Q&A with Dr. Pamela Oliver: Ovarian Health
We recently spoke with Dr. Pamela Oliver, OB/GYN, to learn more about how women can be proactive when it comes to their ovarian health.
What are three things most women don't know when it comes to ovarian health?
First, I would say it's important for women to understand their anatomy and what their ovaries are and do. My patients will sometimes ask me about getting a Pap smear to check for ovarian cancer because they either don't understand what a Pap smear is or how the uterus, fallopian tubes, ovaries, and cervix are different. Women have 2 ovaries (one on each side in the pelvis next to the uterus). Your ovaries store and release eggs (so we can get pregnant if we so choose) and also release hormones that are important for our menstrual cycles, fertility, and overall well-being.
Second, the ovaries are very active organs. During the reproductive years (that time between starting to have menses through to menopause), the ovaries are actively preparing and releasing eggs on a monthly basis. With all of this activity comes normal physical changes in the ovaries, like ovarian cysts. Cysts are not all bad or cancerous, even though that's what many women think when they are told they have a cyst. Certain cysts are a normal part of ovarian activity while other cysts are not normal- but still not cancer. It's important to see an OB/GYN if there is any concern about a cyst that is identified.
Finally, the fear of ovarian cancer comes up in many of my conversations with patients. We all know or heard about someone who developed ovarian cancer and it scares us. We worry about developing ovarian cancer and want a test to pick it up early or we ask to have the ovaries removed to avoid that risk. It's important for women to know that yes- ovarian cancer is scary and it's understandable to want to get it detected early. But a woman's risk of developing ovarian cancer is much less (1 in every 87 women) than her risk of heart disease (affecting 1 in every 2 women over the age of 20) or of other cancers (like breast (1 in every 8 women), lung (1 in every 17 women), and colon (1 in every 25 women)). So don't let that fear overwhelm you or distract you from taking care of your overall health and mental well-being.
Also, unfortunately, there isn't a good screening test that we can offer to all women in hopes of picking up ovarian cancer either before it develops or in the earliest stages. There are tests that are out there that we can use when a woman has an ovarian cyst or mass to help us decide how aggressive we need to be (is there more concern for cancer and therefore we should perform surgery instead of watching and waiting). But these tests aren't good for testing women who otherwise have an average risk of developing breast cancer. (Side note—we need significantly more investment in funding women's health research so maybe we can identify better tests!)
If you could give our readers one piece of advice about their ovaries, what would it be?
A woman's ovaries are important for more than just releasing eggs and helping us make babies. The ovaries release a variety of hormones (most importantly estrogen and progesterone) and impact our metabolism throughout our life span. Even when our ovaries stop releasing eggs (as we transition to menopause) and the level of estrogen being released is less than before—the ovaries do continue to produce some estrogen and progesterone that is important for our overall health. Even that small amount of estrogen is good for our heart, bones, and mind. So we don't give up on the ovaries when you are no longer interested in having babies.
What are three things women can do to OWN their ovarian health?
First, protect your ovaries from infections by getting tested and treated for sexually transmitted infections (STIs) like gonorrhea and chlamydia. These are very common infections, especially in younger women (high school and college-aged). These infections start in the cervix but if they go undetected and untreated, they can spread into the uterus, fallopian tubes and then ovaries (called pelvic inflammatory disease). If this happens, there can be scarring of the fallopian tubes and ovaries that could affect a woman's ability to get pregnant later. So to avoid this—start with prevention. Use condoms to avoid getting an infection. I encourage women to get tested for STIs regularly. That might be once a year if you're in a steady relationship that you consider low-risk. Or it could mean getting tested each time you become sexually active with a new partner.
Second, for women who are in their reproductive years and interested in having children (whether now or sometime in the future), it is important to educate yourself on the "biological clock". For better or worse—this is a real phenomenon that young women should understand so they can own their reproductive journey. The functioning of the ovaries and the quality of the eggs that are released does change as we age. Those changes can make it more difficult for us to get pregnant after a certain age. So I counsel my patients to think about what if and when they may want to have children so we can discuss their options to give them as much control of their journey as possible. We never want a woman to rush to have a baby just because she's worried about age. We're so fortunate to now have options like egg preservation where women can store their eggs (like a bank would store our money) until we are ready to start our family. This is optimally done before age 35, but you should discuss with your physician to understand if this is a good option for you. There are also options like in vitro fertilization, egg donations, surrogates, and adoption based on your unique needs.
Third, we want all women to know as much of their family history as possible so we can have an informed discussion about risks and how to protect you as much as possible. I come from a family that very much believes in privacy and respect and it wasn't common for our elders to talk about their medical history. We have to change that and understand that sharing our medical history with our families is a gift that allows them to best protect themselves. Knowledge is power. If a woman has a family history of breast, ovarian, or colon cancer—then I would recommend she discuss this with her care team so they can assess if there is any additional genetic counseling, testing, or surveillance needed.
