Good health habits for women of every age

What every woman needs to do to protect her health through the decades

kgarloch@charlotteobserver.comOctober 8, 2012 

  • Final notes As always, discuss specific concerns with your doctor. Individuals may have risk factors or family histories that would change the timing or frequency of recommendations for medical tests. And don’t save up a year’s worth of concerns for your annual physical exam. Doctors have limited time to do the necessary checks during a “well” visit, said Dr. Alyse Kelly-Jones of Mintview Obstetrics & Gynecology in Charlotte. A separate “medical” visit should be scheduled for a more complicated discussion of a problem such as sexual dysfunction or hormone replacement. “You can do one or the other, but you can’t do both,” she said.

Health needs change as women age. But there’s one message doctors consistently preach – prevention.

“If I could have a plea for anything, it would be to stress a healthy lifestyle,” said Dr. Jill Rabassa, a family physician with Meridian Medical Group in Charlotte. “We have very poor health habits in this country. As opposed to treating someone for a disease, my big focus is on preventing it in the first place.”

Based on conversations with doctors, here’s a list of health guidelines for women.

In your 20s

• Establish good habits. Eat nutritious foods, keep a healthy weight, exercise, don’t smoke, and drink alcohol in moderation. “The No. 1 problem in my practice today is obesity,” Rabassa said. Becoming overweight as a young adult is “setting the table for the rest of your life.”

• For general health, get checked for blood pressure, cholesterol, thyroid hormone and blood sugar. Consider vaccinations against influenza, tetanus-diphtheria-pertussis, human papilloma virus and meningococcal disease.

• At 21, start having an annual pelvic exam and a Pap smear every two years for detection of cervical cancer. Perform monthly breast self-exams and get breast exams by a doctor every three years.

• If you’re sexually active, get tested for sexually transmitted diseases, such as HIV, syphilis, gonorrhea, chlamydia and hepatitis C. Limit the number of sexual partners and “don’t have unprotected sex with anybody you’re not married to,” said Dr. Beth Perry, an internist with Signature Healthcare in Charlotte.

• If you’re trying to avoid pregnancy, talk to your doctor about which contraceptive method is right for you. If you’re trying to get pregnant, take prenatal vitamins, including folic acid.

• Wear sunscreen. “We have an epidemic of melanoma in young women,” Rabassa said. “Tanning salons are not safe.”

• The leading cause of death in this age group is “unintentional injuries.” Don’t drink and drive, and don’t ride with someone who does. Avoid distractions, such as texting, while driving.

In your 30s

• All of the advice for women in their 20s remains valid.

• Fertility begins to wane after 35. If you’ve delayed pregnancy, you may need to see a reproductive endocrinologist.

• If you’re monogamous and have had several normal Pap smears, you can spread out these tests to every two or three years.

• Step up exercise to manage stress, prevent muscle loss and maintain a healthy weight.

In your 40s

• Get a baseline mammogram. Some doctors recommend mammograms every year or two starting at 40, but this has become controversial because the U.S. Preventive Services Task Force recommends waiting until 50 for routine mammograms.

“A well-informed patient can make their own decision about this,” said Dr. Cristy Page, director of the residency program at UNC Family Medicine in Chapel Hill. She makes sure patients understand that mammograms at this age often produce false positive test results.

• Pregnancy becomes higher risk, with a higher rate of birth defects. Talk to your doctor about these issues.

• Perimenopause may begin in the mid- to late-40s. Consider drug or herbal therapies to relieve symptoms, such as insomnia, hot flashes, mood swings and decreased libido. Hormone replacement therapy can be associated with an increased risk of heart disease, blood clots and breast cancer, but many doctors recommend HRT for at least a few years to alleviate symptoms.

• Consider flu shots annually and a DPT booster every 10 years.

• Prevent cardiovascular disease by getting blood pressure, cholesterol and diabetes screening, particularly if you’re overweight or have family history of heart disease.

• Continue exercising to prevent heart disease, osteoporosis and depression. “Women tend to become a little bit more sedentary” in their 40s, Perry said.

In your 50s

• Heart disease risk increases after menopause. Continue to get blood pressure, cholesterol and blood sugar checks. If you haven’t had discussions about treating menopausal symptoms, do that now.

• Time for the first colonoscopy – and then one every 10 years – to prevent colon cancer. “It’s the thing that no one wants to do, but it’s so important,” Page said.

• Routine mammograms – every one or two years – are widely recommended.

• Start paying more attention to bone health by taking supplemental calcium and vitamin D. Continue weight-bearing exercise to keep your bones strong.

In your 60s

• Redouble efforts to prevent heart disease and osteoporosis. “Eighty percent of the risk of cardiovascular disease is modifiable with lifestyle change,” Perry said. “Maintain a healthy weight. Follow a healthy diet. Exercise.”

• Pap smears can stop after 65.

• In addition to an annual flu vaccine, consider a shingles vaccine and a pneumonia vaccine.

• Stay socially active. If you retire, begin volunteering or other work that gives life some structure. “It’s a good time to start preparing for aging well,” Page said.

In your 70s and beyond

• Continue to exercise to preserve balance and bone health.

• Prevent falls by removing area rugs and putting up safety rails in your home, if appropriate.

• If you haven’t already, make out a living will and appoint a health care power of attorney.

“Having the conversations (with your doctor and family) when you’re healthy is really helpful,” Page said. “Dying well is important, and being respected when you can’t advocate for yourself is important.” Talks about your expectations for care – or discontinuing care – near the end of life are key. Otherwise, your family won’t know what to do.

Garloch: 704-358-5078

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