Womens Health Through the Ages

No one has to tell you there’s a difference between being 25 and 65. Indeed, just about everything in your life changes from decade to decade, as you progress from college-age concerns through marriage, raising a family, working and aging. Health, of course, is a big change-agent. Ask any 50-year-old with an achy back or hot flashes.

And while there are some health concerns common to all ages — eating well and staying active, for instance — each decade of life includes specific health demands. We asked five Baptist Health Care physicians who focus on women’s health to describe what women should do throughout life to main-tain good health now and set the path for a healthy future.

20-29

Staying healthy throughout your life is not your job alone, says Erika Schneider, M.D., an OB/GYN. “It is a partnership between you and your physician and a commitment to be an active member of your own health care team,” she says. And now is the time to form that team by choosing a doctor you feel you have a connection with and you can trust.

“When I have a new patient, during our first visit, I make it a point to sit down and talk, to help better understand what type and level of care she is seeking,” she says. “We have to establish trust, and I do that by taking time to listen and fully understanding and appreciating what the needs are, physically and emotionally.”

In your 20s, you want to start a solid foundation for good health. That starts with staying up to date on your immunizations and receiving age-appropriate health screenings. Dr. Schneider recommends a full yearly checkup that includes blood pressure screening, breast exam, skin exam and screening for weight gain, tobacco and alcohol abuse, mental health and thyroid levels. A pelvic exam and Pap test are recommended beginning at age 21, or earlier if you are sexually active or have high risk factors for pelvic or cervical disease. Tests for sexually transmitted disease, including HIV, also may be discussed.

“We also want to make sure we create a health plan that focuses on healthy levels of nutrition and exercise to ensure a healthy weight and to manage stress and anxiety,” says Dr. Schneider.

Family planning is often a focus. “Family planning is a very intimate, personal journey. Part of that journey includes understanding your desires and creating a plan that is right for you. That can be anything from helping you chose the right birth control to optimizing your preconception health,” she says. If you are planning to start a family, she recommends a pre-conception check-up. “This allows us to identify what we need to do to get your body ready to conceive and potential risk factors in pregnancy that we need to address early on, such as genetics, age, weight and other maternal health issues like high blood pressure, diabetes and depression,” she says. “And we want to make sure you are consuming a diet rich in nutrients like iron and folic acid and start you on a prenatal vitamin.”

20s FAST FACT: Now is the time to prepare for healthy bones as you age. Aim for at least 1,200 mg of calcium and 1,000 IU of vitamin D daily through diet and supplements.

30-39

Rebecca Hall, DNP, FNP-BC, a family medicine provider, recommends a yearly physical exam for all women in their 30s. “At these exams you should be screened for chronic health conditions like obesity, diabetes, high blood pressure and high cholesterol,” she says. “You should also talk to your doctor about any immunizations you may need, like a flu shot or a tetanus booster.”

Maintain a healthy lifestyle. “I recommend a total of 150 minutes per week of physical activity, a balanced diet and, if chronic conditions are evident or there is a family history of, say heart disease, address preventive issues if necessary. I also talk about stopping tobacco use and preventing sexually transmitted diseases if the woman is at higher risk.” Physicians also should screen for mental health issues such as depression, though that may depend on the person and health history, she says.

Yearly mammography typically begins later, but if you have a family history of the disease, you may need to begin in your 30s. A Pap smear is now recommended every three years after age 30, and if you are screened for the human papilloma virus (HPV) and found to be negative, you can go five years between screenings.

As more women have children in their 30s, Rebecca recommends they discuss their plans with their provider and include dietary supplements such as folic acid, which helps prevent some birth defects. “Also, fertility decreases as women age, so if you are under 35 and have been trying to have a baby for a year, or over 35 and trying for more than six months, and haven’t conceived, you may need to see a fertility specialist,” she says.

The 30s are a busy time, and women with new and growing families need to remember to take care of themselves as well as their children and spouse. “I have found that women in their 30s are able to balance a new family very well. They’ve had more life experience and are usually in a stable place in their personal relationships as well as their careers,” says Rebecca. “However, I always stress that in addition to taking care of their families, they still need to take care of themselves and remain informed about their health. They can do that first and foremost with annual checkups and additional visits throughout the year if necessary to keep chronic medical conditions controlled.”

30s FAST FACT: Blood pressure often starts to creep up in your 30s, so get it checked yearly. Remember, heart disease is the number one health risk of women in this country, just as it is with men.

40-49

Jennifer Driscoll, M.D., a family medicine physician, says this is “a very busy decade for women. They have multiple roles, caring for kids, working, perhaps caring for older relatives, and one thing I stress over and over is that women need to take time for themselves.”

Women in their 40s still need to focus on primary care with yearly physical exams. “That’s when chronic health problems, like high blood pressure, high cholesterol and early diabetes may be detected,” she says. A check-up and blood test can diagnose these and other conditions early, when they are the easiest to treat and reverse.

During this decade “metabolism tends to slow down,” Dr. Driscoll says. “If you haven’t adopted good eating habits yet, now is the time. In your 20s you can splurge on cheeseburgers and your body will forgive you. In your 40s, it’s not as easy.” You also need to add exercise to your life if you haven’t already done so,” she says. “It can be as simple as walking for half an hour a day, five days a week.”

