May is a busy month indeed with all the spring activities, graduations and Mother’s Day. It is also Women’s Health Month which puts a spotlight on the important things women need to do to stay healthy. I would like to outline the recommendations for healthy behaviors and screening for women. First, we should look at our lifestyle choices. Women as well as men should exercise a minimum of 30 minutes every day, follow a healthy diet like the Mediterranean eating style, maintain a healthy weight, limit alcohol and not smoke.
There are many screening tests that women should do according to their age and health history. Blood pressure and BMI should be checked at least every two years. For younger women, testing for Chlamydia infection should be done yearly once they become sexually active through 30 depending on personal risk. Pap smear testing begins at age 21 and is repeated every three years if normal. Testing for the human papilloma virus (HPV) is routinely done with the Pap smear starting at age 30 until age 65. If both pap and HPV are negative, Pap smears may be done every five years in low risk women. Pap smears are not recommended for women who had a hysterectomy for benign reasons such as fibroids. Testing for syphilis and gonorrhea are done according to the person’s risk for contracting a sexually transmitted illness. HIV testing should be done at least once in a lifetime.
Mammograms are recommended every one to two years for average risk women ages 50-74. Some providers will recommend starting mammograms at 40. Testing for osteoporosis is recommended at age 65 unless there is increase risk for bone loss such as hyperthyroidism or steroid usage.
Additional screening tests for cancer include colonoscopy for women starting at age 50 and repeated every 10 years unless an abnormality is found. Low dose Chest CT screening for lung cancer is indicated for women age 55- 80 who have at least a 30-pack, per-year history of smoking. Pack years are calculated by multiplying the average number of packs of cigarettes smoked daily by the number of years of smoking- for example a woman who smoked one pack of cigarettes daily for 10 years has a 10 pack year history and would not benefit from this screening test. Women with a 30 pack year history or greater are eligible for the test if they are still smoking or have stopped within the last 15 years.
The US Preventive Services Task Force recommends testing for diabetes at any age if blood pressure is >135/80 and in other high risk settings. Lipid testing should be done according to risks such as family history. Screening blood test for Hepatitis C should be done once in women born between 1945 and 1965.
Each woman should be screened for depression and also interpersonal violence such as domestic violence or date rape. Unfortunately, South Carolina is ranked second in the nation for the rate of women being killed by men they once loved. Fifty women died in this state last year from interpersonal violence which is double the national average. Officials estimate that one in two young women experience some level of abuse in dating relationships.
Women should also discuss reproductive health issues with their health provider. Younger women should discuss the best contraception method. They should also supplement with folic acid 400- 800 mg a day to prevent neural tube defects in their offspring whether they are contemplating a pregnancy or not. Older women face issues of perimenopause and menopause.
Immunizations are very important for everyone. There are several vaccines to prevent high risk HPV infections. These vaccines are indicated at ages 11-26. These vaccines help to prevent cervical cancer. Every adult should receive a Tdap to prevent tetanus and also whooping cough (pertussis). This immunization is particularly important around the birth of children since babies do not do well with pertussis. Pneumonia shots are important at age 65 or earlier for those with particular risk factors such as smoking, diabetes or asthma. There are now two vaccines available and you should discuss the appropriate schedule with your primary care provider. The shingles shot (Zostavax) is recommended particularly after 50 years of age.
There are many issues to explore with your healthcare provider to maintain your health. I have outlined the standard screening recommendations. Many women have particular circumstances that would require additional screening tests. The best way to identify the proper screening tests for you is to have an annual wellness exam with your healthcare provider. You can prepare for this visit by visiting www.womenshealth.gov . Please go to this site and sign the pledge to make a healthy change right now.
By: Dr. Valerie Scott, board certified family medicine doctor with Mt. Pleasant Family Practice and a Roper St. Francis Physician Wellness Champion.