• When was your last period?
• How long does your period typically last?
• At what age did you start your period?
• Are you sexually active?

In addition to checking your height, weight, and blood pressure, your doctor will ask you questions about your general health, menstrual period, and sexual activities. During your exam, your doctor will perform the following exams and tests. If the doctor is male, a female nurse remains in the room during your exam.

Breast Exam 

During your breast exam, your doctor will check your breasts for signs of any potential problems, such as a lump. They will examine each breast by moving their fingers around your breast in a pattern. You may also be shown how to perform monthly self-examinations.

Pelvic Exam

During your pelvic exam, your doctor will examine your vagina, cervix, and reproductive organs. Once you place your feet against the footrests at the end of the examining table and slide forward, your doctor will insert an instrument called a speculum into your vagina to spread the walls apart to examine the area gently.

Your doctor then places one or two gloved, lubricated fingers into your vagina, and the other hand presses on your abdomen from the outside to check the size, position, and shape of your internal pelvic organs. The pelvic exam may feel a bit uncomfortable, but it should not hurt.

Pap Smear

A Pap smear checks for abnormal cells in the cervix that could lead to cancer. The doctor will insert a small cotton-tipped swab through the vagina into the cervix. Cells are removed from the cervix and sent to a laboratory to be checked for any abnormalities. The Pap smear is painless.

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• At 30 Years old – Be sure to talk with your ob-gyn if you are planning on getting pregnant. Continue to get an annual well-woman visit during your 30s.
• At 40 Years old – Decide with your ob-gyn when you should have a mammogram, especially if you have certain risk factors. If you’re having perimenopause symptoms, there may be ways to manage these symptoms.
• At 50 Years old – During your 50s, it is good to get a lung cancer screening if you are a current or past smoker. It is also time to have a preventative screening for colorectal cancer.
• At 60 Years old – Continue to get regular mammograms and osteoporosis screenings during your 60s.
• At 70 Years old – Be sure to get a seasonal flu shot, a shingles shot, and a pneumonia shot, as well as others your doctor may recommend.
• At 80 Years old – Discuss with your doctor ways to prevent falls and if you have any problems with your vision or hearing.

• Women Younger than 21 Years – No Screening.
• Women Aged 21-29 Years – Cytology alone every three years.
• Women Aged 30-65 Years – Human Papillomavirus and cytology co-testing (preferred) every five years. Cytology alone (acceptable) every three years.
• Women Older than 65 Years – No screening is necessary after adequate negative prior screening results.
• Women Who Underwent Total Hysterectomy – No screening is necessary.
• Women Vaccinated Against HPV – Follow age-specific recommendations (same as unvaccinated women).

Menopause typically begins when a woman reaches her 40s or 50s. Symptoms may be more pronounced at the beginning of the process and can last a few years.

Perimenopause  

Perimenopause is the stage that occurs several years before a woman reaches menopause. The body begins to make less of the hormones estrogen and progesterone. During this time, patients may experience symptoms that will continue through menopause. If more than 60 days elapse between menstruation, this may be a sign that a woman is nearing the end of perimenopause.

Menopause

The severity of symptoms and how long they last during menopause varies for each woman. The most common signs of menopause include:

• Irregular periods. When nearing menopause, periods may become irregular regarding how often they occur, how long they last, and how heavy they are. Certain medications, including birth control, can help make your period more regular.
• Hot flashes and night sweats. Hot flashes are the most frequent symptom of menopause and can result in a feeling of heat, a flushed face or neck, or sweating. Many women experience night sweats, which are hot flashes that come on during the night, and can make it difficult to sleep. Avoiding specific triggers of hot flashes can help, like stress, caffeine, alcohol, spicy foods, or tight clothing.
• Changes in mood and memory. The changes in hormones can cause shifts in your mood and can worsen existing anxiety or depression. Forgetfulness can stem from this additional stress. Women should contact a doctor if they have been feeling down for an extended time or think they forget things too often.
• Vaginal dryness. The skin around the vagina can become drier during and after menopause because of the drop in estrogen levels, which can cause sex to be painful.

Hormonal birth control can often help to regulate a woman’s menstrual cycle and associated symptoms by stabilizing her hormones. While hormonal contraceptives are particularly common, they are not recommended for every female. This decision will be based on the patient’s health and any prior conditions or risk factors she may have.

Birth Control Pills
Birth control pills are a form of oral contraception that generally contain two hormones, estrogen, and progestin, and are taken daily to prevent a woman’s ovaries from releasing eggs. They also help to prevent pregnancy by causing the cervical mucus to thicken, which blocks sperm from fertilizing an egg.

