Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Why “I don’t need birth control” still means you might need hormonal control
What if birth control could be your most reliable tool for better cycles, clearer skin, steadier moods, and a smoother perimenopause—whether or not you need pregnancy prevention?
Speaking of Women's Health Podcast Host Dr. Holly Thacker sits down with Certified Nurse Practitioner Dana Leslie to map out a smarter, personalized path through contraception, hormone balance, and sexual health that actually fits real life.
They also break down the latest in at‑home STI testing.
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Welcome to the Speaking of Women's Health podcast. I'm your host, Dr. Holly Thacker, and I am back in our Sunflower House season three to interview one of my favorite ladies of all time, Dana Lynn Leslie. She is our top nurse practitioner in our Center for Specialized Women's Health. And I've often said, I wish she was my daughter or my daughter-in-law. She's just so fabulous. And I've talked about you so much, Dana, on our podcast, including on urinary tract infections, right before I saw you for my annual. And I was scrubbing too hard. I gave myself a UTI. So we are going to talk about all things contraceptives, how you individualize things for your women patients. And I just want to say welcome back. Thank you. And congratulations on your new home purchase.
Dana Leslie:Yes, it's been such an adventure. It's so fun. Who would have thought?
Dr. Holly Thacker:Yeah, I mean, I can't believe how handy you are, and you're, you know, a new homeowner. You know how to redesign things, and you're also a gardener and a farmer and a landscaper.
Dana Leslie:Trying my best. I don't know. Those are adjectives to describe myself, but we're working on it.
Dr. Holly Thacker:Well, anyway, it's so great to welcome you back. We had you on season one, which was when to see a nurse practitioner. And we talked about when it's a good time to maybe see an APP as opposed to your physician. We also talked about all the different types of IUDs. So for any of our listeners, if you didn't hear that one, that's a good one to go back to. Um so Dana is back to discuss how and why individualizing contraceptive options is important, especially in younger women as well as women in perimenopause. And we're also going to talk about a somewhat newer topic, which is um all about in-home sexually transmitted infection testing. Just as a reminder, Dana is a certified nurse practitioner at the Cleveland Clinic Center for Specialized Women's Health. She had her undergraduate degree at Youngstown State University. She was a D1 volleyball athlete, worked her way all the way through school, and then she got her graduate degree at the University of Cincinnati. And she sees patients at the main campus. Um, she previously was seeing patients uh in Lakewood, but now that it's November, uh she's moved to her practice Fridays. She sees women at our Strongsville facility, which is where we're expanding on the west side, and we'll be expanding on the east side with another uh nurse practitioner physician combo that we'll let our listeners know about. So, anyway, welcome back, Dana.
Dana Leslie:Thank you so much. I'm happy to be back.
Dr. Holly Thacker:So let's just start off talking about um if if a woman is gonna go on some sort of contraception for the very first time or decides to make a switch, uh, what should be their first step or what are some of the things that you talk to ladies about?
Dana Leslie:Absolutely. When it comes to contraception, it really depends on the purpose as to why someone's getting on contraception. There's a lot of different reasons to start contraception outside of just preventing from pregnancy. There's reasons for, you know, you for everywhere from cystic acne to heavy menstrual flow to painful periods to perimenopause. So it's really just figuring out exactly what the person is coming in for, the reasoning that they're getting on the birth control, and then moving from there, like going through their medical history and exactly what would be a good fit for them.
Dr. Holly Thacker:Absolutely. You know, one of the conversations I have so much with my patients that are in late perimenopause, about to be in menopause, who don't need contraception uh for a variety of reasons, tubal ligations, vasectomies, not sexually active, uh, etc. Um, they're like, but I don't need birth control, but it's hormonal control. And I it just amazes me that there's a lot of women who come in. I don't know if it's because of everything on social media, but they just want, oh, I want the patch, or I want that bioidentical hormones. And why do you tell them that that that's not the right option for them based on their hormonal status? Exactly.
