A few months ago, I found myself sucker punched with classic influenza symptoms — head and body aches, fever, vivid hallucinations of the next two weeks of my work calendar vanishing into thin air. For as long as I can remember, my ob/gyn has been my primary health provider, so I called her, unsure of whether I should come in for testing. As I waited on hold, a Carrie-from-SATC-esque thought crossed my mental Mac screen:
Why am I calling my vagina doctor for the flu?
I figured it was time to strap on my big-girl panties and make an inaugural appointment with an internist. After all, I’m 42 — and perimenopause, osteoporosis and all other sorts of health adulting are allegedly looming on the horizon. But when my ob/gyn, Seema Venkatachalam (M.D., clinical instructor of obstetrics and gynecology at Northwestern University and a partner at the Northwestern Specialists for Women in Chicago — known affectionately, and for brevity’s sake, by her patients as Dr. V) got on the phone with me, she not only assured me she was more than equipped to continue servicing all of my parts, but she also warned me not to fall into the trap of prematurely ditching my gyn just because I’m done makin’ babies — a trend she sees all too often in her 40-something patients.
“The services performed by your gynecologist don't stop at the Pap smear,” she said. “We do your annual blood work, including tests for your thyroid, cholesterol screening, body mass index. We give immunizations and discuss early genetic screenings for different cancers. And internists are not as likely to ask about perimenopause symptoms, and other things that happen in our 40s.” Generally speaking, she tells patients, “If you’re healthy, an ob/gyn likely serves you better in your 40s.”
Internal medicine doctors may not see eye to eye, though. The president of the American Academy of Family Physicians has compared going to a gynecologist for your regular checkup with “going to a tire shop to get your car checked out.” Vroom, vroom.
American College of Physicians President Ana María López, M.D., says the answer may lie somewhere in the middle, likening the transition from gyn to internist to what we went through when graduating from our pediatrician around age 18.
“There’s no hard line on when to switch; it merits a conversation with your ob/gyn or, if you have one, an internist,” she says. “Some internists are very comfortable checking for STIs or screening for cervical cancer, but not providing birth control or placing an IUD. Some ob/gyns are very comfortable giving midlife immunizations; some are not. Both can talk with you about preserving your bone mass and order a bone density study.” Lopez added that she’s a fan of internists and gyns working as a holistic team.
For women in their 40s with chronic conditions like diabetes, Polycystic ovary syndrome (PCOS), thyroid disease or depression, Venkatachalam agrees that gynecologists and internists can partner to cover all the patient’s bases. For instance, PCOS is very much in the gynecologist’s realm (symptoms include pelvic pain, heavy bleeding and infertility, and it can increase uterine-cancer risk), but it would make sense to have an internist monitor the patient’s insulin levels (PCOS ups diabetes risk).
Fifty and fabulous? Keep your feet in those stirrups! You still have a vagina, after all, plus as divorce rates continue to soar, you may find yourself exposed to sexually transmitted infections by new partners; your ob/gyn can help you protect yourself.
But it may be time to add an internist to your physician roster, as estrogen levels fall during and after menopause, heightening risk of cardiovascular disease. An internist can help manage those potential risks, and the internist and ob/gyn can confer to determine the value of hormone replacement therapy, and how that might impact risks of heart disease. And because a woman’s reproductive health history, like having high blood pressure during pregnancy or delivering a small-for-gestational-age baby, increases your odds of developing heart disease — something your doctors know, but you may not — your ob/gyn can make sure to relay this important information to your internist.
Even then, keep seeing your V doctor, says Dr. V. (Sorry, I had to.)
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