Women's healthcare from top to bottom


In this article:

  • Women sometimes are too embarrassed to report problems to their primary care provider.

  • When you don’t address a problem right away, it could turn into a much bigger health issue.

  • Start a checklist of questions or issues a week or more ahead of your appointment, then use it to guide your conversation.

It happens more often than you might think: A middle-aged woman schedules an annual physical with her primary care physician, dutifully answers all of her doctor’s questions, and completes the appropriate bloodwork. Then, a few months later, she’s struggling with a recurring issue that never came up in a routine exam. As a result, she may have to undergo more extensive medical treatment that could have been avoided if addressed earlier.

It’s important for all women – and especially those who are in their middle years (50-70) – to establish a relationship with their primary care provider, says Melanie Santos, MD, FACOG, FPMRS, medical director of pelvic health for St. Jude Medical Center in Fullerton, California. Santos is a urogynecologist who specializes in treating women with incontinence and other pelvic floor disorders. “I see most patients more often than an annual exam, so sometimes they feel more comfortable with me than they do with their primary care doctor,” she said. “I often find myself recommending that they see their primary care doctor about certain medical conditions that they have been keeping private.”

In some cases, women are too embarrassed to bring up personal concerns with their doctor, such as urine leakage or other pelvic issues. For others, they simply don’t feel they have the time to seek treatment. “Women tend to take care of everyone else in their lives before they manage their own health,” Dr. Santos said. “They wait until the dust settles with everything else, when in reality, their problem may have a simple and quick solution.”

For women who are past their childbearing years, it is especially important to be honest with their primary care doctor, because they may be experiencing treatable conditions related to menopause, heart health, bone health, or pelvic health.

Perimenopause and menopause

During menopause (when a woman’s sex hormone levels decrease, which results in her menstrual cycle stopping) and perimenopause (the time leading up to that point), the body undergoes several hormonal changes that can cause a variety of unpleasant symptoms. While some women believe it’s just a part of aging and something they “have to go through,” there are plenty of ways in which a primary care doctor can help.

Hormone replacement therapy is considered a safe and effective choice for women whose hot flashes and night sweats are intolerable. However, it’s not the only option. Other medications that treat hot flashes and night sweats include gabapentin, an anti-seizure medication, and antidepressants. Doctors also recommend that women avoid hot-flash triggers, including alcohol, caffeine, stress, tobacco, and spicy foods. Additionally, there are other natural ways to manage symptoms that doctors can help recommend and manage.

The key is for a woman to talk about it in detail and describe what is happening so that the doctor can determine the best way to help her. “So many people suffer when they don’t need to,” said Dr. Santos. “That, in turn, can affect mental health, and create a cascade of other problems.”  

Heart health

Heart disease is the leading cause of death for women in America, and it leads to almost as many deaths in women as it does in men. Symptoms of heart disease in women are different than in men and can include (but are not limited to):

  • Chest pain or discomfort
  • Pain in the neck, jaw, or throat
  • Pain in the upper abdomen or back

Dr. Santos said women shouldn’t feel shy about reporting any new or unusual symptoms to their doctor. Even if a patient suspects her symptoms are probably just acid reflux, she should still talk to her primary care provider. “Telemedicine has become a big part of what some providers offer,” Dr. Santos said. “It is very easy to have a quick virtual appointment with your doctor to discuss your concerns.”

Bone health

The Centers for Disease Control and Prevention recommends that women ages 65 and older should undergo a bone density test to learn if they suffer from osteoporosis. If a woman has a parent who has broken a hip or other risk factors for osteoporosis, however, she should undergo her first bone density test between the ages 50 and 64.

Brittle bones can be especially risky for women as they grow older because they are at a high risk of experiencing a debilitating fracture. Early symptoms can include:

  • Receding gums
  • Brittle fingernails
  • Height loss
  • Lower back pain
  • A curved shape to the spine

Pelvic health

There are three main types of pelvic floor disorders: urinary dysfunction or incontinence, or lack of bladder control; bowel dysfunction or fecal incontinence, or lack of bowel control; and pelvic organ prolapse, a condition in which the uterus, bladder, and bowel may “drop” within the vagina. According to Dr. Santos, women who have these issues, such as urinary incontinence, often wait an average of seven years before seeking treatment. That’s living with discomfort for a long time!!

Incontinence can be a difficult topic to broach with a primary care doctor, but it’s an important one. Some women think that leaking urine or fecal matter is just a part of aging they will have to live with, but that’s not true. There are many treatment options, and some are very easy fixes. “If a problem causes you concern, it doesn’t matter if it’s a part of aging,” Dr. Santos said. “You shouldn’t have to ‘just live with it.’”

Make a list

Dr. Santos suggests compiling a list of questions before an appointment to avoid forgetting anything. “When you go to the grocery store, you don’t just wing it,” she said. “You make a list and use that to guide your shopping trip. It’s the same with a doctor appointment.”

A strong relationship with a primary care doctor can lead to overall better health and better quality of life. There is nothing that they haven’t already heard and no issue is cause for embarrassment. Communication is key to treatment.

Find a doctor

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Related resources

Women’s health resources

How heart disease affects women

Pelvic floor therapy


This information is not intended as a substitute for professional medical care. Always follow your health care professional's instruction

About the Author

The Providence Women's Health team is committed to providing useful and actionable insights, tips and advice to ensure women of all types can live their healthiest lives.

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