Dana Leslie:Yeah, we have a lot of patients that are like, well, I don't need birth control. I'm not here for birth control. I need hormonal support, or I want something to help anti-aging as I'm going through this transition and things. Um, and uh, the way I describe it the best is for women that are still having periods or haven't gone through that full 365 days of not having bleeding, their ovaries are still functioning. So you need a different dose of hormonal level to help control that ovarian function so that you're able to successfully get over the symptoms that you're experiencing while also reducing your risk of breakthrough bleeding and spotting.
Dr. Holly Thacker:Yeah, that is so true. And what I also tell women is that even low-dose hormonal contraceptive options, which control the ovaries, which your ovaries are still young enough, they're not functioning right, but they're too still too strong that if you use menopausal hormones, you're probably going to have abnormal bleeding, unless you have an IUD in or you're at that very, very tail, tail end where you know it's just a matter of a few weeks before you you go into menopause, that they're actually getting more hormone. And a lot of times it's actually cheaper. They may not have a copay. So sometimes I think when women hear that, they're a little bit more accepting. Um, but of course, not all women are options for higher dose hormonal contraceptives if they smoke, if they have blood clots, um, if they have other, you know, medical conditions. But a lot of healthy perimenopausal women, whether they need contraception or not, do very well. And I think that those women who are done with childbearing, they've already had their tubal are dismayed because they thought they were just gonna sail right through that process, which doesn't always happen. Correct for sure. So the other day we were talking about some hormonal contraceptive pills that have little twists on them, like being chewable or dissolvable.
Dana Leslie:Absolutely. Yeah, there's a couple different kinds out there on the market now. So the chewable tablet came out, I believe the first one was um FDA approved in 2014. That original pill isn't even on the market anymore because there wasn't such a high demand for it, but it recently has made a retick in, you know, production. Um, there's chewable and dissolvable. They do have flavors with them so that they can taste like spearmint for those people that have a hard time swallowing tablets or swallowing pills. You can chew it. The recommendation is that you drink a whole glass of water after taking the medication to get the absorption. It was interesting, you know, for the chewable tablets, you can chew the tablet or you can swallow it whole. Whereas that dissolvable pet tablet that just came out, that one's the newest one that came out last year in 2024. The manufacturer doesn't list swallowing that tablet whole as an available option that hasn't been studied yet for taking. So it's hesitant to use because if someone accidentally swallows it whole, they say that you should be fine, but it's kind of a murky area. There isn't a lot of research on if you actually take the tablet without letting it dissolve.
Dr. Holly Thacker:I have not had anyone in my practice specifically say that. Now, I know there's lots of people who don't like to swallow big pills. There's people who forget to take pills every day. Um, the only thing that concerns me about the one that dissolves in the mouth is that they think it's a breath mint. Like I'll pop it in before I'm gonna be intimate. But it's not like that. It's not an as-needed thing.
Dana Leslie:Right. Yeah, you still have to take it at the same time every day, just like your other birth control pills.
Dr. Holly Thacker:Yeah, and that is so important, especially with some of the lower dose pills that have a lot more breakthrough bleeding. Do you want to talk about why you might pick certain brands that are better for acne or mood issues versus heavier bleeding versus women that might have be on seizure medicine or have recurrent ovarian cyst or polycystic ovaries that need like high, even higher doses?
Dana Leslie:Absolutely. Yeah. So there's a lot of different reasonings as to why we pick specific pills. If someone's coming in and they want something for their cystic acne, or if they have a condition called PCOS, or if they have elevated androgen levels in their lab work, I like to use a birth control pill that leads with drosperinone, which is a progestin that's in the combination pill. So all of the combination pills have estrogen and progestin in them. There's estrogen and progestin pills, or there's progestin-only pills. There are no estrogen-only birth control pills. There's estrogen-only hormone, hormonal replacement pills, but not for contraception. For contraception, you need the progestin to protect that uterine lining because all these patients have a uterus. So I use typically I really like the yas and the yasmins or the gerosperinone-based progestins in the any type of pill because those seems to do it, seem to do a lot better job with controlling the ovarian function, decreasing the bleeding, and decreasing those other symptoms that women have experienced other than just those heavy menstrual cycles.
