As women navigate different phases of their lives, do they need different doctors?
Many women wonder, for instance, whether they should see their primary care provider or a specialist in obstetrics and gynecology (OB-GYN) — or both.
Are you pregnant or considering starting a family? Is menopause on the horizon? Or, do you have a teen daughter who needs a gynecological exam? How do you know if you should see your primary care doctor or switch to an OB-GYN to help you along your health care journey?
Dr. Stephanie Mager, an OB-GYN for UCHealth in northern Colorado, explains the varying roles that primary care providers and OB-GYNs play in supporting care for women. She helps answer questions about which medical experts can provide the most appropriate care for women during different times of their lives.
What is the difference between a primary care doctor, an OB-GYN and a midwife?
A primary care provider, or PCP, includes doctors practicing in family medicine, internal medicine and pediatrics, along with physician assistants and nurse practitioners. Primary care providers help people stay healthy and diagnose and treat a full array of diseases and conditions, such as diabetes, high blood pressure and behavioral health challenges. When necessary, primary care providers make referrals to specialized doctors, such as oncologists, gastroenterologists or OB-GYNs.
The differences between family medicine, internal medicine and pediatric physician are plentiful. Pediatricians see patients from birth to age 21 and specialize in the unique needs and health issues of that population. Likewise, an internal medicine doctor is also focused on unique needs and health issues, but for adults ages 18 and older. A family medicine doctor sees patients of all ages.
All board-certified primary care physicians receive obstetrics and gynecology training during their residency programs. The difference is that an OB-GYN has even more extensive training and a career focus in obstetrics and gynecology.
“Obstetrics and gynecology are my specialties, which means I spent all of my training focusing solely on all aspects of reproductive health as well as the multitude of gynecologic topics a person may experience throughout their lifetime,” Mager said. “This includes pre-conception counseling, pregnancy-related conditions, postpartum care, menstrual issues, contraception, menopause, sexually transmitted or pelvic infections, among others.”
A certified nurse midwife is also an expert in women’s health and pregnancy, but their educational route is different. An OB-GYN physician completes four years of medical school followed by four years of residency. A midwife gets a nursing degree, completes a graduate program in midwifery and passes a certification exam.
The other big difference is that an OB-GYN physician delivers in a hospital setting, while a midwife has the option to work in a variety of settings, including private practices, birth centers and hospitals.
Neither a midwife nor a primary care provider can perform a C-section or other operative deliveries. OB-GYNs do obstetric and gynecology surgeries.
Is there a difference between an OB and GYN?
Obstetrics (OB) deals with pregnancy care. Gynecology (GYN) focuses on the function and diseases specific to girls and women, particularly concerning reproductive systems, breasts and pelvic regions. An OB-GYN’s care also includes a focus on contraception planning, gynecologic disease prevention, fertility, hormonal problems, menstrual disorders, and gynecological surgeries, such as a hysterectomy.
OB-GYNs are board-certified physicians specially trained in both areas of women’s care. They may choose only to provide one of the areas of services, though it’s not common, Mager said.
What is the difference between an annual well visit and a well-woman exam?
A well-woman exam is a visit that includes a breast exam, pelvic exam and Pap smear. Women can see their primary care provider or their gynecologist for this type of visit. The primary purpose is to address sexual and reproductive health, and Pap smears, depending on a woman’s age and health, are necessary every one to five years.
A wellness visit (or what some call a “physical”) is recommended annually for both men and women of all ages. It includes different screenings, blood work and health topics based on the patient’s age and health factors. A wellness visit is a type of preventive care that looks at the patient’s overall health. It’s an opportunity to identify risk factors for chronic illness, update vaccinations, review family medical history, and discuss mental and sexual health.
As a woman, do I need to have a primary care doctor or an OB-GYN?
It depends, Mager said. And, it’s often a personal preference when it comes to what type of physician manages your overall health care.
Family medicine, internal medicine and pediatrics physicians, nurse practitioners and physician assistants are trained to perform well-woman checkups and exams. Your provider may refer you to an OB/GYN if more complex care is needed.
“If you are healthy and have no history of abnormal exams, I think it is fine to continue receiving your well-woman exams by your primary care physician,” Mager said. “And that doesn’t necessarily need to change if you want to start a family.”
“But you never know what will happen in your pregnancy. You might have to transfer care mid-pregnancy to an OB-GYN if you’re established only with a primary care physician.”
Women who have chronic illnesses or other diagnoses that might make their pregnancy “high risk” should consider establishing care with an OB-GYN, she said.
