During a woman’s lifetime, there are many milestones, including in health care. From adolescence to menopause, women’s medical needs evolve over time.
Samantha Erin Vilano, MD, is an ob-gyn with UPMC Greater Pittsburgh OB/GYN. Dr. Vilano is fellowship-trained in pediatric and adolescent gynecology, with a background in both pediatric gynecology and adult obstetrics and gynecology. She provides gynecologic services to patients of all ages. Below, Dr. Vilano discusses examinations, screenings, and other preventive measures for women and at what age they should make each a priority.
TEENAGERS
According to the American College of Obstetricians and Gynecologists, teenagers should have their first visit with a gynecologist between 13 and 15 years old. Dr. Vilano acknowledges this fact may shock parents of teenage girls. She often assures parents that their daughter’s first visit will likely focus on preventive care and will not routinely involve an internal exam.
“We don’t want it to be a scary experience,” she said. “Many young women fear they are going to have a pelvic exam during their first visit, but, aside from some specific indications, you don’t generally need a pelvic exam until you are 21.”
While Dr. Vilano subspecializes in pediatric and adolescent gynecology, she says adolescents can see any provider in her practice. However, guidelines about seeing teenagers can vary from practice to practice. Some gynecology providers won’t see patients until they are at least 16 years old.
The first visit to a gynecologist should be a safe space for teenagers to ask questions and build trust with their provider. Dr. Vilano spends extra time with her young patients talking about changes they are noticing and addressing any concerns they may have. “Many young people get a lot of their information from social media, and they come in with questions,” Dr. Vilano said. “We can answer those questions and help keep them healthy and safe.”
By beginning regular gynecologic visits as a teenager, young women will be prepared once they transition to adulthood. “We spend time preparing them what to expect, so when they come in at age 21, they’re not seeing a complete stranger,” Dr. Vilano said.
Discussions during the teen years may include:
How regular their periods are and if there are any concerns.
Managing premenstrual syndrome (PMS).
Talking about pregnancy prevention and birth control. Some teens may be prescribed birth control for reasons other than pregnancy prevention, such as heavy menstrual bleeding, cramps, or acne.
Information about sexually transmitted infections (STIs).
Vaccination for human papillomavirus (HPV), which is recommended beginning in the preteen years. HPV can lead to certain cancers, including cervical cancer.
20s AND 30s
Age 21 marks the beginning of cervical cancer screening and when patients can expect to have their first Pap smear. But the Pap test is just one part of the visit. “We’ll spend the majority of the time talking about health history, which is important for preventive care,” Dr. Vilano says. Breast exams are recommended by age 25. While patients do not typically have mammograms at this age, their providers will check their breast tissue for lumps or irregularities.
If patients in their 20s and 30s did not get vaccinated for HPV during adolescence, it’s not too late. “The HPV vaccine has been approved for women up to age 45, and at-risk women who were never vaccinated can still complete the series,” Dr. Vilano said. “Vaccination for HPV is so important for cervical cancer prevention.”
At age 30, many women can begin to space out their Pap tests to every five years. However, an annual gynecology visit is still important. “We encourage a yearly visit,” Dr. Vilano said. “A preventive care visit doesn’t always have to include a comprehensive exam.”
For patients who are planning to become pregnant, preconception health may be a topic that comes up during their routine visits. “To ensure patients are in optimal health, we talk about their lifestyles, nutrition, and weight management,” Dr. Vilano said. “This is also an age group where we want to be mindful about what medications our patients are taking and if there are any changes we need to make before they become pregnant.”
During pregnancy, providers will continue to discuss healthy eating and exercise, as well as physical and emotional changes. “Women go through a lot of body changes with pregnancy, and while this is expected and healthy, it can also be difficult,” Dr. Vilano said. This is also a time to identify any potential risks or complications. “If there are any serious medical concerns requiring more complex care, we can refer and co-manage patients with our maternal-fetal medicine colleagues,” she said.
40s AND 50s
Breast cancer screening typically begins after age 40. While guidelines vary and may depend on a patient’s health history, women should expect to have a mammogram every year to two years once they turn 40. “By ages 45 to 50, most women will have yearly mammograms,” Dr. Vilano said. Most providers recommend annual mammograms until age 75 or until a patient’s health would no longer support breast cancer treatment, she added.
For patients in their late 40s and early 50s, Dr. Vilano spends a lot of time talking about perimenopause and menopause symptoms. These can include menstrual irregularity, hot flashes, night sweats, weight changes, mood changes, and trouble sleeping. Average age of menopause, which is defined as not having a period for 12 months, is 51 to 52.