Birth control pills are safe, effective, and convenient, though they may be less effective for women who are overweight. Additionally, vomiting and/or diarrhea may keep the pill from working properly to prevent pregnancy. If a woman is concerned about this, a backup method of birth control should be used.

Birth Control Patch
Used correctly, the patch is as effective as birth control pills are in preventing pregnancy. The patch is a form of birth control that a patient wears on the skin and looks like a small bandaid. The hormones it contains (estrogen and progestin) are similar to those used in birth control pills but are absorbed through the skin. The patch works by suppressing the pituitary gland which, in turn, prevents the ovaries from releasing eggs. It also thickens cervical mucus making it more difficult for sperm to reach an egg.

Since the patch contains a dosage 60% higher than that delivered by the pills, there is a risk of side effects such as blood clots. Because of this, it is essential that patients using the patch do not smoke. The patch can also be used to treat irregular periods, menstrual cramps, or endometriosis.

The Birth Control Shot
The Depo-Provera or Depo shot is another very effective method of birth control. This shot must be given once every three months by a trained medical professional, typically during a quick appointment at our office locations in Honolulu. Women who receive this shot will typically experience lighter periods or stop getting their period altogether after several months of consecutive shots. This method is especially beneficial to women looking for a flexible and low-maintenance form of birth control that is still highly effective, with a success rate of over 99%.

Vaginal Ring (NuvaRing)
A vaginal ring is a form of contraception that is soft, flexible, and worn in the vagina. The key benefit of the ring is that a patient does not need to take it daily to get complete monthly protection. In a given one-month period, the ring must be inserted into the vagina, removed after three weeks, and a new ring inserted no more than seven days later.

The hormones it contains (estrogen and progestin) are similar to those used in birth control pills. However, unlike birth control pills, they are absorbed directly into the bloodstream through the vaginal wall, delivering a consistent level of medication, improving effectiveness, and limiting side effects.

Some women can experience adverse side effects from adding more hormones to their bodies via contraceptives. Non-hormonal options are ideal in these situations and are also commonly recommended for women who wish to breastfeed while remaining on an effective form of birth control.

Condoms

Condoms are a barrier form of birth control that physically blocks sperm from entering the vagina. They are the only form of protection that can help to stop the transmission of sexually transmitted diseases (STDs), like HIV, and prevent pregnancy. A condom is a latex or polyurethane sheath closed at one end and fits over a man’s penis.

Condoms are also available for females and have a flexible ring at either end. One end is closed and inserted into the vagina, and the other is open, with the ring remaining outside the vagina. To help assure protection, users should read and follow the manufacturer’s instructions.

Diaphragm

A diaphragm is a thin, rubber, dome-shaped device with a springy and flexible rim. Inserted into the vagina by the patient, it fits over the cervix and is held in place by muscles in the vagina. The diaphragm is designed to hold spermicide in place over the cervix to kill sperm. To maximize the diaphragm effectiveness, it should be left in place for 6 to 8 hours.

The effectiveness of birth control ranges from 86-94%. If one chooses to use a diaphragm, it must be fitted in a clinic. Additionally, weight changes, vaginal surgery, and pregnancy can affect how a diaphragm fits, requiring a medical provider to check it to ensure it fits properly and to determine if a new size is needed.

Permanent Contraception (Tubal Ligation)

Tubal Ligation is a procedure that seals off a woman’s fallopian tubes that carry an egg from the ovaries to the uterus. By blocking these tubes, where fertilization usually occurs, sperm cannot reach the egg to fertilize it. The procedure seals the fallopian tubes with thread, bands, clips, an electric current, or small implants. Patients should be aware that this procedure provides permanent birth control and is NOT reversible.

For those women who wish to have dependable birth control without having to remember to take a pill every day, there are implantable devices. 

Intrauterine Device (IUD)

An IUD is a contraceptive device that delivers small amounts of hormones directly to the uterus. It is a form of birth control that remains in the uterus and can last up to 5 years. It is a small, T-shaped, plastic device that is both soft and flexible and is put into place by a gynecologist during a visit to your OBGYN.

An IUD works through several different actions that include thickening the cervical mucus to prevent sperm from entering the uterus, inhibiting the sperm from reaching or fertilizing an egg, and making the lining of the uterus thin. While they are 99% effective concerning birth control, a gynecologist can remove the device if a patient is looking to become pregnant immediately.

