According to the Agency for Healthcare Research and Quality, people ask more questions 
when ordering a meal in a restaurant or buying a cell phone than they do during a medical appointment. That’s not hard to believe. I can easily think of tons of questions to ask at a restaurant: Do you offer half portions? Can I get the dressing on the side? Can I substitute a side item? What are the specials? But at the doctor’s it’s easy to forget key questions or shy away out of embarrassment.
We solicited the help of four area experts to start a list of questions for women to discuss with their health care providers. These topics are relevant for women of all ages, but are by no means exhaustive. Take this list on your next medical appointment, or start your own list. The important thing is to start asking. Your questions, combined with your family history, will help your physician customize his advice to give you the best health care possible.
What is metabolic syndrome?
Metabolic syndrome is a combination of conditions — high blood pressure, elevated insulin levels, excess body fat around the waist and abnormal cholesterol levels — that occur together and increase your risk of heart disease, stroke and diabetes. Research into metabolic syndrome is ongoing, and not all experts agree on its exact definition, but there’s no disagreement on the fact that the more components of metabolic syndrome you have, the greater the risks to your health.
Talk with your doctor even if you only experience one of the risk factors. Aggressive lifestyle changes, such as losing weight, exercising and quitting smoking, can delay or prevent the development of metabolic syndrome and further serious health problems.
If I had gestational diabetes, how does that affect my risk for developing diabetes later in life?
Blood sugar usually returns to normal soon after delivery for most women with gestational diabetes, but the risk of developing Type 2 diabetes in the future remains. Half of women with gestational diabetes will develop diabetes within 10 to 15 years, says Dr. Prashant Patel of Cary Internal Medicine and The Diabetes Center.
Dr. Patel recommends exercising 30 to 60 minutes most days of the week and eating foods high in protein and fiber to reduce the risk of developing future diabetes. Commit to regular blood sugar tests even if your gestational diabetes resolved after pregnancy. Talk with your doctor about how often to undergo tests and other lifestyle adjustments that will help.
Does this mole look strange?
Normal moles and skin pigmentation can change over time. Karissa Binkley, a DONA certified birth doula and owner of the Diapering Doula in Morrisville, acknowledges that hormonal changes during pregnancy and beyond can cause variations in skin’s appearance. However, she cautions if women notice any skin changes that seem unusual, especially size, shade or shape of existing moles, it may be a sign of skin cancer.
According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States, and melanoma, the most serious form of skin cancer, is the most common cancer for young adults ages 25–29. When detected early, the survival rate for melanoma is around 99 percent. So don’t delay: Talk with a doctor about scheduling a head-to-toe skin exam and additional ways to safeguard your skin.
What are the best treatments for dealing with irregular periods?
Keep track of your monthly start date for several months to determine the regularity of your periods. There is a broad range of what is considered normal, and many women 
experience between a 21 and 35 day cycle. If you can’t establish any regularity in your menstrual cycle or if you notice a dramatic change, Dr. Lanford Peck of Apex OBGYN says it may be time to approach your doctor. Irregularities can be caused by many factors from excessive exercising to infection.
Your health care provider can perform a pelvic exam and other tests to determine the cause of your irregularity and can recommend treatment if available.
Is there any reason to start mammograms younger than age 40?
The America Cancer Society recommends clinical breast exams during your 20s and 30s and a yearly screening mammogram beginning at age 40, but is there ever cause to start earlier? Yes, says Dr. Jennifer Van Vickle, of Raleigh Radiology, if you have a family history of breast cancer or have undergone genetic testing that found harmful BRCA1 or BRCA2 gene mutations.
Screening mammograms are most often used to look for breast cancer that is too small to be felt by a doctor. There are other types of breast cancer screening available, such as ultrasound and MRI, that may be appropriate for women with an elevated risk. Based on your family history and personal risks, your physician can work with you to determine the best combined screening options.
What other cancer screening tests should I consider?
Screening tests increase the chances of discovering some types of cancer early, when they are most treatable. To find out what screening tests are available and when you should submit to them, Dr. Van Vickle recommends starting with the American Cancer Society guidelines, which recommend screening for breast, colon, cervical and prostate cancers.
Check out the American Cancer Society website before your appointment so you’re familiar with the options available and can talk specifically with your health care provider about each one. Screening recommendations change with age, so make sure you revisit the discussion often. Don’t forget to include your family history and any personal risk factors that might affect timing or frequency of screenings.
How do heart disease symptoms differ in women?
Heart disease is stereotypically thought of as a problem for men, with crushing chest or arm pain. Many do not realize that more women than man die of heart disease each year, and the symptoms are often very different. Although it is common for women to experience some type of pain or pressure in the chest, it is not always severe or the most prominent symptom. Women often experience symptoms unrelated to chest pain, like neck, upper back or abdominal discomfort, unusual fatigue or dizziness.
Women’s symptoms are more subtle than men’s and can be harder to accurately diagnose. Talk with your doctor about all the possible symptoms of heart disease and how to quickly identify them and get help.
What are the treatment options for bladder control problems?
Bladder control, or urinary incontinence, is uncomfortable for many women to talk about. But don’t let that be the case with your doctor. He or she will be able to recommend a variety of treatments depending on the cause and severity of the problem. Urinary incontinence is more common in women than men and can be aggravated by pregnancy, childbirth, aging, being overweight and smoking.
Treatment options start with non-invasive techniques like physical therapy and increase in seriousness to surgical procedures. There are also several medications available to treat urinary incontinence. Discuss all the options with your doctor.
Are there any natural remedies to reduce the symptoms of menopause and hot flashes?
Until 2002, hormone therapy was widely used to treat the symptoms of menopause. In 2002 a clinical trial found that hormone therapy posed some health risks for women, and many began looking for alternative treatments.
Bioidentical hormones, or man-made hormones that are chemically identical to those your body produces, are gaining popularity as a treatment option. Typically they are derived from plant chemicals and can be custom made for your hormonal needs. Bioidentical hormones are still considered experimental but may be appropriate for some women. Dr. Patel says another possible natural remedy is consuming soy or herbal products that contain phytoestrogen, which may act like estrogen in a woman’s body. Natural remedies still have risks associated with them, and hormone therapy can be a safe, effective method of treatment, so it’s important to discuss all possibilities with your physician.
How do I prevent osteoporosis?
Osteoporosis causes bones to become weak and fracture easily. Increasing calcium intake and exercise and limiting excessive alcohol consumption are steps you can take to protect your bones. Getting enough vitamin D is also crucial to bone health. Sunlight, oily fish, egg yolks and supplements are all good sources.
Doctors usually diagnose osteoporosis by measuring bone density. If your bones have started to lose some of their mass, your physician can recommend medications that slow bone loss. Hormone therapy and physical therapy are also possible treatment programs to discuss at your appointment.
Make an Appointment
Dr. Landford Peck
Apex Obstetrics and Gynecology, PLLC
Apex Medical Park
1021 W. Williams St., Apex
(919) 387-3373
www.apexobgyn.com
Karissa Binkley
The Diapering Doula
4109 Grace Park Drive, Morrisville,
(919) 651-9802
www.trianglediapercompany.com
Dr. Prashant Patel
Cary Internal Medicine & The Diabetes Center
103 Baines Court, Suite 200, Cary
(919) 467-6125
www.caryinternalmedicine.com
Dr. Jennifer Van Vickle
Raleigh Radiology
3200 Blue Ridge Road, Suite 100, Raleigh
(919) 781-1437
www.raleighrad.com