Testing for cervical cancer is the same as in your 30s — every three to five years — but Dr. Driscoll recommends that women begin mammography “at least every other year beginning at 40. Some doctors may recommend waiting until you’re 50 to start mammograms. Your personal physician will help you decide what schedule is best.” Screening for colorectal cancer also typically begins at 50, but those with a family history may need to begin in this decade.

It’s also time to consider some new health issues. Bone health, for instance. To prevent osteoporosis, she recommends weight-bearing exercises and calcium supplements to keep bones healthy as you age. Heart disease is another new concern. “Keeping your heart healthy goes hand-in-hand with regular exercise, eating well, and getting regular check-ups,” she says. If you have a family history of heart disease make sure your doctor knows. Women should be aware that symptoms of heart disease may be different and more subtle than the typical crushing chest pain that men experience. “Women suffering from angina or a having a heart attack may experience unusual shortness of breath, abdominal pain or upper back pain, lightheadedness, or extreme fatigue, rather than crushing chest pain,” she says.

Now is the time women are heading toward menopause, which commonly begins in the late 40s or early 50s. “You may start to have cycle irregularities and symptoms like hair changing, hot flashes, insomnia,” she says. “The doctor can make sure these are normal processes and not something else and may offer treatments for the symptoms.”

40s FAST FACT: Your metabolism is slowing down, so calorie intake should too. Portion control is critical. Use a doggy bag and take home half your meal when you eat out.

50-59

Kacey Gibson, D.O.,  a family medicine physician, says that, “age truly is a number, and we should not focus on getting older, we should focus on staying healthy.”

That begins with primary care and yearly physicals. Screening for high blood pressure, high cholesterol, high blood sugar and other chronic conditions is, of course, the cornerstone of primary care. But new concerns need attention as well.

“At 50 women need to have a mammogram every year,” Dr. Gibson says. “Age 50 also is the time to start getting a colonoscopy every 10 years to screen for colorectal cancer, if you haven’t already done so.” Colon cancer is the second leading cause of cancer deaths in this country, but it is often curable when detected early.

“At 50 osteoarthritis becomes more common in women than in men, so you should talk to your doctor about bone health too,” Dr. Gibson says. That means increasing weight-bearing exercises to strengthen bones, taking calcium and vitamin D supplements and discussing whether a bone mineral density test is appropriate.

“Here in sunny Florida, you also need a good skin exam,” she says “What we did before age 18 is coming back to haunt us.” Your doctor will check for suspicious spots or moles and suggest follow up treatment with a dermatologist if necessary.

As metabolism continues to slow during this decade, diet and exercise become more important. “Stay healthy by being more active and eating more high-quality food,” she advises. Thirty minutes a day of “good old walking,” she says, is the exercise prescription. “It doesn’t have to be all at once. Ten minutes, three times a day is just as healthy.”

Finally, menopause “is either knocking on the door or already came in,” she says. Women should not simply accept symptoms; doctors can often help treat the more uncomfortable aspects of “the change.” “Talk about it with your doctor,” she says. For example, medications, such as some antidepressants, can help relieve hot flashes. “You don’t have to go through menopause alone,” she says. “Sometimes just talking about it can help.”

50s FAST FACT: The flu claims about 36,000 American lives a year, and sends hundreds of thousands to the hospital. The flu vaccine is now recommended for every age, but it’s especially important after age 50, when the risk of serious and even life-threatening complications increase.

60 and up

Senior women “have a whole gamut of things to focus on,” says Layla Lundquist-Smith, M.D., a family medicine physician. Preventive care weighs heavily on this age group, she says. “There are a lot of preventive measures available for successful, healthy aging. Be proactive.”

Along with the usual screening for heart health, diabetes and the other chronic conditions you’ve been monitoring since your 20s, senior women need to address special concerns. Vaccinations against the flu and pneumonia, which can be devastating at this age, are critically important. You need a new flu shot every year. If you had a pneumonia vaccine before age 65, you may need another. If you haven’t had one yet, one is usually enough for the rest of your life. You also should have the shingles vaccine once after age 60, she says, and other childhood vaccines against diseases like pertussis (also known as whooping cough) may need a booster. “We are seeing an increase in pertussis in the elderly as childhood vaccines start to wear off,” she says.

Bone health is very important now. “All women in this age group should be screened for osteoporosis, and a bone density test is recommended at age 65,” Dr. Lundquist-Smith says. Exercise is extraordinarily helpful, not just for bone health but also for aging joints. Arthritis pain can be relieved with regular exercise, even just walking or pool-based movements, she says. Balance exercises may be useful, too, but follow guided programs. “I tell my older patients I am like their personal trainer because the typical trainers out there know young bodies, but older bodies need different exercises,” she says.

Mammography and Pap smears are still extremely important for this age group, she says, depending on the patient’s capabilities, functioning and projected lifespan. So are eye and hearing exams, because loss of sensory function is closely related to depression and other mental health issues, including isolation. “Social engagement is important because this is when people tend to retreat, and that’s when a lot of illnesses pop up,” she says. “There is no known way to prevent dementia, but we do know that engagement helps.”

So does keeping your mind active. “Use it as much as possible,” she advises. “Reading, writing, playing music, doing puzzles all help slow cognitive decline.”

60s FAST FACT: Many seniors fall short of recommended guidelines for vitamin B12, a vitamin found in seafood, beef and fortified breakfast cereals that helps produce healthy red blood cells, protect your nervous system and may help prevent memory loss. Ask your doctor if you need to take B12 supplements.

To make an appointment with a physician quoted in this article, visit their physician profiles.