Medical Tests Every Woman Needs to Be Healthy for Life
Take control of your health with the tests every woman should have done in her 20s, 30s, 40s, 50s and 60s.
You exercise, eat right and get plenty of sleep -— great! But if you're only going to the doctor's office when you think you have a cold or need a refill on your birth control, you're missing out on a huge area of preventative health. Having regular check-ups and routine screenings and tests can help you catch health problems and help you avoid a full-blown health crisis years down the road. So to help you take control of your health, here are the tests every woman should have done in her 20s, 30s, 40s, 50s, 60s and beyond.
Medical Tests Women Need in Their 20s
Many twenty-somethings are guilty of blowing off doctor visits and skipping baseline screenings thanks to a combination of other preoccupations (dating, new job, starting motherhood) and, in some cases, less than adequate health insurance. But now is when you want to find a primary care physician you like, and trust, says Dana Simpler, M.D., primary care practitioner at Mercy Medical Center in Baltimore.
“Your goal is to set yourself on a healthy course while it’s still relatively easy,” she says. This includes developing healthful eating habits, getting regular exercise and plenty of sleep. What you do now and how you take care of your body will help prevent health issues that can crop up as you age, such as high blood pressure and diabetes, Dr. Simpler says.
1. Annual Physical
Most insurance companies cover routine visits and screenings, so why not take advantage and get familiar with some numbers like your blood pressure and cholesterol level. A thorough physical includes a total blood work-up (CBC), which tests for conditions such as anemia (low red blood cell count).
You might also get a cholesterol test, and/or a fasting glucose test (especially if you are overweight) to check for diabetes and pre-diabetes. Your doc will listen to your heart and lungs; examine your eyes, ears, lymph nodes and abdomen for anything out of the ordinary. He or she will also make note of your age, height and weight, and ask about your family medical history.
2. Vaccine Update
According to National Institutes of Health guidelines, you should get an updated Tdap vaccine (tetanus-diphtheria and acellular pertussis), since immunity from childhood vaccines will likely have waned. If you were born after 1980 and never had chickenpox as a child, get that vaccine as well. The MMR vaccine (measles, mumps and rubella) should be updated if you were born after 1956, according to the Centers for Disease Control (CDC) guidelines.
And don’t forget the HPV (Human Papilloma Virus) vaccine. All cases of cervical cancer have now been shown to originate with an HPV infection, says Dr. Simpler, so if you weren’t vaccinated as a teen, do it now. Check with your insurance company about coverage; some only pay for the shots if you’re under age 27.
3. PAP Smear
According to the U.S. Preventive Services Task Force, a PAP smear (in which a scraping of cells from the cervix is examined to detect abnormalities that could lead to cervical cancer) should be performed starting in the 20s (or soon after becoming sexually active), and then once every three years throughout adulthood. Yes, this used to be recommended annually, says Dr. Simpler, but that’s changed if your results remain consistently negative.
4. STD/HIV Screen
The CDC recommends that all sexually active adults be tested for chlamydia and gonorrhea, and that all patients seen in any healthcare setting receive HIV testing unless the patient opts out.
5. Breast Self-Exam
Past emphasis on monthly self-exams at home has faded, thanks to the changed recommendations from the U.S. Preventive Services Task Force, which found such exams ineffective in finding potential cases of cancer. That said, women in their 20s should get to know the girls as a way to know what feels normal for your body, but not as a replacement for the clinical breast exam your doc will give you at your ob/gyn check-up.
Medical Tests Women Need in Their 30s
If you’re thinking: “It’s cool — I see my OB/GYN every year,” think again. Too many women put their overall health on the back burner while focusing solely on their lady-part health, not to mention that of their family.
“Statistically, 30-something women aren’t getting heart attacks and strokes, but now is the time to be proactive about [behaviors] that will positively impact your health,” says Dr. Simpler. Get your weight in check, don’t smoke, exercise and try to fit in enough sleep.
1. Cholesterol Test
The American Heart Association (AHA) recommends a fasting lipoprotein test starting at age 20. Aim for just keeping your LDL (bad) cholesterol low — 100 mg/dl is optimal — and inching your HDL (good) cholesterol higher. Optimal is over 60mg/dl, according to the AHA. The total number to aim for is 200 mg/dl or less, and over 240 is considered high.
Triglycerides inching over 150 mg/dl should send up a red flag also, because a high triglyceride level combined with low HDL or high LDL may speed up atherosclerosis, increasing your risk for heart attack and stroke. You’ll want to repeat this test every five years, more often if you have a family history of heart disease, if you smoke or are overweight or obese.
2. Skin Check
The American Academy of Dermatology outlines an ABCDE approach when assessing moles on your body that require a professional’s eye:
- A for asymmetrical
- B for bleeding
- C for (changing) color
- D for diameter (greater than 6mm)
- E for evolving
Fair-skinned women are at higher risk for skin cancer than those with darker skin. People who’ve had blistering sunburns before age 18 and those with a close family member diagnosed with melanoma are at higher risk for skin cancer. According to the Centers for Disease Control and Prevention stats, melanoma rates among women increased significantly between 1999 and 2008.
