Two Conversations Every Woman Deserves to Have With Her Doctor
- Apr 29
- 4 min read
By Dr. Anne Marie Valinoti
There are certain conversations between a woman and her doctor that cannot be rushed. In over 25 years of clinical practice, two topics that frequently concern my patients as they enter their forties and fifties are the effects of perimenopause and how to approach cancer screening as they age.
The traditional doctor’s office, where time is a limited commodity, may not be conducive to having these important conversations. Practicing medicine in a smaller, less hectic environment allows me to have deeper conversations with patients about these issues and provide individualized care fit to their unique needs.
Perimenopause: More Than a List of Symptoms
Perimenopause refers to the years-long process that usually begins in a woman’s forties, where ovarian function begins to change and decline, ultimately leading to menopause. In my experience, every woman experiences this differently.
Effects can be wide-ranging: disrupted sleep, changes in mood and energy, shifts in cognitive sharpness, irregular cycles, and changes in body composition. While some women have minimal symptoms, others have a significant decrease in their sense of well-being and ability to function. Because symptoms don't follow a predictable pattern or arrive together, they're frequently addressed in isolation. Sleep difficulties are treated as a stress response. Mood changes are attributed to life circumstances. Weight gain is blamed on lifestyle issues.
A review of detailed medical history will often reveal that perimenopause is at play and can explain symptoms. Often, a woman will be relieved to have her experience validated and attributed to real physiologic and hormonal transitions that are happening in her body.
After identifying perimenopause, managing it – and getting patients to feel better – comes next. It’s important to go over different treatment options together, paying attention to which therapies are evidence based and what the evolving medical literature tells us about risks and benefits of different approaches. Menopause management has changed significantly over the years, and it’s important to have a physician who is updated on the latest society recommendations and scientific studies.
The best treatment depends on a patient's health history, her symptoms, her preferences, and her specific risk profile. There is no single right answer. But the discussion deserves to happen thoughtfully, without assumptions in either direction. A physician with sufficient time and real familiarity with her patient is well positioned to have this kind of conversation.
Cancer Screening: Why Your Plan Should Be Built Around You
Most women are familiar with standard screening guidelines. Mammograms beginning at a certain age, colonoscopies at another, cervical cancer screening on a defined schedule. These guidelines exist for good reason and apply meaningfully across the general population. They are, however, population-level recommendations, and for many women the right plan may look different from the standard one.
A patient’s family history is a key variable in determining her risk for a particular cancer. Depending on which diseases may run in the family, breast cancer and colon cancer screening may happen on a different timeline than the standard one. It’s also important to elicit a family history of less common cancers, such as ovarian or pancreatic, as additional testing may be indicated. Sitting down with a patient to get a detailed family history is critical to planning individualized cancer screening.
Genetic testing has become more available and clinically useful over the past decade as well. For women with significant family histories of cancers, a conversation about whether genetic counseling or testing is appropriate can be incredibly useful. Many women who would benefit from this conversation have simply never had it because the opportunity didn’t come up in a busy, time-constrained appointment.
Cancer screening needs to be done in a thoughtful way, considering the patient’s own values and concerns, in addition to her overall risk related to her genetics and environmental exposures. Patients need to understand the limitations of screening and even risks that can be associated with certain screening tests. In-depth discussions between a doctor and her patient can help lead to the most appropriate cancer screening plan.
Whether the conversation is about perimenopause, cancer screening, or any number of important health issues, being able to have tailored, in-depth discussions with your doctor is the best way to start on the path to addressing these matters. This is not complicated medicine. It just requires time and genuine familiarity with the patient. That's what we provide at Harley Street Medical, and we'd be glad to tell you more about how we approach it.
Dr. Anne Marie Valinoti is a physician at Harley Street Medical in Ho-Ho-Kus, NJ, bringing more than two decades of internal medicine experience to her patients. She joins HSM from the Valley Medical Group/Prospect Medical offices, having been recognized as a Top Doctor by Castle Connolly for over 15 years and as an Exceptional Woman in Medicine.
If you’d like to learn more about concierge medicine or Harley Street Medical, please email inquiries@harleystreetmed.com, call (551) 284-4044, or visit our website at www.harleystreetmed.com/nj.
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