Gynecological care remains necessary after age 70, even though routine reproductive screenings often cease. The purpose of these visits changes significantly from a woman’s younger years. Continued specialized care shifts its focus from fertility and menstrual management to preventative wellness and managing the effects of prolonged estrogen deficiency. Care also includes vigilant, targeted screening for cancers whose risk increases with age.
Shifting Priorities in Gynecological Care After Age 70
Gynecological appointments for women over 70 shift toward a holistic, geriatric-focused approach rather than routine annual screenings for common reproductive issues. The visit focuses on a comprehensive health assessment and managing structural and functional changes resulting from decades of hormonal shifts.
The post-menopausal body is significantly impacted by the long-term absence of estrogen, which affects connective tissues throughout the pelvis and vulva. Managing symptoms related to urogenital atrophy and pelvic support becomes a central priority. The goal is optimizing quality of life and sexual health through careful symptom management.
Visits also aim for the early detection of non-reproductive cancers, such as ovarian and uterine cancer, whose incidence rates rise substantially in this age group. The gynecologist brings a specialized perspective to the unique vulnerabilities of the female genital and lower urinary tracts. These visits are often driven by symptoms or specific risk factors rather than a uniform protocol.
Cervical and Endometrial Cancer Screening Guidelines
Cervical cancer screening, which relies on Pap smears and Human Papillomavirus (HPV) testing, is typically discontinued for women over age 65 or 70. This cessation is recommended only if the patient has a documented history of adequate prior screening with no concerning results. Specifically, the woman must have had three consecutive negative Pap tests, or two consecutive negative co-tests (Pap and HPV) within the last 10 years, with the most recent test performed in the last five years.
The rationale for stopping screening is that the risk of developing new cervical cancer is extremely low for women consistently screened with negative results. However, women with a history of high-grade precancerous lesions, a compromised immune system, or exposure to diethylstilbestrol (DES) still require continued, individualized screening. Screening of the vaginal cuff is generally not required for women who have had a total hysterectomy for benign reasons.
Unlike cervical cancer, there is no routine screening test recommended for endometrial cancer in women at average risk, regardless of age. Endometrial cancer is the most common gynecologic malignancy, with the median age of diagnosis being around 61 years. The primary method of early detection relies on the patient immediately reporting any unexpected bleeding or spotting to her provider. Postmenopausal bleeding is never considered normal and warrants prompt investigation, typically involving a transvaginal ultrasound or an endometrial biopsy.
Addressing Non-Oncological Health Issues
The most common complaints in the post-70 age group stem from prolonged hypoestrogenism, leading to significant changes in the genitourinary system. Vulvovaginal atrophy, now termed Genitourinary Syndrome of Menopause (GSM), causes the vaginal walls to become thin, dry, and less elastic. This can lead to chronic irritation, increased susceptibility to urinary tract infections (UTIs), and discomfort during sexual activity (dyspareunia).
Pelvic floor disorders also become highly prevalent as aging weakens the supporting muscles and connective tissues. This weakening can lead to pelvic organ prolapse, where the bladder, uterus, or rectum descends, creating a sensation of pelvic pressure or a palpable bulge. Urinary incontinence, including stress and urge incontinence, affects a significant percentage of women over 65 and is a primary focus of specialized gynecological care.
Treatment for these issues is often highly effective and includes localized therapies that a gynecologist can prescribe and manage. Low-dose vaginal estrogen creams, rings, or tablets can reverse the symptoms of GSM by restoring tissue health without significant systemic absorption. Pelvic floor physical therapy is a highly effective, non-surgical option for managing many types of incontinence and prolapse, with gynecologists often referring patients to specialized therapists.
When Immediate Consultation is Required
While routine screening may decrease, certain symptoms in a woman over 70 must be addressed by a gynecologist immediately. The most important red flag is any episode of postmenopausal bleeding or spotting, even if it is very light or occurs only once. This symptom requires urgent evaluation to rule out endometrial hyperplasia or cancer.
Other symptoms that necessitate an unscheduled visit include new or persistent unexplained pelvic or abdominal pain, especially when accompanied by bloating or a feeling of fullness. These non-specific symptoms can sometimes be the only early indication of ovarian cancer. Persistent, non-healing sores, a change in skin texture, or chronic, severe itching on the vulva should also be evaluated promptly, as these can be signs of vulvar cancer or other dermatologic conditions.
A sudden, significant worsening of urinary or bowel function, or the rapid onset of a new, painful pelvic mass or pressure, also warrants immediate gynecological attention. Though often related to benign prolapse, the gynecologist must assess the severity and rule out any rapidly growing tumors or infections.