazards, because if you get pregnant, you want to have already cut back on potentially harmful substances your baby may be exposed to. You want to do this before pregnancy, not just after a positive pregnancy test.
Q: Let's talk about Sexually Transmitted Infections (STIs). What are your top tips for prevention?
A: Abstinence is great for prevention. But abstinence doesn't just mean abstaining from intercourse. It means abstaining from intimate contact. Unfortunately, abstinence is often ineffective — let's call it user error. For couples who are sexually active and don't use a form of contraception, they have about an 85% chance of experiencing a pregnancy over the course of a year.
Many STIs like HIV, chlamydia, and gonorrhea can be prevented with latex or silicone condoms. But herpes, HPV, and crabs are spread through any skin-to-skin contact. You can use condoms, but they don't cover the shaft of the penis or the vulva, so to prevent those you would want to use a female condom instead.
Also, know your partner. Ask your partner to get tested. Have that talk.
Q: We know periods can be uncomfortable, but if you're experiencing pain, what's the best way to talk to your doctor about it?
A: Most women experience some menstrual pain or other symptoms at some point in their lives. For most women, an over-the-counter medication can relieve the pain. If that doesn't work, some hormonal birth control methods can help. For some women, exercise can reduce cramps.
Talk to your doctor if you can't work through your pain and if it's recurrent. Watch it over time — what makes it worse and what makes it better. Sometimes menstrual pain is the sign of an underlying disorder, such as endometriosis or fibroids.
We hope you'll keep Dr. Imershein's advice in mind for your next well-woman visit. In the meantime, if you're looking for information on specific health topics, check out our A–Z health topics page.
To learn more about Dr. Imershein, follow her on Twitter: @SaraImersheinMD.
The statements and opinions in this interview are those of the interviewee and do not necessarily represent the views of the U.S. Department of Health and Human Services' Office on Women's Health.