Woman's Health

The best check-up at every age

It's time, once again, for your annual checkup. And, if you're like most women, you wish you could go back to the time when "checkup" meant a few taps on the chest with a stethoscope and walking away with a lollipop in hand. As grown women, we have more serious -- and sometimes, more invasive --things to look forward to. But the annual once-over doesn't have to be a major source of anxiety, especially if you're prepared. Here, a decade-by-decade guide to getting the best exam possible.

Tests Every Woman Needs. Everyone should get a standard yearly physical, during which you can expect a few basics -- no matter what your age -- says Lori Farnan, M.D., an instructor of clinical medicine at Harvard Medical School. Among them: height, weight and a head-to-toe skin check for any suspicious moles that might signal cancer. If you have a family history of certain diseases or if you have specific health concerns, you might also get a blood test that checks things such as your blood's iron level or your thyroid function. And if you have any special risk factors for coronary heart disease - that is, if you smoke, are very overweight, have diabetes or high blood pressure, or if you've had a close female relative who developed heart disease before age 65 -- your doctor may recommend an EKG or a chest X-ray.

Regardless of whether your primary care physician is an internist, a family practitioner or an ob-gyn, you should get a Pap test at least every three years (some doctors recommend them annually). During this procedure, the doctor uses a small tool to scrape a bit of tissue from the cervix; these cells will be tested for abnormalities that might indicate cancer. Pap tests also can detect human papillomavirus, or HPV, a sexually transmitted disease that can increase a woman's risk of developing cervical cancer, says Douglas Laube, M.D., chairman of the department of obstetrics and gynecology at the University of Wisconsin. Plus, every 10 years, you should get a booster shot against tetanus and diphtheria. If your exam is missing any of these basics, find a doc who'll give you a more thorough exam.

If you're 20 or older
In your 20s, in addition to the tests outlined above, you should also get your cholesterol checked; if it's normal, the test should be repeated every five years. You should also be provided with some general health and wellness counseling. "With my patients in their 20s, I always emphasize the importance of doing breast self-exams and practicing safe sex," says Kathleen K. Fry, M.D., an obstetrician-gynecologist in Scottsdale, Arizona.

If you're 30 or older
When you're in your 30s, you can look forward to roughly the same tests and exams that you got in your 20s, plus any discretionary tests your doctor orders (for example, a mammogram if you have a family history of breast cancer). Also, your birth-control regimen may change, depending on whether you are trying to get pregnant or think you're finished with childbearing.

At 35, you should also start paying attention to your bones. "I talk to my patients about getting enough calcium and doing weight-bearing exercise," whether that means pumping iron in the gym or starting a power-walking regimen, says Dr. Fry. Most women don't require a bone-density exam for another 15 years, but those who are significantly underweight or who've had an eating disorder may need the test early; that's because women who are very thin can stop having periods -- and stop producing the estrogen that's required to maintain healthy bones. "We've seen women as young as 20 with serious osteoporosis," warns Fry.

If you're 40 or older
Beginning at age 40, you can add a mammogram to your health exam checklist. (Mammograms, which screen for breast cancer, are recommended every other year from ages 40 to 50, and annually after that.) Your doctor may also begin to focus on your diet and fitness, since, according to Dr. Laube, "this is the age at which most women put on weight." Another addition to your annual physical: screening for colorectal cancer. This can include a fecal occult blood test, which evaluates any blood in your stool; a barium enema; or either a sigmoidoscopy or colonoscopy, in which the doctor views your colon using a tiny camera that's mounted on a slender, flexible tube.

And even though the average age of menopause is 51, many women in their 40s are curious and/or apprehensive about the signs and symptoms of this upcoming hormonal shift. "Women realize that there's a connection between menopause and lifestyle, and they want to know more about the alternative things they can do," says Laube.

If you're 50 or older
Beginning at age 50, you should add a bone density exam as well as a thyroid test to your checkup. (If you show signs of a thyroid problem, such as significant weight gain and persistent fatigue, you might be given this test earlier.) Starting at 55, you'll also be advised to get an influenza vaccine every year, although women with asthma or other respiratory diseases may need them earlier.

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Starting around age 20, you should examine your breasts every month to know how they feel so you can detect any new masses or lumps. It's best to check about a week after your period, when breasts are not swollen or tender; if you no longer have a period, examine yourself on the same day every month. If you see or feel a change in your breasts, see your doctor immediately. But remember, most of the time breast changes are not cancer.

Look for any changes in contour, swelling, dimpling of skin, or appearance of the nipple. It is normal if your right and left breasts do not match exactly.

Using the pads of your fingers, press firmly on your breast, checking the entire breast area. Move around your breast in a circular, up and down, or wedge pattern. Remember to use the same method every month. Check both breasts.

There are three patterns you can use to examine your breast: the clock, the vertical strip, and the wedge. Use the pattern that is easiest for you, and use the same pattern every month.

Gently squeeze the nipple of each breast and report any discharge to your doctor immediately

Examine both breasts lying down.
To examine the right breast, place a pillow under your right shoulder and place your right hand behind your head. Using the pads of your fingers, press firmly, checking the entire breast area. Use the same pattern you used while standing. Repeat for your left breast.