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Called the “Plan B” pill, this emergency contraception can be used the morning after unprotected sex. It has to be taken within 72 hours to be effective. This method is not made to be used as regular birth control but instead as an emergency method in cases of forgotten birth control, birth control failure, or rape.

• Painful menstrual cramps.
• Chronic pelvic pain in the lower abdomen or intestines.
• Chronic fatigue. Pain during or after sex.
• Painful bowel movements or pain when urinating during menstrual periods.
• Longer and heavier menstruation.

In addition to discussing your symptoms with your gynecologist, they may suggest another exam to diagnose endometriosis. During a pelvic exam, your gynecologist may be able to feel for large cysts or scars behind your uterus. Our team may also do an ultrasound or MRI to check for ovarian cysts.

Surgery is the only way to confirm that you have endometriosis. Your gynecologist may perform a laparoscopic procedure to see or biopsy the endometriosis growths.

Endometriosis treatments depend on the condition’s severity. Since there is no cure for endometriosis, talk with your gynecologist about your situation and the best endometriosis management options for you. Because some treatments can end your fertility, one consideration is if you want to have children in the future.

• If you are not trying to get pregnant, hormonal birth control is usually the first step to help reduce pain and bleeding. Hormone therapy is also used in some cases to balance and regulate the hormones that can worsen endometriosis.
• If you are trying to get pregnant, other hormonal medications may help treat endometriosis. When birth control isn’t an option, pain medications may also be suggested for your symptoms. Some of the medicines are anti-inflammatory and will focus on reducing inflammation and pain.
• Surgery is typically recommended only when symptoms are severe, other treatments haven’t worked, or you have infertility problems. During surgery, the endometriosis growths are removed, which provides short-term relief from pain.

• The overall 5-year survival rate is 68%.
• The overall 10-year survival rate is 64%
• The early-stage 5-year survival rate is 92%. (Early-stage cervical cancer is defined by cancer only being present on the cervix.)
• The mid-stage 5-year survival rate drops to 57%. (Mid-stage cervical cancer occurs when cancer has spread to tissue near the cervix.)
• The advanced-stage 5-year survival rate dramatically decreases to 17%. This happens when cancer has spread to distant parts of the body.

There are two powerful tools that women should use in the fight against cervical cancer:

HPV Vaccination 

The Human Papillomavirus (HPV) is the most sexually transmitted disease in the United States. It is estimated that approximately 90% of men and 80% of sexually active women have at least one type of HPV. Of these types of HPV, two are responsible for approximately 70% of all cases of cervical cancer.

HPV vaccinations have been found to provide nearly 100% protection against the two HPV types that can cause cervical cancer (types 16 and 18). The vaccine can be given at any age, but if a person has been sexually active, there is a chance that they’re already infected. Ideally, the vaccine will be administered before a person becomes sexually active.

Pap Tests

Typically performed on women aged 21 to 65, the pap test allows the doctor to look for changes in cervical tissue that can potentially turn cancerous. The doctor will examine the vagina and cervix and collect samples of any abnormal tissue. The tissue will then be sent to the laboratory for testing.

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• Irregular bleeding. This may occur between periods and after sexual intercourse. Irregular bleeding is especially problematic in postmenopausal women and could indicate a severe problem.
• Vaginal discharge. A discharge that is white, clear, brown, or tinged with blood could be an additional warning sign.

• Back pain.
• Pelvic pain.
• Difficulty urinating.
• Swelling of the legs.
• Weight loss.
• Fatigue.

• Gender. Women are far more likely to be affected by osteoporosis than men. In general, women’s bones are smaller and are more vulnerable to degeneration due to hormonal changes that occur after menopause.
• Age. Bones naturally become thinner as we age. When women reach menopause, they may rapidly lose bone in the first four to eight years of menopause. For example, if a woman begins menopause at 50, the most dramatic loss of bone mass may occur between 51 and 58.
• Race. Due to differences in genetic makeup, Caucasian and Asian women are more likely to be affected by osteoporosis than African-American and Hispanic women.
• Family History. Women whose families have a history of developing osteoporosis are more likely to develop it themselves.

Bone density is measured using a process called dual-energy x-ray absorptiometry, commonly known as a DEXA scan. This procedure measures the density of bones in body areas prone to breaks and fractures, such as the spine, hips, and forearms.

DEXA scans do not require any preparation. The patient will lie on an examination table while an x-ray scans different body areas. The process is painless and only takes about ten minutes to complete.

