This week I listened to a free lecture series by JOWMA, the Jewish Orthodox Women’s Medical Association. I thought I’d recap a bit of what was presented as far as it related to single women. This is by no means comprehensive, nor is it medical advice and should not take the place of having a conversation with your doctor. However, I think that singles in the frum community are more likely than married women to fall through the cracks in terms of having access to age-appropriate information, and I hope that this is a helpful starting point for some of you, or helps to clarify some things. Also, I’m going to use straightforward (mature) language, as I think that’s the most helpful, so heads up.
These are notes from the webinars; reminder that this does not constitute medical advice or a substitute for the same.
-All adult women should see a gynecologist yearly by or before age 21, even if they are single and have not been sexually active. The gynecologist will do a pelvic examination, which is an exam of your reproductive organs, for any abnormalities. All women should get a Pap smear starting at age 21, even if they have not been sexually active. A Pap smear is a sample of cells from your cervix that are screened for abnormalities that can be a sign of cervical cancer. Additionally, the gynecologist will do a breast exam to check for any lumps or abnormalities. (Self-exams tend to not be very helpful, but you should have an idea of what normal feels like for your body). If your doctor has a concern, she will send you for imaging, such as ultrasound.
-Menstrual cycles/periods within the range of normal are 24-35 days. The way you count your periods is from the first day of one to the first day of the next. You can keep track in a calendar or an app. Anything longer or shorter than that should be brought up with your doctor. Unusually heavy or light bleeding, or pain in the pelvic area, should also be brought up with your doctor.
-If you are Ashkenazi (or even part Ashkenazi) or if you have a family history of breast cancer, especially at a young age, your doctor will more likely than not refer you to a genetic counselor to talk about testing for the BRCA mutations, which are mutations of the genes that suppress certain tumors and make the likelihood of developing breast or ovarian cancer in your lifetime much higher. Obviously the decision to test is very sensitive and personal. If someone tests positive for a BRCA mutation, there are a number of preventative measures they can take, ranging from heightened surveillance, such as imaging every 6-12 months from a young age, to surgery to remove the breast tissue. Your doctor can refer you to a breast specialist who will develop your prevention plan with you.
-Fertility preservation/egg freezing. This is big topic and frankly what caught my eye in the JOWMA ads to begin with. I think this is really valuable information for single women and I hope this breakdown is helpful.
As women age, the number of eggs and the quality of those eggs (meaning how likely they are to form embryos and develop into babies) decreases. If a woman is single and wants to start a family one day, she can preserve her own eggs to use later on, a process known as egg freezing. The best time to do this is before the quantity and quality of eggs start to decrease at around age 35 — so by the low 30’s — although women older than this certainly can go through this process successfully. Eggs harvested at a younger age are more likely to result in a healthy pregnancy in the future. Egg freezing is done in a fertility clinic under a reproductive endocrinologist (such as at Extend Fertility, where the doctor who gave this talk works). The doctor will examine the health of your ovaries and your ovarian reserves, prescribe medication that will stimulate your ovaries to develop more eggs, monitor the development of the eggs, and then retrieve them via needle (you’d have anesthesia). The eggs are then prepared for storage and stored until they are ready to be fertilized. They can be safely stored for many years. If used, the eggs are fertilized using IVF (meaning, outside of your body) and then the fertilized egg (embryo) is implanted in your uterus. If you want to increase the chances of becoming pregnant successfully with the stored eggs, or of having multiple pregnancies with them, you can choose to do a second cycle to retrieve additional eggs. Your doctor will help you figure out if that’s recommended in order to achieve your goals. Unfortunately, there is no guarantee that any number of stored eggs will result in a pregnancy, but there is data on the likelihood of getting pregnant with stored eggs based on the number of eggs stored and at what age. The process can be pretty pricey (like in the $10,000-$20,000 range), but many clinics have payment plans and there may also be funding or loans available through nonprofit organizations like Bonei Olam. Egg retrieval does not deplete your egg supply more quickly; the medications you take at the beginning of the process just ensure that more eggs develop fully than typically do during a menstrual cycle. Every cycle, multiple eggs begin developing but most die off and only one is ovulated, or released from your ovaries — so in this case, all those eggs are given a boost to complete their development so they can be retrieved.
I hope this is helpful! Check out JOWMA’s website and of course if you have questions, comments, or helpful information, please share!