Dr. Holly Thacker:Yes, absolutely. But the Yas and BAS and saffron and yasmin, they have ethenolesterdiol, which is synthetic estrogen. One of the newer options that I've been using in some of my perimenopausal patients is Nextelus. It has the same three milligrams of drosperinone, which is about equivalent to 12 and a half of spironolactone for those that are on spironolactone for acne or abnormal hair growth. I see a lot of dermatologists and primary care doctors put women on spiron lactone for acne or hair thinning, androgenic hair thinning. However, if they're pre-menopausal and they're not on something to control their cycle, it can actually cause some cycle abnormalities. So I always like to use the both together, and it's usually not too much as long as there's normal kidney function. But this next stellus has estetrol, which is E4, which is a natural estrogen. And so for women who might not have tolerated other birth control pills, I think that's a good option, particularly if they have skin or hair or mood issues, or they're closer to menopause and want not quite as strong of a synthetic estrogen.
Dana Leslie:Absolutely. Yeah. And now, luckily, those medications are becoming more affordable, which makes it a lot better, too.
Dr. Holly Thacker:Yes, because when they first came out, they weren't. And the other one that I've talked to your colleague, uh, another nurse practitioner in our center, a new mom, Kelsey Kennedy, about abnormal bleeding was all about Nitasia, which was the first birth control pill with natural estradiol in it, formulated. Each pill is slightly different, pretty much almost through the whole pill pack, except for the last two pills, uh, which are dummy pills, formulated to treat abnormal bleeding. And for the longest time, we didn't have very good insurance coverage, but it's it's certainly getting better. And what's interesting about those two pills, especially Natasia, but but even potentially Nextelis, is you can still many times see that increase in the FSH level and measure the estrogen level where you cannot in other birth control pills. And I see so many people order hormones in women on birth control pills, and they're they say, you know, they're not they're not valid at all. And women get confused. Correct. And you were telling me the other day that women ask you a lot for progesterone testing and tell me about that.
Dana Leslie:There is a lot of um buzzword with progesterone testing, and that's not something that we necessarily do in our center. I can personally have never ordered any type of progesterone testing. That's something that we really focus on when people are trying to get pregnant or if they're doing like um intrauterine pregnancy or if they're going through infertility treatments and things like that. But that is not something that we focus on in a perimenopausal or post-menopausal stage of life.
Dr. Holly Thacker:Right. How I tell my patients is if we're worried that you're not on enough progesterone, we want to get a tissue level of progesterone. And the way we do that is an endometrial sampling, which is a little bit more than a pap smear, where we go in and get a sample of that lining of the uterus to look under the microscope. Because if it's proliferative or disordered proliferative or even hyperplasia or cancer, well, then the cat's out of the bag and clearly you haven't had enough progesterone. If it's secretory, it means that you're making enough or taking enough progesterone, or if it's just benign or inactive. So for anyone who's concerned they're not on enough progesterone and they're not in the phase of trying to get pregnant or maintain a pregnancy. I think that's just a lot of hype by some people who really aren't menopause specialists. You know, people like yourself and so many of the people that we have in our center. And I just think that for so long there's been no attention on perimenopause. And now there is, and now everybody is thinking that whatever issue they have, if they're over 30, if they're between 30 and 50, they think it's perimenopause. So, how do you differentiate some of some of that in your practice?
Dana Leslie:Absolutely. There's a lot of it has to be my hormones, which is fair and understood because hormones fluctuate everything, but there's a lot of different hormones outside of just perimenopausal hormones that could be affecting things. So we get a really good medical history. We make sure we see what the family history was like. We I ask about mothers and sisters or siblings that have gone or if they have gone through perimenopause yet. And then we do some lab testing. As long as, like you said, they're not on hormones and they're not on biotin or anything like that, that we can check and get an accurate hormone level. And then I really focus on their bleeding patterns and what those symptoms look like. Because if you're having monthly periods, you're the the question of am I in menopause is out of the window, you know, and then we have to figure out exactly what's going on behind the scenes. And we make sure we're checking the thyroid, make sure we're checking all other aspects to see what exactly is going on instead of it just being solely perimenopause or menopause.