3. Thyroid Check
The gold-standard thyroid test is a blood screen for TSH, or thyroid stimulating hormone, which detects hyperthyroidism, an overactive thyroid, causing insomnia and weight loss; or hypothyroidism, an underactive thyroid, causing sluggishness and weight gain. Thyroid tests can also reveal autoimmune conditions such as Graves’ disease. Get checked if you have symptoms such as unexplained changes in mood, weight, sleep habits or cholesterol level.
4. Blood Pressure
You have that familiar BP cuff check every time you go to a doctor’s office, but now’s the time to start paying closer attention, especially if you have any risk factors for heart disease or stroke — a strong family history, being overweight or smoking.
Numbers to worry about: a systolic, or top, reading over 120 and a diastolic, or bottom, reading over 80, according to the American Heart Association. Hypertension — high blood pressure — is defined as 130/80 or higher.
Medical Tests Women Need in Their 40s
At age 40 and beyond, a woman’s risk of developing conditions such as high blood pressure, heart disease, osteoporosis, diabetes and arthritis increase, and most primary care physicians encourage annual routine physicals, especially when they’re covered by most insurance plans.
This is the decade to take a hard look at family history. Take colon cancer for example: While colonoscopies are not recommended until age 50, if you have a parent or sibling who had the disease, or had precancerous or cancerous polyps removed, “You should get screened 10 years younger than that relative was when he or she was diagnosed,” says Dr. Simpler. So if your mom had colon cancer at 55, schedule a test for yourself when you're 45.
The American Cancer Society had recommended that you begin annual breast-cancer screening at age 40, but the U.S. Preventive Services Task Force came out with a new stance in 2009 when it stated that routine screening need not begin until 50. They felt the risks of a decade of annual screenings outweighed the benefits.
That said, it should be noted that these new guidelines are based on clinical outcomes, not emotional concerns, and The American Cancer Society has not altered its recommendations. While mammography can be an imperfect tool, it’s still the best available. To figure out what’s right for you, discuss your personal risk and history with your doctor.
2. Eye Exam
If you already wear glasses, see your ophthalmologist to discuss whether you should have separate reading glasses or a bifocal prescription. Otherwise, just grab a pair of magnifying readers from the drug store.
Those who have never seen an eye doctor should make an appointment for a comprehensive exam, which, according to the American Academy of Opthalmology, can pick up early signs of age-related problems — cataracts, glaucoma, diabetic retinopathy, age-related macular degeneration — that may be lurking without symptoms. The exam will also include an eye pressure test; pupil dilation so the doctor can look at your retina and optic nerve; and a test of visual acuity, reading letters on an eye chart.
3. Blood Sugar/Diabetes Test
If you haven’t already been screened for type 2 diabetes, starting now is a must, according to the American Diabetes Association. Most commonly, you’ll be given a fasting blood glucose test. A normal fasting blood glucose reading is below 100 mg/dl. If your results come in between 100 and 125 mg/dl, you're considered pre-diabetic. If your FPG is 126 mg/dl or above, you have diabetes.
A more accurate screen for diabetes is the hemoglobin A1C test. Whereas a fasting blood test is a snapshot in time, the A1C give your doctor an estimate of your blood glucose level over a three- to four-month period. An A1C at 5.6 percent — that means the percentage of sugar in your blood — is normal; a pre-diabetic range is between 5.7 and 6.4 percent. Anything over that indicates diabetes.
4. Rectal Exam
Grin and bear it when your gynecologist inserts a gloved finger in your rectum during your regular pelvic exam. This on-the-spot test for fecal occult blood is important because blood in the stool is an early indicator of colon cancer, which can be diagnosed with further testing.
Medical Tests Women Need in Their 50s
After menopause, women lose some of the protection that estrogen offered during childbearing years, increasing the risk for health problems such as osteoporosis and heart disease. Go Red for Women, a heart-health initiative at the American Heart Association, notes that more women die of cardiovascular disease than from the next four causes of death combined, including cancer.
Annual physicals should be routine, and include blood pressure checks and cholesterol testing every three years. Keeping your weight under control is especially important: Declining estrogen levels also cause fat storage to shift from the hips to the waist, and increased abdominal fat raises your risk for diabetes and heart disease.
“No matter what your family history, age 50 is recommended for a first screening,” says Dr. Simpler. If no polyps are found, repeat testing every 10 years. “But if your doctor finds polyps classified as adenomas, which have cancerous potential, you need repeat colonoscopies every three years.”
