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Telemedicine is a great choice for women with gynecologic concerns. The My Virtual Physician founder, Dr. Howard, recently joined a call to explain the value of telemedicine in gynecology. So how can virtual gynecology address women's health concerns?
Irregular periods are one of the most common reasons that women see gynecologists. Here's a look at what Dr. Howard shared.
One of the most common questions about Virtual Gynecology is, "how much of gynecology can be dealt with through telemedicine?" How can diseases or conditions be dealt with through a video visit?
One of the most common reasons women see their gynecologist is irregular periods.
Some women have regular but heavy periods, which are abnormal periods. Abnormal or irregular periods are one of the most frequent reasons why a woman will go to the gynecologist. In young or premenopausal women, the most common reason for irregular periods is a hormonal imbalance. In other words, they're not ovulating regularly. Other times, the lining of the uterus is dysfunctional.
One of the most common ways in young women to fix irregular periods is to manage hormones through a trial of hormonal contraception. To be clear, this is through the use of birth control pills.
For a young woman who visits a doctor for irregular periods, the doctor will take a good history. He or she will make sure that there is not a specific reason for the irregularity. For example, if the young woman has previously had an ultrasound that showed she has fibroids, or other specific structural pathology in the uterus, that could explain the abnormal periods.
An online physician can take a thorough patient history through a video visit and prescribe birth control pills. This is one of the most common things that gynecologists do for young women: start a trial of birth control pills.
Young women with irregular periods do not need a pelvic exam initially.
However, if birth control pills fail to regulate periods, then a woman may need imaging. In some cases, a doctor may even need to look inside the uterus with a camera to see if there is any pathology. And before any invasive procedure, the doctor must do an exam to see how big the uterus is and which way it points because that will guide any surgery.
But initially, when a woman first presents with irregular periods, a video visit is appropriate because a pelvic exam is not needed up front. The doctor needs a good history followed by a trial of hormonal management. Birth control pills can be prescribed electronically, and the entire visit can be be done virtually.
After a few months, if the patient's periods are still irregular, then it may be time for a pelvic ultrasound. This test can be ordered electronically.
The patient will go to a radiology facility for an ultrasound and the report will be faxed to the physician. In some cases, the doctor will have electronic access to the images if the radiology site has a provider portal. Many facilities do. They may provide referring doctors with usernames and passwords they can use to log in and view the ultrasound results. Depending on what the imaging shows, the doctor may move forward with certain treatments.
Although many people would stereotypically think, "oh, I've got to go in," for irregular periods in a young woman, this problem can actually be dealt with through a video visit, at least initially. Depending on ultrasound results, there may ultimately be a time when a patient must go into a gynecology office. But initially, the assessment and management of abnormal periods can be done entirely through a video visit.
"A lot of people would stereotypically think, 'oh, I've got to go in,' ... you can see that actually, abnormal bleeding can be dealt with through a video visit."
- DR. DAVID HOWARD
Now consider the opposite extreme, a woman who is postmenopausal, having bleeding or spotting, the first thing the OB/GYN might do is get a pelvic ultrasound. If the uterine lining is less than five millimeters thick, a biopsy is not indicated. Current evidence shows that.
This transcript was exported on Sep 16, 2021
Still, a patient who has postmenopausal spotting should be evaluated. Since a pelvic ultrasound is not necessarily needed on a first visit, a woman can choose a video visit.
However, if bleeding is heavy, they should go to an emergency room (ER). An ER doctor can assess why the bleeding is heavy. They can assess the amount of bleeding.
If a woman has one episode of postmenopausal spotting but is worried, they can book a video visit. Through a virtual consultation, the doctor can take their history. Then a pelvic ultrasound can be ordered for the physician to review. After this, the doctor will schedule a follow-up visit by video to discuss results with the patient.
If the lining of the uterus is less than five millimeters thick, then the doctor does not have to do a biopsy. The chances of a patient having endometrial or uterine cancer then is very low.
On the other hand, if the lining of the uterus is thick, more than five millimeters, then a woman does need to go into the gynecologist's office for an exam and possibly a procedure such as a biopsy. Yet, the initial part of the assessment and management of postmenopausal bleeding can be done through video visits.
In summary, medical management for abnormal bleeding can be thought of as a three-step process:
As discussed, the first steps can be done through a video visit. At step three, that is when a woman needs to go in office to see a provider.
In short, abnormal uterine bleeding is a common condition that many women would go in to see their gynecologist for. And a lot of people would think, "how can you deal with that through a video visit?"
It is clear that a doctor can start off with a history through video and order a pelvic ultrasound electronically. In some cases, a young patient in their 20's with irregular periods can start with a trial of birth control pills. Postmenopausal women with irregular bleeding can also be treated through a video visit. In the best case scenario, the case can be managed entirely through video visits.
The uncomfortable truth is that doctors probably do too many pelvic exams. Many times they are not necessary. Sensitivity and specificity of pelvic exams, in many cases, is actually really low. Gynecologists should probably be doing a lot less pelvic exams. And when it is really necessary, physicians should be doing them in a very targeted manner.
History, imaging, and blood work, that is the trifecta that accounts for the overwhelming majority of the diagnostic process in gynecology.
"A careful history, imaging, like a pelvic ultrasound, and sometimes blood work. The combination of those three things, that's what really makes the diagnosis overwhelmingly the majority of times in gynecology."
- DR. DAVID HOWARD
Hopefully, eyes are opened as to how abnormal uterine bleeding can be managed through a video visit. A lot of people would not think that it could. Many still don't realize the value of telemedicine in gynecology.
Connect with Our Board-Certified Gynecologists online now. MVP’s founder Dr. Howard is a board-certified physician practicing in Las Vegas, Nevada. He is passionate about medicine and research. He has authored/co-authored several publications and is among the top 10% of scientific reviewers in the United States. Dr. Howard and his team are now accepting new patients.
This transcript was exported on Sep 16, 2021