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PMS and OPC

Premenstrual Syndrome (PMS), also called premenstrual tension, is a common female disorder. Although this recurrent condition used to be considered an emotional psychosomatic condition, today it is recognized as a physiological problem caused by fluctuating hormone levels of estrogen and progesterone.

Familiar symptoms include tension, irritability, depression, abdominal bloating, headache, backache and tender breasts. The symptoms occur seven to fourteen days before menstruation. This condition effects one out of every three women between the ages of 30 to 40 years of age.

In his book, OPC in Practice Dr. Masquelier (the person who discovered OPC) reported that in 1987, 165 patients with PMS were given 200 mg of OPC per day. These women were administered this dose during the second half of their cycles. In 67 percent of the women, their physical symptoms disappeared within four cycles. More still, 50 percent of those women suffering from psychological symptoms reported that their symptoms disappeared after the fourth cycle.

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Are Periods Obsolete?

Women's Health Proponents Recommend Continuous Birth Control Pills

Whether you call it Aunt Flo, the crimson curse, code red, or your monthly visitor, menstrual periods leave many of us feeling bloated and blue. And frankly, surveys suggest, we'd rather not be bothered with them.

The fact is, menstruation, as we know it, could be obsolete. At the very least we may only get a period once a season, several leading women's health experts said Tuesday.

With traditional birth control pill regimens, a woman takes hormones on days one through 21, and she takes a placebo on days 22 through 28. During this time, withdrawal bleeding occurs in a timely fashion, like monthly periods. But taking birth control pills back-to-back with no placebo eliminates a monthly period. These predictable cycles are desired by many women for many reasons including social, recreational, and sexual activities.

"The continuous method provides excellent contraceptive protection -- maybe better than traditional," says Carolyn Westhoff, MD, professor of obstetrics and gynecology and public health at Columbia University in New York. Westhoff spoke at a briefing sponsored by the Coalition for Cycle Freedom of Barr Laboratories, Inc. What's more, the continuous method has been shown to lower risk of breast and gynecological cancers, she says.

For years, some doctors have been prescribing "continuous" birth control pills to treat conditions such as endometriosis, migraine, and iron-deficiency anemia. But once there is an FDA-approved long-interval pill regimen, more women will have the option to control their periods, experts say. One such pill, Seasonale, is being tested by Barr Laboratories. With Seasonale, women take the product for up to 84 consecutive days, followed by seven days of placebo. The regimen is designed to reduce the number of withdrawal periods from 13 to four per year.

It's what women want, Westhoff says.

"Across all age groups in three surveys, women said they would like shorter, lighter, and less painful periods," says. In one survey, three-quarters of women said they would want their periods less frequently -- or never at all, she says.

What's more, more than 90% of women already taking birth control pills say they chose to take them longer then the traditional 21 days to limit the number of times they experienced periods and 94% said their quality of their life improved by doing this.

Estrogen and progestin are the main hormones in birth control pills. Estrogen causes the uterine lining to grow and thicken; progestin inhibits ovulation and changes the secretions in the vagina that makes sperm less likely to enter to uterus. When women stop taking active pills, the uterine lining begins to shed, resulting in bleeding -- a period. Oral contraceptives were originally developed to include a monthly menstrual periods so that they would seem more "natural," but there is no real reason for it, Westhoff explains. While not getting monthly periods may seem unnatural, experts say that throughout the centuries, most women did not menstruate as regularly as we do today.

In the past, women had an average of six pregnancies and breastfed for one to two years after each pregnancy. Today women average two or three pregnancies and breastfeed for a few months, if at all. In addition, puberty began at age 16 in the past and now the average age is just over 12. Many women in the past had their first birth at age 19, but today it is closer to 25. Menopause, too, occurs later.

Fewer periods are healthy, says Ann Davis, MD, an assistant professor of obstetrics and gynecology at Harvard University School of Medicine in Boston. "It is not not-ovulating that is dangerous, but why you are not ovulating," Davis says. "If you are not using hormonal contraceptives to alter your menstrual cycle and you are not getting your periods regularly, that is unhealthy," she says. Underlying diseases including eating disorders could be too blame, she adds. Misperceptions about menstruation abound, says Hester M. Sonder, MD, clinical instructor of medicine at Temple University in Philadelphia.

Hippocrates, the father of medicine, believed that menstruation was designed to purge women of their bad moods; ancient Roman physicians believed that contact with menstrual blood could turn wine to vinegar; and some myths persist in the 21st century. But, she explains, the purpose of ovulatory, "Natural" menstrual cycle is to establish a pregnancy. Menstruation follows an unsuccessful cycle.

"When pregnancy doesn't occur, menstruation does," she says. But some ob-gyns are not sold on the idea of continuous hormones. "My concern about continuous oral contraceptives is that we don't have long-term data supporting this type of use," Brian Levitt, MD, of Atlanta explains. For example, "until last summer, women were told that taking hormone replacement therapy (HRT) long-term after menopause could lower their risk for diseases, but now we know that it may actually increase risk for some of the same diseases it was thought to prevent." Levitt did not participate in the briefing.

SOURCES:
Carolyn Westhoff, MD, professor of obstetrics and gynecology and public health, Columbia University, New York, Ann Davis, MD, assistant professor of obstetrics and gynecology, Harvard University School of Medicine, Boston. Brian Levitt, MD, Atlanta.