I've often wished I could work from home, but as an OB/GYN I would giggle at the impossibility of doing pap smears and delivering babies remotely. Fast forward to the global pandemic of 2020, where each day before I leave for work, I make sure my tablet is fully charged because about half of my visits each day are done by telehealth. As we all carefully ration each excursion outside our home, it's challenging to know what types of gynecological concerns warrant an office visit, which can be discussed on telehealth, and what issues can really wait until life gets a little more back to normal.
In my community, the majority of people are sheltering at home and avoiding the hospital. The hospital wards are eerily quiet, except for labor and delivery and the COVID units. While this is good in theory, we are seeing a lot of patients who are ignoring worrisome symptoms for too long, due to fear of COVID-19. Conditions that could have been treated easily in the office if the patient had come in quickly are progressing to more serious issues that now need emergency surgery or hospitalization. I'm not suggesting anyone run to the E.R. for a yeast infection (this is an always rule, not just a COVID rule), but there are some symptoms that should not be ignored.
Call your doctor to arrange an office visit if you are experiencing any of the following:
- New onset of pelvic pain. I don't mean a twinge or cramp that goes away in an hour or two, but severe pain (enough to keep you awake or stop you from doing normal activities) that doesn't go away with rest or acetaminophen.
- Heavy vaginal bleeding. If heavy periods are your norm, now is probably not the time for a workup; but new onset heavy bleeding is concerning. "Heavy" bleeding would be soaking your pad or tampon more than once an hour for more than 24 hours. If you feel weak, dizzy, or lightheaded with the bleeding that is especially worrisome.
- Pelvic pain with fever. New onset pelvic pain with fever could be the sign of serious infections, especially if associated with a change in your vaginal discharge or if you have had recent unprotected sex with a new partner.
- Breast mass. If you notice a new breast lump, especially if you are over 40 or have a family history of breast or ovarian cancer, then an immediate evaluation of this lump is indicated.
- Pain or bleeding in early pregnancy. If you have not yet had an ultrasound in your pregnancy and you begin to experience bleeding or persistent severe pain, then this could be a sign of a serious complication.
- Bleeding after menopause. I often see women who minimize postmenopausal bleeding and blame it on stress; but bleeding after menopause is not normal. It can be a symptom of uterine cancer and should always be evaluated.
- Domestic violence. One of my biggest worries right now is for the women in abusive homes. If you are unsafe, the OB/GYN office is safe place. We are currently not letting spouses come to appointments so if you need help please reach out to us.
In-person appointments for annual exams and chronic conditions (issues that have been going on for more than 6 months and haven't changed) can likely wait until after the COVID-19 crisis. However, there are some health concerns that be handled remotely. These are issues patients typically ask about at the end of their annual exams, often right as I'm walking out the door. These concerns are important enough deserve a visit all to themselves, as I usually don’t have time to fully explore them at a routine check-up. Since I am not currently doing any routine visits, my schedule is slower than normal and have more time to discuss these topics in depth via telehealth.
These topics are ideal for a telehealth discussion:
- Preconceptual counseling
- Decreased libido
- PMS, PMDD
- Birth control options
I appreciate everyone's sacrifices as they shelter at home and avoid unnecessary office and E.R. visits, but I don't want women to ignore serious gynecological issues that could affect their long-term health and fertility if not treated quickly. If you are experiencing gynecological symptoms, please call your women's health provider. We are here for you during this scary time and will guide you to the best option for your symptoms whether it's an urgent visit, telehealth, or a routine checkup scheduled for later in the year.