One thing we can never stop or change is aging. And while it may bring us increased confidence and accomplishments, it does have some unwanted side effects: the aches, the pains, the wrinkles, and the grays. The maintenance alone can become a full-time job. And the cosmetic side is the least of it. Doctor’s visits go from twice a year to twice a month and, in some cases, twice a week. Arthritis sets in, blood pressure creeps up, weight becomes hard to shed, and hearing goes downhill. Sounds like a ball of laughs.
But the reality is that we women are kicking aging’s behind. We are living longer and longer, and today, the life expectancy for a woman in the US is 81. Go, girls, go! One of the ways to make sure you make it to 80 and beyond is to maintain good preventative care (a.k.a. see your doctor when you don’t feel sick) and follow health screening recommendations, as outlined by the ACOG (American Congress of Obstetricians and Gynecologists) and the U.S Preventative Services Task Force.
Here’s what is on our list of things to do for women who are over 40 each year.
The majority of what we as MDs do is talk (wait, all those years of training, and we mostly talk?). In all seriousness, we can make a pretty good assessment of a woman’s overall health just from chatting with her. It’s all about knowing which questions to ask and how to listen.
- Physical Exam
Although no one likes the check-up part, it is a must. Getting into that gown and being weighed, poked, and prodded are no one’s idea of a fun day off. However, it is important that someone gives you a good onceover at least once a year to make sure nothing is out of place.
- Breast Exam
An annual breast exam (a.k.a. the clinical breast exam) should be performed each year. It might surprise you to know that we, as MDs, can feel lumps and bumps that are really tiny and may go undetected by your monthly self-breast exams. While our exam does not replace a mammogram, it is definitely an important yearly checkpoint.
Recently mammogram screening has become more controversial than if you’re going red or blue during an election year. The U.S. Preventative Task Force changed their recommendations and no longer recommend that mammograms start at age 40 or occur every year—they now recommend a screening mammogram (in a woman with no personal or family history) at age 50. If all is ok, they want to see you back two years later. The every-two-year schedule (as opposed to the traditional every one year) will stay as long as nothing notable is noted (say that five times fast!). However, many, such as the ACOG, are going old school and recommend you start at 40 and go every year to your friend the mammographer. We tend to side with the ACOG on this one and still advise our patients to follow the more traditional screening protocol. Of note, family histories matter big time on this one. You may need to be screened even before 40 if your sis or your mom had early breast cancer. So be certain to share this info with your MD!
Once you hit the big 5-0, it’s time to get cleaned out and checked out! Colorectal cancer screening in the form of colonoscopies should begin at age 50 (unless you have a family or personal history that requires an earlier exam). In most cases, the intestines are inspected every five years.
- Bone Mineral Density Test
In many ways, our bones resemble our ovaries—time is not on their side! As women age, their bones are prone to breakage and fracture. This condition is called osteoporosis, and it is fueled by low estrogen, low vitamin D/calcium, and age. Most women start getting bone mineral density testing (a.k.a. DEXA) starting at age 65. However, women with risk factors (think a family history of osteoporosis, history of fractures, or an elevated risk assessment on what is called the FRAX test) need to dial up the DEXA testing.
- Cervical Cancer Screening
Pap smears are like the never-ending story—they just keep on going. However, the good news is that, due to a revamping of Pap smear guidelines, at some point most women can close the chapter on Pap smears. Women between the ages of 30 and 65 can hold off on Pap smears for five years if both cytology and HPV testing are done together and are negative. If you have passed the 65 mark, you may be done with Pap smears. What dictates where your finish line is, is your Pap smear history. It’s important to keep track of your tests (especially if you switch GYNs) and stay in touch with your GYN so that you know when you can throw in the cervical cancer-screening towel.
- Cholesterol Testing
No matter how much you weigh, how much you eat, or how much you exercise, it’s important to check your cholesterol. Although obesity and a diet high in fats make you more prone to high cholesterol, there are genetic conditions that can predispose even the healthiest of us to cholesterol abnormalities. We have a whole slew of good medications to manage cholesterol, and therefore, the sooner you know, the sooner you can start treatment. Anyone who is above the age of 45 (or younger than 45 but with risk factors for heart disease) needs to sit in the blood-draw chair for a cholesterol check at least once every five years.
- Blood Pressure
When it comes to blood pressure, higher is not better. Here, less is more. Elevated blood pressure is a predictor of heart disease and many not-fun medical conditions. It should be checked at the least every two years, if not every year. Don’t let the white coat scare you; it’s all good!
Diabetes is no joke. If untreated, it can have some of the most devastating medical complications, from blindness to limb loss. Being checked for diabetes should be at the top of everyone’s list. A simple blood test checking your glucose level will give us a hint as to how “sweet” things are. It’s important to be screened diabetes in a regular fashion (particularly if you have a family history of diabetes, elevated blood pressure, and obesity).
- STDs (a.k.a. gonorrhea and chlamydia)
Just because you are not 23 does not mean you can’t acquire a sexually transmitted infection! For this reason, women who are sexually active should have STD testing (gonorrhea and chlamydia).
All women should have HIV testing at least once in their lifetime. If you are in a high-risk category (certain behavior patterns), the testing should be done more than once.
We are not all the same. Our genetics and our environments differ big time. Your doctor will decide based on your past (and your family’s past) what tests should be done yearly to maintain your present. However, the only way this will work well—and allow your GYN to tailor a treatment plan to prevent what may lie in your path—is to be honest with your GYN. We need to know it all to know what tests need to be run.
The list may seem long, but checking the boxes can be pretty quick. We can tackle a lot of the issues at once at your yearly visit. Don’t brush us off because it seems like no big deal. Yearly checkups, preventative care, and screening can be the key to longevity. You’ll take that 81 and see you 10 more!