Dr. Holly Thacker:Yeah, I do see a lot of women who have perfectly monthly cycles, they know when they ovulate, sometimes they even have premenstrual symptoms. And I'm like, you can't have menopause and PMS. Now, it is possible to sometimes ovulate and have premenstrual symptoms and then not ovulate and have hot flashes and perimenopause. And so that can happen. But people who just are completely perfectly normal, nothing has changed about their cycle, and they're complaining about things. It makes me wonder: do they have a vitamin deficiency, a sleep disturbance, some psychosocial stress, do they have sleep apnea, do they have some other undiagnosed medical problem? Because I've seen women with fibromyalgia, lung cancer, all sorts of different serious conditions who had regular cycles who went to some outside practitioner and they gave them a pellet and superdoses of hormones. So, so tell me how you deal with the women that are coming in with these pellets.
Dana Leslie:So, you know, there is a population of people out there that swear by their pellets, and that's awesome for them. Pellets aren't FDA approved. We do not do them in our center, we do not promote them. They give you a huge burst of hormones, specifically, typically it's testosterone, and then you can have a huge androgen excess. So people can come in with facial hair growth, changes in their voice, changes in body structure. There's a lot of different negative side effects that we see often. So we stay away from pellets. You inject something, you're stuck with it for three months, you have no control over what happens after that, and they're not FDA approved or regulated. So we really don't use those at all.
Dr. Holly Thacker:Yes, that is for sure. And I think that anytime you boost hormones, just like when sometimes people take prednisone or steroids for some rheumatic condition, oh, there's a boost of energy. Yes. I had to take uh some systemic steroids a few years ago, and I'm like, I feel like I'm 20. I have all this energy, I don't feel anything in my joints. But long term, you that's just not sustainable. And um having a higher level of testosterone than is appropriate for a female can really cause long-term irreversible effects. And what women need if they are truly low in estrogen is estrogen. They don't, they may or may not need testosterone, and we certainly prescribe lower doses of either oral or transdermal topical uh testosterone in those women that need it. But um I think it's definitely abuse. And I think a lot of women get tired of paying the money and having abnormal bleeding and then they show up in our office. And there is like an addiction tachyphylaxis. If you get used to these really high burst of hormones, um it takes like more and more to kind of reach that peak, and then that causes havoc on your breast, your uterus. Um, it's just it's not sustainable. And we have so many other options that people don't have to suffer that it's really a shame that um so much of the care that's cash-based uh by people who really are not certified menopause practitioners, what they're what they're doing. Yeah. So you have been listening to the Speaking and Women's Health podcast. I'm your host, Dr. Holly Thacker, the executive director of speaking and women's health, and I am with nurse practitioner uh Dana Leslie. We've been talking about uh contraception, and we're gonna move into STDs, but before we leave, um contraceptives, do you want to make any comments about intrauterine systems, implants, diaphragms, condoms?
Dana Leslie:Absolutely. Yeah, so the biggest thing that um, you know, the Marina IUD came out with some new research that now it is good for eight years from a contraceptive standpoint. And I think the biggest misconception, especially in our practice, is that that IUD can stay in for eight years for endometrial protection. And that's not true. We could only use it for five years for endometrial protection. So even though it's good for eight years for birth control, then you but you still need something after that five-year mark to help protect you if you're on an estrogen to help with perimenopausal symptoms.
Dr. Holly Thacker:Yeah, I really like to get people at the five-year mark, have it switched out as as they're getting older, especially if they've got any risk for uterine cancer or abnormal bleeding, and it's only FDA approved to manage abnormal bleeding as well for five years, whether or not you're adding the the estrogen patch or not. Um, and I've seen some decidual tissue in people up to eight years. So personally, I, if I was using it for contraception, would want it out at seven years, but um yeah, they have kept pushing it back. And tell us about there's an over-the-counter progesterone-only contraceptive. Tell us about that.