“This is an opportunity to discuss not only what we can do hormonally, but also what patients can do to support their symptoms,” she said. “While many women benefit from hormone therapy, sometimes menopause symptoms respond to non-prescription supplements or lifestyle changes.”
Another aspect of care for patients in midlife revolves around sexual health. “A lot of women come to our offices with concerns because their enjoyment of sex changes over time,” Dr. Vilano said. “It’s something women want to talk about, and we are here for them.”
60s AND BEYOND
Discussions about bone health and osteoporosis may begin around the menopause transition, when bone mass drops most rapidly, but becomes very important for patients in their 60s. Bone density scans are recommended for women ages 65 and older. For women who reached menopause early, they may need to start bone density scans sooner. Other risk factors for osteoporosis, which include family history of osteoporosis, fractures, low body mass index (BMI), and use of certain medications can be discussed and may lead to earlier screening and management.
To keep bones healthy, patients should maintain an active lifestyle that includes plenty of weight-bearing exercise and avoids alcohol and tobacco. Many patients will also benefit from taking a vitamin D supplement.
A LIFETIME OF CARE
No matter what age her patients are, Dr. Vilano wants them to have a positive experience when they come in for their exams. She’s also passionate about patients being informed about what is happening to them. “I’m known to bring out my drawing paper,” she said. “It’s very important for women and young girls to know how their bodies work, so I do a lot of drawings to explain. I spend time talking about how we’re going to address concerns and deal with any issues together.”
Sometimes, patients just need someone to talk to. Dr. Vilano emphasized that it is OK to use their time with their providers for this purpose, and that it should be a safe space for them to discuss their concerns.
“I really enjoy my conversations with women and girls,” she said. “It’s satisfying when you can make such a big change in somebody’s experience.”
UPMC MAGEE-WOMENS IN PITTSBURGH'S NORTHERN SUBURBS
UPMC Magee-Womens provides an array of women’s health services in convenient locations throughout the northern suburbs, from routine to specialty care.
At UPMC Lemieux Sports Complex in Cranberry, patients have access to a variety of services under one roof, including:
Breast imaging and ob-gyn ultrasound at UPMC Magee-Womens Imaging.
Breast surgery consultations with UPMC Magee-Womens Surgical Associates.
Routine ob-gyn care, including midwifery.
Specialty ob-gyn care focusing on minimally invasive surgery, reproductive endocrinology, and midlife health.
UPMC Passavant–McCandless offers specialty women’s health care and breast imaging in a newly renovated suite on the first floor of the hospital. Specialty services available at UPMC Passavant include:
Gynecologic oncology
Urogynecology
Minimally invasive gynecologic surgery
UPMC-Magee Womens providers also see patients at office locations in Wexford and Allison Park.
For more information about women’s health services, or to find a provider near you, visit UPMC.com/DeliveringMore.
Katielyn’s Story: Embracing Support
As the office coordinator for UPMC Greater Pittsburgh OB/GYN in Cranberry, Katielyn Mannas is familiar with the inner workings of an ob-gyn practice. When she became pregnant with her son, Brantley, she didn’t need to look far for a doctor to deliver her baby.
About four years ago, Katielyn and her husband, Kyle, decided that the time was right to start building their family. However, they faced a lot of uncertainty and unexpected difficulty in their journey to conceive. Eventually, they turned to an in vitro fertilization specialist north of Pittsburgh.
Finally, in the spring of 2023, Kaitelyn was pregnant.
She tried to stay positive throughout the experience. “I had a lot of support from my family and friends. I prayed and had a lot of faith, and I hoped for the best,” she said.
Fortunately, once she was pregnant everything went according to plan.
“I had a pretty stress-free pregnancy, which was nice,” she said, adding her coworkers treated her very well. “They made me feel at ease and reassured me. Everyone at the practice was great.”
On Feb. 24, 2024, Brantley was born at UPMC Magee-Womens Hospital. He was delivered by Samantha Erin Vilano, MD.
“It was a wonderful experience,” she said. “All of the nurses were very nice and attentive. With this being my first pregnancy, I wasn’t sure what to expect. They walked me through everything.”
Katielyn advises anyone who is trying to become pregnant to be patient and not afraid to talk about what’s happening.
“Make sure you have a good support network, because I think that’s what got me through the whole process,” she said. “Just embrace it and talk about it. If you can find someone else who knows what you’re going through, it’s helpful to talk about it.”
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