September is Gynecologic Cancer Awareness Month and is an opportunity to learn about cancers affecting the female reproductive system, preventive care, and, most importantly, the symptoms and changes in your body that are worth discussing with your provider. The goal is not to assume every change is something serious, but recognize when something may be new, persistent, or unusual for you and know when it’s time to check in.
What a Pap Smear Screens For and What it Misses
One common misconception is that staying up to date on your Pap smear means you’re being screened for all gynecologic cancers. In reality, a Pap smear is a cervical cancer screening test. During this test, a provider collects cells from the cervix to identify abnormal or precancerous cell changes. HPV testing is often used alongside a Pap test as part of cervical cancer screening to look for high-risk types of HPV that can cause changes in cervical cells. If precancerous changes are detected, you have the opportunity to intervene before cancer develops.
A Pap smear does not screen for:
- Ovarian cancer
- Uterine/endometrial cancer
- Vaginal cancer
- Vulvar cancer
This is one reason why, even when you aren’t due for a Pap test, routine gynecologic care provides an opportunity to discuss changes in periods or bleeding, pelvic pain, sexual health, vulvar or vaginal changes, family history, new or persistent symptoms, and any other concerns you may have noticed.
Types of Gynecologic Cancer
There are 5 main types of gynecologic cancers, and because each starts in a different part of the reproductive system, there is not one universal set of symptoms.
- Cervical Cancer – Cervical cancer may not cause noticeable symptoms early, which is why routine screening is so important. Potential warning signs include abnormal vaginal bleeding, bleeding after sex, bleeding between periods, unusual vaginal discharge, and pelvic pain or pain during sex.
- Ovarian Cancer – Potential symptoms can include persistent bloating, pelvic or abdominal pain, feeling full quickly or difficulty eating, and urinary urgency or frequency. An isolated day of these symptoms should not necessarily scare you. When there is persistent change from your normal, you should have a conversation with your provider.
- Uterine/Endometrial Cancer – One of the most important warning signs is abnormal vaginal bleeding or discharge. Bleeding after menopause should always be discussed with a provider, but changes in bleeding before menopause, such as unusually heavy or irregular bleeding, may also warrant evaluation.
- Vaginal Cancer – Vaginal cancer is rare and may not cause symptoms early on. Potential symptoms can include abnormal bleeding or discharge, bleeding after sex, pelvic pain, and changes involving the vagina.
- Vulvar Cancer – External changes matter too. Potential symptoms include persistent vulvar itching, burning or pain, bleeding unrelated to menstruation, and a lump, growth, sore, ulcer, or skin change.
Normalized Symptoms and When to Stop Ignoring Them
Women are often used to changes in their bodies throughout different stages of life. Periods change, hormones fluctuate, bloating happens, and perimenopause can bring entirely new symptoms, which can make it easy to brush off changes that may deserve a closer look.
You might think, “It’s probably just my period,” when bleeding becomes heavier or starts happening between cycles, or “I’m just bloated,” even though bloating has become persistent and is accompanied by pelvic discomfort or feeling full more quickly than usual. Persistent vulvar itching may seem like another yeast infection, pelvic discomfort can easily get pushed aside when life gets busy, and irregular bleeding in your 40s might be attributed entirely to perimenopause.
Most of these symptoms will not turn out to be cancer, but it is important to recognize when you should seek further evaluation and care. Pay particular attention to changes that are new for you, and remember symptoms do not need to become severe before mentioning them to your provider.
Knowing Your Body
Recognizing gynecologic cancer symptoms comes down to establishing your normal. We encourage every patient to know their typical cycle length, flow, discharge, bloating levels, pelvic discomfort, and urinary habits, then pay attention to any changes. You do not need to (and shouldn’t!) medically diagnose yourself, but it is important to notice when something is different with your body and communicate it to your care team.
Some patients find it helpful to track symptoms using a notes app, period tracker, or calendar. Consider making note of when the symptom started, how often it occurs, whether it relates to your cycle, and anything that makes it better or worse. You don’t need a perfect record. Even a few notes about what you’ve been experiencing can be extremely useful when you talk to your provider!
What Happens When You Bring Up a Symptom?
We always encourage our patients to speak up in their appointments. Don’t minimize a symptom because you’re afraid it sounds insignificant. If something feels different from your normal, say so, and be specific about how long it has been happening and how it affects your life. Your provider’s job is to determine what evaluation, if any, makes sense based on your individual situation.
When you bring up a symptom, it does not automatically start a cancer workup. You’ll start with a conversation with your provider where they may ask about when symptoms began, whether they have changed over time, menstrual history, medications, personal and family cancer history, and more. Depending on the concern and this information, your provider may recommend a pelvic or vulvar exam, an ultrasound, bloodwork, cervical testing, imaging, or another appropriate test. In some cases, no additional testing may be necessary. The goal is to determine what makes sense for you.
At Essex County OB/GYN, we want you to feel comfortable bringing us your questions and concerns, no matter how small they may seem. If you’ve noticed a change that doesn’t feel normal for you, you don’t have to wait until your next annual visit. Contact us today to schedule an appointment.