Dana Leslie:Yeah, so the over-the-counter progesterone only, those are your north endrones. We prescribe them often in the office, but now they're giving people the options to get them without going to the doctor's office for people with less insurance, or for whatever reason, if they don't feel comfortable talking to their provider about contraception. The North Indrones do a really good job of preventing pregnancy as long as you're taking them at the same time every day. Northindrones do have an increased risk of breakthrough bleeding and spotting, and they have a very narrow window of how far off you can divert from that hourly mark when you're taking it before they start to have where you can you still ovulate with the north endrones. They don't manipulate the ovarian function. They work more on the mucus and the lining to help prevent pregnancy. And they're typically pretty expensive. So if you have insurance, it's not a if you feel comfortable, it's not a bad idea to talk to your provider or your practitioner because those in the um over-the-counters, they I think they're about $50 a month from last I checked. But um, they they do work well if that's what you have and that's your option, that's great. But they can be a little pricey and they're not always the best option.
Dr. Holly Thacker:Yes, certainly. And they they probably wouldn't help skin and hair, although the newest progestant only that's by prescription, SLInd, is one of my favorite. It's four milligrams of drosperinone, which doesn't raise blood pressure, and it seems a lot stronger. I do see FSH suppression, so I think it's a better contraceptive. And uh sometimes it's not really a progestant, it's similar to spironolactone, and so it's not really a C19 um derivative. So I think there's a lot of women who tolerate that that better.
Dana Leslie:Yeah, absolutely. And just like those other um birth controls we talked about, since it's becoming more popular, the price of it has gotten a lot more reasonable, which is nice because it's a great product.
Dr. Holly Thacker:Yes, yes. So um any any comments about implants, about who might want a copper IUD as opposed to a progesterone IUD?
Dana Leslie:Yeah, absolutely. Some people um feel like they have a very strong sensitivity to any type of hormonal fluctuation. So a lot of times then then we can recommend the copper IUD. The copper IUD is good for 10 years, it's strictly pregnancy prevention. It doesn't have a positive effect on the the cycles. Typically, your periods get heavier, at least for the first six months with the copper IUD, because of a fore body being in the uterus. Um, but other than that, it's strictly just for pregnancy prevention, and that's good for 10 years. The next planon is good for three years. It's goes, it's a small rod that goes into the arm. It's about the size of a matchstick. Um, that's they those are all very efficacious for pregnancy prevention. My biggest side effect that I see with my patients with the Nexplanon, it's very hit or miss. So some people love it, have had a year through every three years, get it exchanged and they do perfect. Other people have a lot of abnormal bleeding, so they like it out and they want a different option.
Dr. Holly Thacker:I think for people who want an option but they don't want something put in their uterus, um, one option that I use, and I actually prefer it over the moraine, even if they don't have an objection to an IUD. But if they need ovarian suppression to reduce their risk of ovarian cancer, like we have BRCA patients who are not quite old enough to have their ovaries out and they don't want two surgeries. Some people go get the tubes out to reduce ovarian cancer, but keep their ovaries until their late 30s or depending on if it's BRCA1 or two, their family history by age 40 or done with childbearing, then they take the ovaries out and hopefully the uterus. But while they may need contraception, which a morena would give, it doesn't reduce ovarian cancer like hormonal estrogen progestins do. So I like the annovera ring that has enough hormones to last the whole year. So someone who's busy, shift worker, doesn't, you know, want something implanted in their skin, wants the suppression to reduce ovarian cancer, uh, they can just slip that ring in. And even though it's packaged to come out for a week, like the Nuva ring, rinsed off and the same ring put back in, it really can stay in the whole time and um last a whole year. So um that's a little niche that I I I don't see. I don't know how many if w women just don't know about that option. But anyone who's been a long-term Nuva ring option, those rings only last for three weeks, and then you have to throw it away and get a new one. Absolutely, yes. So switching gears a bit, uh let's talk about in-home S STI testing. What is an STI test?
