By Dr. Jessica Blumenthal, board-certified Ob/Gyn at Carolina Women’s Health Associates
Women’s health needs and risk factors change through the decades. Taking care of ourselves at every age – beginning in our youth – strongly impacts our health in the midlife and later years.
Childhood – Adolescence: From our skin to our bones, what we do in these has a direct impact on health or problems in later years. Unfortunately, it is difficult for young people to imagine a future when today’s actions result in problems 30 years or more in the future. So parents must monitor and encourage healthy behavior during these formative years.
Every sunburn through childhood and adolescence increases the risk for skin cancers later in life. And that sun over time will result in earlier and deeper wrinkles – something everyone would like to avoid! Tanning beds have the same risks as sun exposure. Protecting with sunscreen, shading and clothing can decrease these risks.
Bone is living tissue and the bone mass we develop in the first 25 years of our life is the foundation for our entire life. After 25- 29 years of age, we no longer add bone, but must continue calcium and vitamin D intake and exercise to maintain the bone already developed.
A newer development is the increase in heart disease in children. While most heart disease is related to obesity (caused by poor nutrition and lack of exercise), plaque in the arteries has been seen in youth who are not overweight. Routine screening for cholesterol is starting at a younger age. Decreasing processed and high fat foods (like fast food) can decrease the risk. Substituting a Mediterranean-style diet which includes fresh fruits and vegetables, fish 2-3 times per week and whole grains can make a healthy difference.
Immunizations are a crucial factor in long-term health. Some deadly diseases have essentially disappeared with the worldwide use of vaccines. Some controversy continues to surround the use of vaccines, but the claims have not been supported through multiple medical research trials. Vaccinating against human papillomavirus virus (HPV) is the newest recommendation for children. HPV causes most cervical cancer, and this vaccine will dramatically change the number of women who develop this cancer over time.
Ages 20–29: These are prime childbearing years and women should begin regular gynecologic exams. The first Pap test (screening for cervical cancer) should occur at age 21 and then every 1-3 years based on each year’s result. However, a pelvic exam is recommended annually and anytime symptoms of problems appear. While a blood pressure check is recommended yearly and an initial cholesterol test at age 20, a general physical exam may or may not be needed and would be based on the test results and your overall health needs.
Again, because of the risk of skin cancer starting at an early age, women should begin to do a monthly skin check at age 20. Every three years have a healthcare provider check your skin head to toe. When you go for your regular gynecologic exam, that care provider can do the skin check and recommend appropriate follow-up as needed.
If the HPV vaccine was not received previously, it can be considered and given up to age 26. The tetnus-diphtheria vaccine is needed every 10 years so will be repeated once during this decade.
Ages 30–39: The childbearing years continue with women beginning to focus on their overall health and wellbeing. It is time to refocus on bone health; you are no longer adding bone but working to maintain the bone that was built over the first 25 years. It is crucial to take in enough calcium and Vitamin D as well as doing weight-bearing exercise to maintain bone strength and prevent osteoporosis later in life.
All exams and testing continue as before with the addition of a screening thyroid test starting at age 35 to check for endocrinology concerns. This should be repeated every five years.
Ages 40–49: Continued childbearing in the early 40s is becoming increasingly more common and care providers will offer additional testing and possibly closer monitoring of the pregnancy.
Routine mammogram screenings to check for breast cancer are started at age 40 and done every 1-2 years. For some women who are high risk for developing breast cancer, mammograms may have started in their 30s.
For many, this decade brings the first symptoms of menopause, a transition in a woman’s life. While the average age of the last menstrual period is 52, it can occur earlier and the symptoms often begin a few years before and continue for a few years after that last period.
In many ways, this decade continues the patterns of health monitoring set in the 30s. Blood glucose testing is the only new testing recommended, and it starts at age 45 and should be repeated every three years.
Ages 50–59: If you have not experienced menopause before, it will happen in this decade. Some women ease through this transition with minimal symptoms; others will need assistance to manage. There are a variety of medical and non-medical ways to relieve symptoms, so seek out educational opportunities and talk frankly with your healthcare provider about your symptoms and management options to determine your personal plan.
For many women, if you have not already selected a primary care physician, now is the time to make that selection. While your gynecological health needs continue, your overall health and other body systems begin to need more attention. Menopause along with other normal body changes can impact your bones, joints, heart, blood vessels, stomach and intestines.
Colon health becomes a focus at the start of this decade. Fecal occult blood testing is started and done yearly, rectal exams are included in physical exams and 50 is the recommended age for the first colonoscopy. This test is one many dread, but in reality is a quick and easy procedure. What most people find the least appealing is the preparation for the test, a cleansing of the system! The good news is as long as the test results are good, it is only repeated every 10 years!
Bone density testing is often done following menopause. It is a simple test with no discomfort at all. The test looks at the density of the bones in your lower spine and hips. Both are analyzed and if your score is below a certain point, you may be a candidate for medication to help add bone. Again, continuing calcium, vitamin D and weight-bearing exercise is essential.
Ages 60 and beyond: Another new vaccine is available to be considered at age 60 and discussed with your doctor. The herpes zoster vaccine to prevent shingles can be given only once if you and your doctor decide it is right for you. You can choose to have it at any point after age 60.
If you have not had a bone density test before, one is recommended at age 65 and then repeated as determined by your results or recommended by your healthcare provider. If you are on medication for bone strengthening, your care provider will follow your status about every 2-3 years with a repeat of this test.
All other testing and routine vaccines will continue. You and your care provider will continue to discuss your health and options you have at each milestone along the way. Keeping preventive health as a goal, we hope you will be able to avoid health problems and enjoy an active, healthy life.
Carolina Women’s Health Associates is your total partner in women’s healthcare. Carolina Women’s Health Associates is located in Salisbury and China Grove. To learn more, call 704-636-9270.