Checklist for health: Tips for women of all ages

Women in different age groups are disproportionately impacted by a number of health issues, including metabolic disorders, cardiac disease, gender-specific cancers, mood disorders and osteoporosis.

Though there are age-specific healthcare recommendations, women of all ages should have an annual preventive healthcare visit, or a well-woman exam. It’s an opportunity to be assessed by your women’s health specialist for the following:

• General well being
• Screening for depression or stress
• Blood pressure, heart rate and basal metabolic index
• Exposures to toxins like nicotine, alcohol and other drugs
• Counseling for sexual health and contraception
• Screening for abuse or neglect
• Counseling on healthy lifestyle choices, including exercise, diet and sleep
• Skincare and cancer prevention
• Risk assessment for heart disease, diabetes and gender-specific cancers
• Use of complementary or alternative medicine

Wondering what an age-specific well-woman exam should entail? See the following guidelines.

Women ages 18-39

Cervical cancer and STI screening:

• The cervical cancer screening with Pap smear should begin at age 21. If the screening is negative, it should be repeated every three years. By age 30, Pap smear and co-testing for HPV is initiated. If negative, it should be repeated every three to five years.
• Gonorrhea and chlamydia screenings are recommended every year once sexually active until age 24. After age 24, STI screenings are personalized according to individual risk.

Breast cancer screening:

• The significance of breast self-exams and clinical breast exams has not been proven by experts in medical literature. However, breast cancers have been diagnosed in young, lactating women. Therefore, it’s important to know how to perform a breast self-exam and talk to your doctor if you notice any lumps or changes in skin.
• If you have a family history of breast cancer, a baseline mammogram should be completed at age 35.

Cardiovascular risk assessment:

• Blood pressure monitoring, cholesterol and diabetic screenings are personalized according to lifestyle, BMI, family history and chronic use of medications like steroids or contraception.
• Patients with history of gestational diabetes or eclampsia are considered more at risk for cardiovascular health issues.

Women ages 40-64

Cervical cancer screening:

• If the most recent Pap smear was negative, it’s recommended to repeat the Pap smear alone every three years or with HPV co-testing in five years.
• If there are any symptoms of abnormal vaginal bleeding, discharge or pain, pelvic exam can be repeated anytime and is not limited to annual exam.
• If hysterectomy is completed for any non-cancerous indication, no further cervical pap is indicated.
• In the case of high-risk sexual behaviors, your women’s health specialist can recommend STI screening.

Breast cancer screening:

• Mammogram screening is recommended every one to two years starting at age 40. The screening can be more or less frequent depending on patient’s risk factors and family history.

Cardiovascular risk assessment:

•  The annual risk assessment by measuring blood pressure, BMI, heart rate and inquiring about personal and family history defines the possible need for cholesterol, diabetes and thyroid function testing.
• There are no recommendations for annual EKG or stress testing. It’s personalized to patient’s health risk assessment.

Colon cancer screening:

• The recommended age for colon cancer screening is 45. If there are any abnormal findings, the screening could be repeated every three to five years. In case of a normal colonoscopy, it’s repeated every 10 years.
• If there is a family history of colon cancer in first-degree relatives, screening starts at an earlier age or is completed more frequently after clinical risk assessment.

Women ages 65 and above

Cervical cancer screening:

• If previous Pap smears and HPV testing are negative, the last Pap smear is completed by age 65. If it’s normal, no further cervical cancer screening is recommended.
• If there are any symptoms of abnormal vaginal bleeding, discharge or pain, pelvic exam can be repeated anytime.
• In case of vaginal atrophy or frequent urinary infections, your women’s health specialist may recommend vaginal estrogen.

Breast cancer screening:

• Mammogram is recommended every one to two years but its frequency can be personalized according to risk factors like family history of breast cancer, personal history of breast biopsy, or cancer.

Cardiovascular risk assessment:

• Blood pressure, cholesterol and diabetic screenings are recommended.
• Always discuss with your provider before initiating daily use of aspirin. It is not recommended for all patients.

Colon cancer screening

• Colon cancer screening continues every 10 years unless the gastroenterologist recommends that there is more risk with the procedure at a certain age.

Osteoporosis screening

• Bone density assessment starts at age 65 for low risk patients according to U.S. Preventative Services Task Force guidelines. It’s repeated every two years.
• The bone density assessment can be started any time after age 50 if patient is at high risk for bone loss.

Be sure to contact your women’s health specialist with any questions regarding screenings, immunizations, or overall health concerns.

-By Dr. Sobia Khan, director of the Women’s Center for Comprehensive Care and assistant professor of medicine at Baylor College of Medicine

Additional Resources:

Learn more about women’s health services at Baylor College of Medicine.

See a comprehensive list of recommended immunizations.

View the latest well-woman recommendations.

Read information about National Women’s Health .