Dana Leslie:Absolutely. STI tests are swabs that we do to check for gonnery and chlamydia primarily. When you're in the office, we do the swabs that we do are a little bit more involved and a little bit more detailed, but the home kits currently are testing for gonneria and chlamydia. They're a great option for people that are don't have a lot of access or um are nervous to ask for the FCD screening when they're in the office or whatever reason, personal or whatever, that they don't want to get it done in a private in a um uh office setting. They are efficacious, they do just as well as detecting gonorrhea and chlamydia. The issue in the hiccup comes with transportation and packaging and making sure that once the swab's completed, you're putting it back in that test tube and getting it off into the mail as fast as you're able to to make sure that it gets sent in a timely fashion so that there's no false positives or false negatives that are detected with the lab work once it gets ran.
Dr. Holly Thacker:And so then do they notify the patient who's purchased this over-the-counter device directly if if if it's abnormal or if it's it's negative, and then they're told to contact a healthcare clinician to actually order the appropriate prescriptions?
Dana Leslie:Absolutely. And I believe a lot of the programs now or a lot of the systems that are doing this even have like their virtual their virtual practitioners that they can make an appointment with to get these prescriptions and go over that with them.
Dr. Holly Thacker:Now, there's it depends on, I'm sure, state law, and you know, we're practicing in the state of Ohio, but uh not too long ago, one of our fellows uh prescribed uh S STI treatment for her patient and a male partner, and the pharmacist had called for some question about it, and one of our nurses was upset. Why why is one of our women's health doctors who only sees women prescribing for a man? This doesn't make sense. Did she just not get it right? But it was very specific about applying something to the penis, so clearly it was instructions for a man. And um, I told her, Well, you can do that, you're allowed by state law to prescribe for someone you haven't seen if that's a sexual partner.
Dana Leslie:Absolutely. Yeah, it's called expedited patient treatment, so or expedited partner treatment, excuse me. In the state of Ohio, we're legally allowed to prescribe for the patient's uh partner if they aren't able to get in or if it's easier just to get them a quicker treatment and then they can get tested uh afterwards, after about three months after treatment to make sure that it's cleared up.
Dr. Holly Thacker:And I think it's important for people to know about antibiotic allergies. And I think ideally it's better to see a healthcare clinician in person. Um, and it's possible that the partner could have other things too that might need to be treated and be instructed on, you know, risk reduction, perhaps even HIV testing, which is of course one of the more serious uh sexually transmitted infections. Um but um any other comments about about treating women, why you want to treat young women who have sexually transmitted infections and not just let that fester?
Dana Leslie:Absolutely. So the CDC recommends that women that are sexually active under age 25 get screened every year. And then after that, at least every three years, for sure, uh depending on, you know, risk behaviors and things like that. Um, we I like to go, I ask every single patient when they come in if they want STD screening because you never know. And some people just like to know and to make sure in the back of their head that they are okay in that department. Most of the symptoms of STDs are silent, which is why we really want to get those screenings done because the long-term effects can scar fallopian tubes, which can cause issues with infertility in the future. Also, it can cause issues with the cervix, causing different um pelvic inflammatory disease symptoms, and can in the long run become very painful and very problematic for patients if they don't get them treated.
Dr. Holly Thacker:And it can certainly affect fertility, you know, scarring the tubes, causing ectopic uh pregnancies, um, which can be deadly actually. Uh, talking about self-screening, um, talk a little bit about HPV human papillomavirus uh home testing and where you might recommend that.
Dana Leslie:Yeah, so back in 2024, I believe in July of 2024, the FDA approved the first self-suab pap smear or HPV detection. So it's still in the United States, it's still only approved to do in an office. They don't recommend it after there's no like home kit yet. Um, but the patient comes into the office. These are, I use this specifically for people that aren't currently sexually active, have maybe never been sexually active, are nervous, have uh traumatic experiences with pelvic exams or whatever their medical history will be, and they just do not tolerate speculum exams. There are swabs that you put into the vagina, you insert it about two inches into the vagina, and then you turn it or move it around for 20 to 30 seconds, and then you put it into the test, the tubes, and send it off to the lab. It specifically is testing for HPV, which is the virus that leads to most cervical cancers, and it can reflex the cytology. However, their cytology the cytology isn't as accurate as what your typical PAP smear is, but it at least can detect those high-risk HPVs, and we can get a lot of people that have CIN2 and lesser have a good idea of exactly what we're dealing with, so we can get them the adequate treatment that they need.
