On 27 Apr, 2024, SeniorsToday hosted their weekly Health Live webinar with Dr Rekha Ambegaokar who spoke on and answered questions about Preventive Gynaecological Health Care for Seniors.
About Dr Rekha Ambegaokar
Dr Rekha Ambegaokar is a popular and renowned obstetrician and gynaecologist with 40+ years of experience. Dr Ambegaokar is devoted to ‘Safe Motherhood’ practices, having contributed significantly to women’s health and wellbeing.
She established private nursing homes in Santacruz West in Mumbai, conducting more than 12,000 deliveries in the past 27 years. Dr Ambegaokar advocates for the art and skill of vaginal surgery while welcoming advances in robotic and laparoscopic surgeries. She emphasises compassionate and ethical patient care, and quality healthcare for all sections of society. Dr Ambegaokar was earlier Consultant, Obstetrics and Gynaecology, Surya Hospital.
An MBBS from the TN Medical College, Mumbai, she has done an MD in Obstetrics and Gynaecology from the BYL Nair Charitable Hospital, Mumbai. An award winning doctor, she is a member of leading professional and community organisations.
By 60 years of age when the distressing symptoms of menopause settle down, many women assume that the role of their gynaecologist is over.
Many women meet with their gynaecologist in their 20s and 30s- for contraceptive advice, for infections, labour and delivery, infertility. Then come the years of perimenopause and menopause. And finally by 60, when the women have crossed over to their post menopausal stage, many women think that they no longer need to visit their gynaecologist. However, that is not true.
Preventive gynaecological health care in seniors is important in today’s time. It has been estimated that by 2023, 7.1% of the population will be aged 60 years and above and with this increase in longevity it becomes very essential to define healthcare services for this group.
Common reason to visit your gynaecologist:
- Uterine prolapse: women occasionally present with the complaint of something coming out of their vagina.
- This is due to weak ligaments which happen with age. This is why it is important to exercise- especially those exercises which strengthen the pelvic floor- these are called Kegel exercises.
- These exercises strengthen the pelvic muscles and help in preventing a prolapse.
Urinary issues: some patients may also present with the urinary symptoms such as increased frequency of urination or distressing symptoms like leakage of urine or urinary incontinence
- When facing these problems it is important to visit your gynaecologist to see if you are suffering from a condition called atrophic vaginitis which is a condition where the lining of the vagina is very thinned out.
- Screening for genital malignancies: especially cancers the breast, uterus, cervix, ovaries and the external genital- vulva, vagina. Yearly gynaecological check ups and screening tests are advised.
Sexual dysfunction: many women, because of dryness of the vagina, find intercourse very painful and difficult. Even if they have the desire, they tend to not induce in sex due to this discomfort. And they often feel too shy to discuss the same with their gynaecologist. There are however solutions and lubricating creams to address the issue.
Warning symptoms at and above the age of 60 years:
- Feeling of something coming out of the vaginal orifice. Whenever the woman strains, to pass urine or stools she feels like there is some foreign body in her vagina or she sees a bulge coming out of the vagina
- Leakage of urine
- Unexplained bleeding post menopausal, per vaginum
- Unusual bloating
- Pressure in the pelvis
- Change in urinary frequency
- Severe constipation
- Lump in the breast
- Change of appearance of the external genitalia/ vulva
Screening tests are tests that are aimed at detecting a disease before the symptoms develop so that complete cure is possible. And we have 2 very good examples for screwing tests:
- Pap smear: cervical cancer
- Mammography: breast cancer
The frequency of the above mentioned screening tests is as follows:
- Lifelong a woman should visit her gynaecologist at least once a year for a pelvic and breast examination
- Mammography should be done every 2 years till the age of 75 years
- Pap smear every 3 years till 65 years of age, after which she can stop doing her pap smear provided her last 3 consecutive results were negative
- Pelvic sonography: it is the only method to screen for ovarian tumours
While a balanced diet is the best, it may not sufficient at this age group due to:
- Poor appetite
- Poor absorption
- Chronic diseases
- Regular medications- common one being antacids
Hence, it is important to take supplements to improve bone health, nerve health, muscle mass, immunity and haemoglobin
Take- home message:
It is very important for women not to feel embarrassed or shy in discussing their problems with the gynaecologist
Many disorders at this age, unfortunately are diagnosed late because of the woman’s hesitation in meeting her gynaecologist.
Symptoms like leakage of urine and difficult intercourse do have solutions, if discussed.
The common cause for urinary tract infection in women that have achieved menopause is because of a very thinned out vagina because of the lack of the hormone- oestrogen. So when women have repeated urinary tract infections at an age over 60 years, we ask the patient to come for a pap smear and if the pap smear is normal, we frequently prescribe hormonal oestrogen creams for a period of 3 months to build up the vaginal wall and prevent recurrent urinary tract infections
At the same time, a urine culture is also advised to try and identify the causative organism and give appropriate antibiotics.
An emphasis is made on drinking adequate water- between 2- 3 litres/ day
Certain supplements such as cranberry can also be taken to reduce the incidence of UTIs.
There is a triad of cancers:
- Breast
- Ovary
- Colon
If a female member in the family has been diagnosed with any of the above mentioned cancers then that woman should screen herself for the other 2 conditions.
Most screenings for gynaecological malignancies begins at 40 years of age but these women should go for screening at a much earlier age, in their 30 years of age.
If any woman in the family is positive for BRCA genes, then all the women in the family should get themselves screen for breast malignancy.
Similar, ovarian cancer is also familial.