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First, I would say it's important for women to understand their anatomy and what their ovaries are and do. My patients will sometimes ask me about getting a Pap smear to check for ovarian cancer because they either don't understand what a Pap smear is or how the uterus, fallopian tubes, ovaries, and cervix are different. Women have 2 ovaries (one on each side in the pelvis next to the uterus). Your ovaries store and release eggs (so we can get pregnant if we so choose) and also release hormones that are important for our menstrual cycles, fertility, and overall well-being.
Second, the ovaries are very active organs. During the reproductive years (that time between starting to have menses through to menopause), the ovaries are actively preparing and releasing eggs on a monthly basis. With all of this activity comes normal physical changes in the ovaries, like ovarian cysts. Cysts are not all bad or cancerous, even though that's what many women think when they are told they have a cyst. Certain cysts are a normal part of ovarian activity while other cysts are not normal- but still not cancer. It's important to see an OB/GYN if there is any concern about a cyst that is identified.
Finally, the fear of ovarian cancer comes up in many of my conversations with patients. We all know or heard about someone who developed ovarian cancer and it scares us. We worry about developing ovarian cancer and want a test to pick it up early or we ask to have the ovaries removed to avoid that risk. It's important for women to know that yes- ovarian cancer is scary and it's understandable to want to get it detected early. But a woman's risk of developing ovarian cancer is much less (1 in every 87 women) than her risk of heart disease (affecting 1 in every 2 women over the age of 20) or of other cancers (like breast (1 in every 8 women), lung (1 in every 17 women), and colon (1 in every 25 women)). So don't let that fear overwhelm you or distract you from taking care of your overall health and mental well-being.
Also, unfortunately, there isn't a good screening test that we can offer to all women in hopes of picking up ovarian cancer either before it develops or in the earliest stages. There are tests that are out there that we can use when a woman has an ovarian cyst or mass to help us decide how aggressive we need to be (is there more concern for cancer and therefore we should perform surgery instead of watching and waiting). But these tests aren't good for testing women who otherwise have an average risk of developing breast cancer. (Side note—we need significantly more investment in funding women's health research so maybe we can identify better tests!)
If you could give our readers one piece of advice about their ovaries, what would it be?
A woman's ovaries are important for more than just releasing eggs and helping us make babies. The ovaries release a variety of hormones (most importantly estrogen and progesterone) and impact our metabolism throughout our life span. Even when our ovaries stop releasing eggs (as we transition to menopause) and the level of estrogen being released is less than before—the ovaries do continue to produce some estrogen and progesterone that is important for our overall health. Even that small amount of estrogen is good for our heart, bones, and mind. So we don't give up on the ovaries when you are no longer interested in having babies.
What are three things women can do to OWN their ovarian health?
First, protect your ovaries from infections by getting tested and treated for sexually transmitted infections (STIs) like gonorrhea and chlamydia. These are very common infections, especially in younger women (high school and college-aged). These infections start in the cervix but if they go undetected and untreated, they can spread into the uterus, fallopian tubes and then ovaries (called pelvic inflammatory disease). If this happens, there can be scarring of the fallopian tubes and ovaries that could affect a woman's ability to get pregnant later. So to avoid this—start with prevention. Use condoms to avoid getting an infection. I encourage women to get tested for STIs regularly. That might be once a year if you're in a steady relationship that you consider low-risk. Or it could mean getting tested each time you become sexually active with a new partner.
Second, for women who are in their reproductive years and interested in having children (whether now or sometime in the future), it is important to educate yourself on the "biological clock". For better or worse—this is a real phenomenon that young women should understand so they can own their reproductive journey. The functioning of the ovaries and the quality of the eggs that are released does change as we age. Those changes can make it more difficult for us to get pregnant after a certain age. So I counsel my patients to think about what if and when they may want to have children so we can discuss their options to give them as much control of their journey as possible. We never want a woman to rush to have a baby just because she's worried about age. We're so fortunate to now have options like egg preservation where women can store their eggs (like a bank would store our money) until we are ready to start our family. This is optimally done before age 35, but you should discuss with your physician to understand if this is a good option for you. There are also options like in vitro fertilization, egg donations, surrogates, and adoption based on your unique needs.
Third, we want all women to know as much of their family history as possible so we can have an informed discussion about risks and how to protect you as much as possible. I come from a family that very much believes in privacy and respect and it wasn't common for our elders to talk about their medical history. We have to change that and understand that sharing our medical history with our families is a gift that allows them to best protect themselves. Knowledge is power. If a woman has a family history of breast, ovarian, or colon cancer—then I would recommend she discuss this with her care team so they can assess if there is any additional genetic counseling, testing, or surveillance needed.
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