Dr. Holly Thacker:Now, one thing I've been seeing a lot of, uh I mean, I think that the co-testing, if you're over 30, with both the PAP smear to look at the cells, which is a scrape of the cervix with a brush and a spatula, spatula first, then the brush, um, is and and HPV testing is better than just HPV testing for sure, but you know, something is better than nothing. And I've seen a lot of women who, you know, follow instruction, they have insurance, they don't have any problem with coming in and getting, you know, a pelvic exam. But they're so far arrears in their PAP. And um, you know, a lot of them say, well, I was told I don't need it or I can do it every five years. Do you want to talk about how what our practice is like?
Dana Leslie:Yeah, yeah, absolutely. You know, a lot of people also don't know. So they think that just because whatever clinic that they went to in the past, or whoever they saw didn't contact them, or they didn't read it out, or they never saw anything, that they have to be absolutely normal and everything was negative, everything was fine. A lot of people don't realize that they have had a positive HPV in the past, or they did have some atypical cells on their PAP smear. So everyone's guidelines are a little different. You know, most insurances cover your PAP to be done every single year. Um the guidelines currently still are at every five years. However, I personally practice, and in our practice, we do every three years. I see a lot happen between three and five that I don't like waiting, and I've had enough experiences where we've caught things because we've done it in three years that it doesn't seem logical to do it in five years, in my perspective. I do have some patients that do not want it in three years, and that's absolutely right, 100%. But I do recommend getting it done at least every three years. If you've ever had an abnormality, I like to do a PAP every year for at least three normal consecutive years in a row. If they're normal negative for those three years, then we can go back to that every three-year screening. Someone that says, Oh, I had a leap 10 years ago, I don't need it anymore. Depending on what that cytology looked like prior to that leap, you still probably need a PAP every year until 65, if not older. So there's a lot of miscommunication and misinterpretation between, well, it happened in my 20s. It doesn't matter anymore. And that's absolutely not the case, especially with PAP SNEARS.
Dr. Holly Thacker:And the immune status, too, you know, for patients that are on uh immunosuppressant medicines are transplant patients, uh patients that might be daughters of uh women who took DES during pregnancy, they may need yearly PAPS indefinitely. And so one size doesn't fit all, and um it just annoys me when someone goes and gets a pelvic exam and it's been four uh years and a few months since their last PAP and they don't get it, and the patient thinks because a speculum was put in and they had a bimanual exam that oh, that was their PAP, which is very different than just getting a pelvic exam. So I think a yearly checkup, whether you're examined or not, whether you get a PAP or not, is really important overall because there's so many changing uh guidelines. So tell us how can people see you who want to see you at main campus or uh at your new Strongsville location.
Dana Leslie:Absolutely. So there's a couple different avenues. You know, we have Sarah who took the place of Ronda when Miss Ronda retired. Um and we can contact her. She I know there's a new number out for them now, but I always give everybody the 216-444-6601 to get a scheduling appointment. And then, you know, if you've seen me in the past ever, you can always schedule through my chart as well. And it typically about a week or a couple weeks or so typically to get in, depending on what that schedule looks like. I always tell my patients too, if they're having a hard time, try to really call our secretaries or schedulers because it seems like patients fall off a lot or cancel, and there's a lot of same-day openings. If they're able to make it in that day, they could get in a lot sooner.
Dr. Holly Thacker:And you're the best, you know. If I ask you, oh, can you see this patient? They're from, you know, another state. You're just so terrific.
Dana Leslie:Well, you're awesome and you make it easy. So it's easy to do.
Dr. Holly Thacker:Well, thank you so much for joining us on this episode of Speaking of Women's Health. If you've enjoyed it, give us a five-star rating. Uh, send it to your friends. And if you don't already follow or subscribe or collect this free podcast, please do that. And remember, be strong, be healthy, and be in charge. And we'll see you next time.
