Gynecology After 60: Hormone Therapy, Medicare Coverage, & More

Dr. Derin S. Rominger, MD an OB-GYN at Women’s Health Care Specialists of Decatur, splits life into two parts – the first half, where your body can recover quickly, and the second half, where it’s less forgiving.

In the second half of life, women often deal with brain fog, joint pain, and hot flashes (thanks to menopause), bladder control issues, and unexpected weight gain.

Get ready for answers to your burning questions about health screenings, bladder control issues, menopause, hormone therapy, and Medicare’s coverage of it all.

Health Screenings at the Gynecologist After 60

There’s a lot of confusion surrounding health screenings after age 60. How long do you need to get mammograms, pap smears, and other health screenings?

Dr. Rominger explains there are different philosophies, which adds to the confusion.

The US Preventive Task Force generally suggests stopping pelvic health exams at age 65. He says the government is primarily looking at the overall cost/benefit ratio to society as a whole.

On the other hand, the American College of Obstetricians and Gynecologists suggests looking at each patient as an individual. What is their life expectancy, and does it make sense to continue health screenings?

For example, if a patient in their mid-50s has multiple advanced diseases, the doctor may determine they will die of their existing conditions long before they’d die of breast cancer. In that case, they may not need a lot of health screenings in their second half of life.

However, Dr. Rominger says he has several patients in their 80s who should continue to get health screenings for breast and cervical cancer: “They’re spunky and busy and have a lot of life ahead of them! For them, cancer could impact their life expectancy. Why die of a preventable disease if we can catch it early?”

So, should you continue to visit your gynecologist after age 60 for regular health screenings?  

Dr. Rominger says you should consult with your doctor and make that decision together.

Bladder Control Issues Are More Common Than You Think

Anywhere from 25-45% of women suffer from urinary incontinence, or leaking at least once in the past year (WebMD).

If you’ve started mapping out bathroom locations, stopped travelling, or no longer go out with friends because you’re afraid you smell like urine, it’s time to see a gynecologist!

“Urinary incontinence is common, but it’s not normal,” says Dr. Rominger. “So many older women have limited their life because of bladder control issues, but we can address it.”

There are procedures that can help, such as colposuspension or sling surgery, and sometimes, you can even adjust your diet to fix the issue. There are also medications available that can help with bladder spasms.

“Be a master of your bladder, not a slave to it,” Dr. Rominger advises.  

Let’s Talk About Menopause

Menopause is a huge time of transition, and it’s one of the most complex subjects Dr. Rominger covers with his patients.

The first matter to tackle is the misconception about estrogen, specifically hormone therapy, and its relation to breast cancer.

Misconceptions About Hormone Therapy

The Women’s Health Initiative (WHI) published a study in 2002 that claimed hormone therapy (estrogen and progestin) for menopause symptoms increased risk for breast cancer. Even 20 years later, there’s still a perception that hormones or estrogen is bad for you.

Dr. Rominger says that’s just not the case.

“It was a 5-year study, and it claimed hormone use and breast cancer are related. Hormone therapy would have to be a remarkably powerful carcinogen to cause cancer in such a short time,” he explains.

“We’re clear that smoking leads to lung cancer, but that’s not 2 or 3 years – it’s 20 years or more. We know sun damage leads to skin cancer, but it’s not from a few years of sunburns – it’s from a lifetime of sun damage. For estrogen, a naturally-occurring hormone, to cause cancer in such a short time is not biologically plausible. We spend a lot of time educating patients about this,” Dr. Rominger explains.

Providing perspective on this study is a key educational point for Dr. Rominger, because hormone therapy is a viable method of treatment for many women with uncomfortable menopause symptoms.

Menopause Symptoms Go Beyond Hot Flashes

Menopause, the stage in life when women stop having their monthly period, is a part of normal aging. The ovaries stop producing high levels of hormones, including estrogen, and progesterone.

While menopause is often synonymous with hot flashes and night sweats, the symptoms go far beyond to include:

• Thinner skin
• Brain fog
• Vaginal dryness
• Difficulty finding words
• Hip and knee pain
• Sleep disturbances
• A general feeling of mental imbalance.

All of these symptoms are related to the decreased production of estrogen.

“Your skin loses protein and collagen layers – that’s estrogen mediated. A lot of women report brain fog and feeling frazzled all the time – there are estrogen receptors in the brain,” Dr. Rominger explains.

For many women, estrogen restores their balance, helps them feel like themselves again, and improves their sense of well-being.  

“Estrogen is a hormone, much like thyroid replacement. If your thyroid quits, we replace that. Even insulin – it’s a hormone. Estrogen, likewise, is a whole-body thing. Without it, you don’t feel quite right,” Dr. Rominger says.

How to Proactively Take Care of Your Health

Dr. Rominger says the preventative measures you can take to avoid common concerns as you age are pretty standard.

Eat right, exercise, and get plenty of rest. In general, take care of yourself!

Later in life, most people have the financial means to go out to dinner more often. He advises to be careful with that – you’ll eat more than you should and spend more time sitting on the couch at night.

He advises consuming 60% of your calories in the first half of the day so your body has time to burn it off. “Go lighter on the evening meal,” he advises.

When your activity levels are down and you go through menopause, it’s common to experience weight gain. While menopause is partly to blame, lifestyle is often the worst offender.

Dr. Rominger’s last bit of preventative advice is to make sure you’re getting enough calcium, continue health screenings so you can find any problems early, and ask questions about the changes to your body.

“You need to know if the changes to your body are normal,” Dr. Rominger says. “Remember: changes might be common, but it does not mean they’re normal.”

Medicare & Gynecology

Dr. Rominger says Medicare covers most services that have a clear, defined diagnosis, like incontinence surgery.

However, sometimes, he struggles getting Medicare to cover certain exams. Patients with Medicare will typically get exams when Medicare will cover them. In the case of pap smears, Medicare covers one exam every 24 months, so those patients will come in every other year.

The real issue Dr. Rominger has with Medicare is its lack of coverage for hormones: “With the controversy around hormones, we struggle getting Medicare to pick it up.”

He says Walmart has some drug programs that help you get the medications a bit cheaper, and mail ordering can also be a money-saving option.

Be sure to talk with your gynecologist about the costs and risks associated with hormones.

Our team of licensed agents here at Sams/Hockaday can also help you find the best Medicare drug plan for you based on the exact medications you take. We’ll also help you determine which pharmacy will have the lowest out-of-pocket costs for your specific hormones.

Conclusion

Dr. Rominger’s message to all women is to have a plan and a strategy.  

“It’s important that as you age, you continue to be strong advocate for yourself and your own health. You are valuable – I don’t think we respect seniors and the elderly as much in this country as we should,” he says.

Get educated on the changes to your health as you age. Don’t assume your symptoms or concerns are a natural part of aging. Just because an issue is common does not mean it’s normal and that you should just live with it.

Finally, consult with your gynecologist, and never stop advocating for your health.

Featuring Advice and Insights from OB-GYN, Dr. Derin S. Rominger, MD

Since Women's Health Care Specialists of Decatur opened in 2011, Dr. Rominger has been a part of the experienced team. He has practiced medicine since 1993 and attended the University of Illinois College of Medicine. He is married and has two children.