A gynecologist specializes in the health of the female reproductive system, treating conditions affecting the cervix, uterus, ovaries, vagina, and breasts. Routine care often focuses on reproductive health and cervical cancer prevention. After age 65, women have typically navigated menopause, which alters the body’s needs and the focus of preventive care. Specialized gynecologic expertise remains valuable, shifting from reproductive-focused screening to age-related health maintenance throughout a woman’s later life.
Shifting Focus: Changes to Routine Preventive Screenings
The most significant change in gynecologic care after age 65 is the discontinuation of routine cervical cancer screening (Pap test and HPV co-testing). Medical guidelines recommend stopping these screenings at age 65 for women who meet specific criteria, as those consistently screened for decades have a very low risk of developing a new case.
To qualify, a woman must have adequate negative screening results within the preceding decade. This requires three consecutive negative Pap tests or two consecutive negative HPV tests or co-tests, with the most recent test occurring within the last five years. She must also have no history of a high-grade precancerous lesion or cervical cancer within the past 20 to 25 years.
If medical records are incomplete or if a woman has a history of high-risk lesions, continued screening may be necessary. Even without the routine Pap test, the physical pelvic examination remains important. This exam allows the clinician to inspect the vulva and vagina and manually check for masses or changes in the uterus and ovaries.
Monitoring for Gynecologic Cancers
While cervical cancer risk decreases after age 65, the risk for other gynecologic cancers, including ovarian and endometrial (uterine) cancers, generally increases with age. The gynecologist focuses on heightened awareness and early detection. Endometrial cancer is often detected due to a distinct symptom: any unexpected vaginal bleeding after menopause requires immediate evaluation.
Postmenopausal bleeding is the most common symptom of endometrial cancer, necessitating a prompt workup, such as an endometrial biopsy or transvaginal ultrasound. Ovarian cancer is difficult to detect early as there is no reliable screening test. Vigilance for subtle, persistent symptoms is paramount, including bloating, feeling full quickly, pelvic or abdominal pain, or changes in urinary habits.
Breast cancer screening also remains a priority. The gynecologist performs a clinical breast exam during the annual visit and coordinates mammography. For women aged 55 and older, screening is recommended every one or two years, continuing as long as the woman is in good health and has a life expectancy of at least ten more years.
Managing Post-Menopausal Health Concerns
Gynecologists provide specialized care for common conditions arising from estrogen loss after menopause. This includes Genitourinary Syndrome of Menopause (GSM), formerly called vaginal atrophy, which affects many postmenopausal women. GSM is caused by the thinning and drying of vulvar and vaginal tissues, leading to symptoms like dryness, burning, irritation, and painful intercourse.
A gynecologist diagnoses GSM during a pelvic exam and offers effective treatments. These include low-dose topical estrogen (creams, rings, or tablets) to safely restore tissue health. Non-hormonal options, such as specialized vaginal moisturizers and lubricants, also provide symptomatic relief and can significantly improve comfort and quality of life, including sexual function.
Gynecologists are also experts in managing pelvic floor disorders, which become more common with age and estrogen loss. Conditions like pelvic organ prolapse (where organs descend into the vagina) or urinary incontinence can be evaluated and treated. Management options include lifestyle modifications, pelvic floor physical therapy, fitting a pessary device, or surgical intervention. Addressing these issues requires a specialized understanding of pelvic anatomy and the effects of aging on connective tissue.
Determining Visit Frequency and Specialty Care
Women over age 65 are generally advised to continue with a yearly well-woman visit, even if a Pap test is no longer performed. The annual visit allows for crucial health maintenance, including a clinical breast exam, pelvic exam, and a discussion of any new or ongoing postmenopausal symptoms. This appointment is an important opportunity to discuss cancer risk, bone health, sexual function, and urinary health.
The decision to see a gynecologist versus a primary care provider (PCP) depends on the nature of the concern. The PCP is suited for general health management, chronic disease management, and standard screenings like cholesterol and blood pressure checks. However, when a problem is specific to the female reproductive tract—such as abnormal postmenopausal bleeding, pelvic pain, severe GSM symptoms, or pelvic floor dysfunction—a gynecologist’s specialized expertise is warranted. The gynecologist remains the expert for the ongoing health of the reproductive system, providing tailored care that evolves with age.