2. Heart Health Check
A thorough exam early in this decade should include screening for your overall risk of heart disease. First up, a look at waist circumference. A circumference of more than 35 inches is risk factor for diabetes and heart disease. Think about asking for a blood test called the C-Reactive Protein test, which the American Heart Association recommends to assess silent heart disease risk.
An electrocardiogram (EKG), says Goldberg, is smart for any woman over age 50, even in the absence of symptoms. If you have a family history of heart disease, “or if you have symptoms like chest discomfort, shortness of breath, palpitations, or if you’ve been diagnosed in the past with a heart murmur,” says Dr. Goldberg, you’ll want to schedule an echocardiogram, a noninvasive sonogram of the heart.
3. Bone Density Test
The U.S. Preventive Services Task Force has tweaked its recommendations for bone-density testing, saying that routine screening should start at age 65, while younger women should be screened only if they are at risk for fractures. Same advice comes from the National Osteoporosis Foundation guidelines. That said, “most women today have been getting screened earlier,” notes Dr. Brangman.
Think about getting your bone density checked if you are or were a smoker, if you were prescribed steroids such as asthma medications, are very thin — there's an added risk for being thin and Asian — have a strong family history of osteoporosis or have lost height in the last year.
4. Vaccine Update
The Centers for Disease Control and Prevention has issued a recommendation that everyone born between 1945 and 1965 get tested for hepatitis C. The organization notes that 75 percent of adults with the virus were born during those years. While the reasons are not completely understood, what is known for certain is that early detection and treatment will save lives.
It was previously thought that only those with certain risk factors get tested, but given that many people are silent carriers and considering that hepatitits C can lead to deadly diseases including cirrhosis of the liver and liver cancer, screening seems smart. Check on your tetanus booster, too; you need this vaccine once every 10 years.
Medical Tests Women Need in Their 60s and Beyond
“After age 65, your risk of getting cervical cancer goes down, so if you’ve had three negative PAP tests in the last decade, you can skip it,” says Dr. Brangman. Continue to get mammograms, however, and follow up with cholesterol screenings every three years. You might want to talk to your doctor about a cognitive or memory screen.
And keep exercising. Exercise has been shown to reduce the risk of dementia, lower blood pressure and blood sugar — and it will give you more energy to enjoy the grandkids. Studies have shown that older women who began or maintained weight-training programs improved their overall health in so many ways, including increasing bone mineral density, increasing strength and the ability to perform daily activities, which decreases the risk of falls and injuries.
1. Vaccine Update
The flu vaccine is recommended for just about everyone, but if you’re over 65, it’s especially important. Other shots you need, says Dr. Brangman: the herpes zoster vaccine, to protect against shingles, a painful condition caused by the same virus that gave you chicken pox when you were a kid (and which lays dormant for decades, but can reactivate later in life).
The United States Advisory Committee on Immunization Practices (ACIP) has recommended that adults older than 60 receive the herpes zoster vaccine as part of their routine medical care. It’s a personal decision, but keep in mind that the nerve pain and possible nerve damage from a case of shingles can be severe, and long lasting. Also recommended: a tetanus booster, necessary every 10 years, and a pneumonia vaccine.
2. Bone Density Test
According to the latest recommendations by the U.S. Preventive Services Task Force (USPSTF) all women over 65 should receive routine bone-density screenings. The National Osteoporosis Foundation’s guidelines concur.
If you haven’t gotten a bone-density test before, do so. If you are or were a smoker, or you used steroids for extended periods in the past (for example, to treat asthma), if you are very thin, have a family history of osteoporosis or have lost height in the last year, your risk for the disease increases.
3. Vitamin D Test
The older you get, the harder it is for your body to make vitamin D, even if you are spending some unprotected time in the sun, says Dr. Brangman. As a result, you may end up more vulnerable to osteoporosis. Ask your doctor to test your vitamin D level, particularly if you live in the Northeast, or are African-American.
Some recent studies have linked higher levels of Vitamin D3 (2000 IUs daily) with lower rates of colorectal cancer, and reduced risks of other cancers including breast and pancreatic, as well as protection against osteoporosis.
4. Depression Screening
According to the National Alliance on Mental Illness, depression affects more than 6.5 million Americans who are 65 and older. Talk to your doctor if you’re feeling blue, uninterested in activities you used to enjoy or if you have significant sleep or appetite changes.
“Your doctor can administer what’s called a Geriatric Depression Scale, which will help him or her understand if you need further treatment,” advises Dr. Brangman. Once diagnosed the prognosis is good: According to NAMI, 80 percent of clinically depressed individuals can be effectively treated by medication, psychotherapy, electroconvulsive therapy (ECT) or any combination of the three.
How Does Your Health Measure Up?
Is your health record on track? Are there any tests you now realize you need to catch up on? Which of these tests did you already know were recommended for men? Were there any that surprised you? Will you do anything differently with your health now that you have this info? Share you thoughts, stories and questions in the comments section below!
Additional reporting from Denise Schipani
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