When Should You See a Gynaecologist? 5 Reasons for an Annual Check-up

For many women, an obstetrics and gynaecology specialist (in everyday language, a gynaecologist) only comes to mind when a symptom appears. Yet the American College of Obstetricians and Gynecologists (ACOG) recommends a regular (periodic) preventive women’s health visit, even though components such as cervical screening are not needed every year ¹; whether or not a pelvic examination is done, it asks that a woman see her doctor at least once a year ². Based on current guidelines, this article explains under five headings what an annual check-up without symptoms is for.

An annual check-up is, first and foremost, a conversation rather than a procedure. The conversation begins with a detailed history: your menstrual pattern, pregnancy plans, medicines you take, and any family history of cancer, heart disease or osteoporosis (bone thinning). ACOG states that family history is a risk assessment tool that should be updated regularly, and that which parts of the examination are needed is decided on the basis of a comprehensive history, including symptoms and past medical and gynaecological history ¹. In women without symptoms, whether a gynaecological (pelvic) examination is done is decided together with the doctor, through shared decision-making ².

1. Cervical cancer screening is done on time

The cause of cancer of the neck of the womb (cervix) is persistent infection with high-risk types of HPV (human papillomavirus). According to the World Health Organization (WHO), in 90% of people who have HPV infection, the immune system clears the infection on its own; progression to cancer usually takes 15–20 years after infection ³. This long window is the strength of regular screening: precursor changes can be caught and treated before they turn into cancer. The Sağlık Bakanlığı (Ministry of Health), referring to the WHO definition, also describes cervical cancer as “a preventable cause of death” ⁴.

In Türkiye, the National Cancer Screening Programme offers women aged 30–65 an HPV DNA test every five years; the test is done in all 81 provinces, including Van, at family health centres, community health centres, healthy living centres and KETEM units (Kanser Erken Teşhis, Tarama ve Eğitim Merkezi; Cancer Early Diagnosis, Screening and Education Centre), and no fee is charged under the programme ⁴. The WHO also recommends screening every 5–10 years from the age of 30 ³. An annual check-up does not mean a smear test (Pap smear) every year; it means talking about which test is needed when, and how the result should be interpreted ¹.

2. Your menstrual pattern is a sign of your health

In its 2018 definitions, the International Federation of Gynecology and Obstetrics (FIGO) considers a normal cycle to be 24–38 days long and bleeding to last 8 days or less ⁵. Periods that come more often or less often, bleeding that lasts a long time or is of an unusual amount, and spotting between periods need assessment. FIGO classifies the causes of this bleeding using the PALM-COEIN system; polyps, adenomyosis (tissue from the lining of the womb settling in its muscle layer), fibroids, ovulation disorders and clotting problems are among them ⁵.

Most of these causes are not as frightening as feared. According to ACOG, monitoring may be enough for fibroids that cause no symptoms; for those that do, there are many options, including medicines and surgery that preserves the womb (uterus) ⁶. Endometriosis (tissue similar to the lining of the womb growing outside the womb) affects about 10% of women of reproductive age ⁷; according to the 2022 guideline of the European Society of Human Reproduction and Embryology (ESHRE), surgery is no longer required for diagnosis, and the first step is clinical assessment and ultrasound ⁸. Simple ovarian cysts that cause no symptoms are also, in the great majority of cases, benign; most disappear on their own and can be monitored with ultrasound ⁹.

3. Your reproductive plans are discussed

ACOG regards developing and discussing a “reproductive life plan” for every woman of reproductive age as one of the core components of the preventive women’s health visit ¹. If you do not want a pregnancy at the moment, this plan covers the method of contraception that suits you; if you are thinking about pregnancy, it covers the steps to prepare. The Antenatal Care Management Guideline of the Sağlık Bakanlığı (Ministry of Health) recommends that every woman planning a pregnancy take 400–800 micrograms of folic acid a day, starting at least one month before pregnancy; in situations with a high risk of neural tube defects (defects in the development of the baby’s brain and spinal cord), the dose and duration are set by the doctor ¹⁰.

When there is concern about not being able to get pregnant (infertility; in everyday Turkish, “kısırlık”), timing matters. According to ACOG, assessment is recommended if pregnancy has not occurred despite regular unprotected intercourse for 12 months in women under 35, or for 6 months in women aged 35 and over; over 40, or if there is a known risk factor such as irregular periods, you can seek care without waiting ¹¹. Because a male factor plays a role in 40–50% of couples experiencing infertility, the assessment includes both partners from the start ¹¹. An annual check-up makes sure these questions are asked in good time.

4. The menopause transition is a checkpoint

According to the Türk Jinekoloji ve Obstetrik Derneği (Turkish Society of Obstetrics and Gynaecology, TJOD), the age at which menopause begins in Türkiye is about 47–49 ¹². Menopause is diagnosed looking back, after 12 months without a period; the perimenopause before it (the transitional period before menopause) can show itself through irregular periods, hot flushes and sleep problems ^12,13. ACOG emphasises that periodic women’s health visits are also appropriate and necessary for perimenopausal and postmenopausal (after menopause) women ¹. In other words, check-ups do not end when the fertile years end.

Two findings make this period a checkpoint. According to the American Heart Association’s (AHA) 2020 scientific statement, the menopause transition is a time when cardiovascular risk speeds up, independently of age; unfavourable changes in fat distribution, blood fats and blood vessel structure become noticeable during these years ¹⁴. The North American Menopause Society’s (NAMS) 2021 statement reports that, in the US, the remaining lifetime risk of an osteoporosis-related fracture for a 50-year-old white woman is estimated at about 40%, and recommends that fracture risk factors be assessed in all postmenopausal women ¹⁵. For this reason, blood pressure, blood fats and bone health are on the agenda of the annual check-up.

5. It opens the door to concerns that go unspoken

Concerns such as urinary leakage, painful sex or vaginal dryness are often put down to “part of getting older” and not mentioned. Yet the first step is often not surgery: according to the guideline of the UK’s National Institute for Health and Care Excellence (NICE), the first step for stress urinary incontinence (leakage when coughing, sneezing or exerting yourself) or mixed urinary incontinence is supervised pelvic floor muscle training lasting at least three months ¹⁶. TJOD also recommends that women with such problems share them with their doctor without hesitation and have the necessary investigations ¹².

When you go for a check-up with a gynaecologist, noting down the date of your last period, the medicines you take and any illnesses in your family makes it easier to take the complete, comprehensive history that ACOG emphasises ¹. At the end of the consultation, the timing of the screening test, any ultrasound or blood tests if needed, and the date of the next check-up are planned together. Every step, including the pelvic examination, is decided by talking it through with you, according to your age, your history and your preferences ². In this way, the annual check-up stops being a dreaded appointment and becomes a meeting in which you plan your health.

If you have symptoms, please see an obstetrics and gynaecology specialist.