Even if you’re not looking to have a family, Mager said it may still be good to establish care with an OB-GYN.
“We can manage all phases of your life,” she said. “Whether hormonal issues or bleeding changes, working with your body after children, or into menopause.”
But most importantly, she said, find a physician who listens and makes you feel heard.
“If you don’t feel like you’ve gotten the answers, the explanations, or the care that puts you at ease about what is going on with you, always get a second opinion,” Mager said. “I think patients must understand, not just be given a diagnosis.
“You need to find a provider willing to go through that because you should understand why they mention medications for treatments. That doesn’t have to mean switching to a different clinic. You may find a provider you like within the same medical group. But no matter what, find a provider where you feel heard.”
At what age should a woman see an OB-GYN or begin well-woman exams?
Pelvic exams and Pap smears should begin at age 21 as part of your well-woman exam, according to the latest guidelines by the American Society for Colposcopy and Cervical Pathology (ASCCP).
“If you have a 16-year-old with heavy periods and on birth control, she still doesn’t need that routine pelvic exam until 21,” Mager said.
A pelvic exam is a physical exam of the vulva, vagina, cervix, uterus, fallopian tubes, ovaries and rectum to check for signs of disease. The physician also checks the uterus and ovaries’ size, shape, and position.
A Pap smear is where a physician takes cell samples to screen for cervical cancer. An HPV test might also be done during these exams, as certain types of HPV cause cancer.
These exams should be done every one to three years, depending on a woman’s risk factors for cancer and previous test results, between ages 21 and 29.
At 30 years old, pelvic exams and Pap smears change to every five years until age 65.
“At 65, we stop doing routine cervical cancer screening as long as there have been no abnormalities,” Mager said. “A family history of cervical cancer is not the deciding factor. If everything has been normal throughout their lifetime of consistent routine cervical cancer screening, the risk of getting cancer is low.”
Breast exams are examinations to detect a lump in a breast or other changes that might require more testing. It is one of the most important early breast cancer screenings.
Clinical breast exams should start at age 25 and occur every one to three years, then annually starting at age 40, along with an annual mammogram, according to The American College of Obstetrics and Gynecology. Both screenings should continue until the age of 75.
At what age can I stop seeing a gynecologist?
Recommended screenings stop between ages 65 and 75, but you can continue annual wellness visits with your OB-GYN if you wish.
“It’s always good to have an OB-GYN because we can manage your life in all phases,” Mager said. “Our bodies continue to change, and we are here to let you know that many of those changes are normal.”
Should I establish care with an OB-GYN if I’m pregnant or want to become pregnant, and what should I expect at that first appointment?
“Most women, if their primary care physician is providing their well-woman exams, come to us when they start their pregnancy,” Mager said.
“When you get a positive pregnancy test, it’s good to reach out to your provider to schedule an intake appointment for about six to eight weeks (gestation),” Mager said. “At that appointment, you’ll have a first-trimester ultrasound to ensure the pregnancy is viable and in the right position for growth and ensure that data is consistent with your last period. We will do prenatal routine blood work and screen for things like hepatitis.”
You should see a provider every four weeks until 28 weeks’ gestation; every two weeks between 28 and 36 weeks’ gestation, and weekly from 36 weeks until you deliver.
You should see your physician at least six weeks post-delivery for a mental and physical evaluation, including a postpartum depression screening. Recent guideline changes now recommend you see your physician for a follow-up two weeks postpartum.
“I like to see women two weeks postpartum no matter the number of pregnancies they’ve had,” Mager said. “I want to make sure they’re doing well and adjusting. Postpartum depression is a big problem that is undertreated and overlooked. We want to see if there are signs of that.”
“There are so many changes in the first six weeks (postpartum),” she added. “It’s not uncommon to feel symptoms of depression, but a two-week check-in helps us answer those questions about mental and physical changes.”
As an OB-GYN, Mager said she often sees postpartum issues and can help her patients manage those issues long term.
Can my primary care doctor follow me through my pregnancy and deliver my baby if I don’t have an OB-GYN?
Your primary care physician may be able to follow you through your pregnancy into the delivery room if you are low-risk and have had no pregnancy complications.
“When a primary care physician manages a labor, there is always an OB-GYN on-call if there are problems,” Mager said. “If a C-section or operative delivery is needed, we would come in at that point.”
Do I need a referral to see an OB-GYN?
You do not need a referral to establish care with an OB-GYN. Your primary care physician might refer you to an OB-GYN if specific female issues arise that they feel would be better addressed by a specialist.