Understanding DEXA Results
In most cases, the patient’s bone density will be compared to that of an average healthy young adult. The results of this comparison are called a T-score. This will help the doctor determine if the bones are normal (T-score between +1 and -1,) have lower than average mass (T-score between -1.1 and -2.4,) or have Osteoporosis (T-score of -2.5 or less.)

How Often Should DEXA Scans be Performed?

Because of the radiation exposure, DEXA scans should be completed a maximum of once every two years. Even with high-risk patients receiving treatment, doctors will monitor bone health in other ways.

The main goal of treatment will be to prevent fractures and breaks. In addition to recommending a proper diet rich in calcium, a doctor may prescribe medication. The following is not a list of all medication options, but simply the most commonly used:

• Bisphosphonates. This type of medication slows cell activity that is responsible for bone loss. Bisphosphonates are intended to maintain or even increase bone density.
• Parathyroid Hormone. This option is for postmenopausal women who are at high risk for fracture.
• Estrogen Agonists/Antagonists. Typically used to treat postmenopausal women, these medications are not estrogen, but they have estrogen-like effects on the body.
• Calcitonin. Meant for women who are at least five years into menopause, calcitonin helps to regulate calcium and bone metabolism.

Osteoporosis is a condition that shouldn’t be taken lightly. A broken bone can result in hospitalization and even surgery.

• Cramping of the lower abdomen.
• Bloating.
• Fatigue.
• Increased number of headaches or migraines.
• Breasts that become swollen and tender.

• You have a new sexual partner. Everyone who is sexually active should receive an STD screening at some point, mainly if they are engaged in sexual relations with a new person.
• You are having unprotected sex. Not wearing protection increases people’s risk of getting an STD. If a person is having unprotected vaginal, anal, or oral sex, it is recommended that they receive a screening.
• You are engaging in high-risk behavior. If you or your partner have multiple partners, are an IV drug user, or have had contact with a sex worker, you are strongly advised to receive more frequent STD screenings.
• You are exhibiting symptoms. If you notice anything out of the ordinary, it is always best to have it examined by your physician to determine the cause.

• Painful urination.
• Frequent urination.
• Pain during intercourse.
• Blisters or sores on genitals or anus.
• Itchy or irritated genital area.
• Unusual discharge. Fever / flu-like symptoms.

• Bacterial STDs. Chlamydia, gonorrhea, and syphilis are good examples of STDs caused by bacteria. These cases can be treated with antibiotics and should go away after the treatment is completed.
• Parasitic STDs. STDs caused by parasites like Trichomonas Vaginalis can be cured using antibiotics, antiparasitic drugs, or prescription shampoos.
• Viral STDs. STDs caused by a virus cannot be cured completely, but they can be managed. The most common types are HPV, genital herpes, hepatitis B, and HIV.

• Yeast infections are very common and occur when yeast cells in the vagina multiply and take over. Typically, yeast infections are caused by irregular vaginal activity, such as hormone therapy treatments or antibiotics. Other health conditions like diabetes or HIV can also lead to yeast infection.
• Bacterial vaginosis is caused by the rapid multiplication of bacteria in the vagina. This bacteria normally exists in the vagina, but when it multiplies very quickly, it can lead to worsening symptoms. It is unclear what can cause bacterial vaginosis. Still, experts believe that having multiple sex partners, having a sexually transmitted infection, using an IUD, and douching can all lead to developing this infection.
• Trichomoniasis is a sexually transmitted infection that is caused by a parasite. This parasite is spread during intercourse with an individual who is already infected with trichomoniasis.
• Atrophic vaginitis is usually seen in women who are experiencing menopause or by those who have undergone surgery to remove their ovaries because this particular type of vaginitis is directly related to the reduction of estrogen. Atrophic vaginitis will lead the tissues of the vagina to begin thinning and losing moisture, which often causes irritation.

• Vaginal odor.
• Redness, swelling, or itching of the vagina.
• Light bleeding or spotting.
• A change in the coloring of your vaginal discharge, such as grey, green, or yellow.
• Pain during sex.
• Painful urination.

• You have never had a vaginal infection before.
• You have had multiple sex partners or a new partner that may have given you a sexually transmitted infection, which will often show symptoms similar to vaginitis.
• You have a fever, chills, or pelvic pain.
• You have completed an over-the-counter treatment, but your symptoms persist or worsen.

• Not douching.
• Not using feminine deodorant sprays or perfumed products near your vagina.
• Changing your tampon at least three times a day during your menstrual cycle with no more than 8 hours between changes.
• Not taking antibiotics unless absolutely necessary.
• Use a condom during sex.
• Limit your number of sexual partners.