Routine Healthcare for Women

Routine checkups can find treatable problems early. For many medical problems, early treatment can help prevent more serious problems. The value of checkups and how often you have them depends mainly on your age. Your personal and family medical histories are also important. This summary of routine checkups is intended for people who are feeling healthy and not having any symptoms of illness. If you are having any symptoms that you think may mean a problem, do not wait for your next regular checkup to see your healthcare provider. Get it taken care of right away.

What needs to be checked and how often?

The tests listed below are recommended for routine healthcare by the US Preventive Services Task Force (USPSTF) or the American Academy of Family Practice (AAFP). They are the minimum checkup recommendations. Be sure to talk to your healthcare provider about how often you should have a physical exam and how often you need these or other tests.

• Weight: At least once a year, preferably each time you visit your provider.
• Blood pressure measurement: At least yearly for all women.
• Clinical breast exam by your provider: At least every 3 years if you are 20 to 39 years old. Get an exam every year if you are 40 or older.
• Mammogram: As often as your healthcare provider recommends based on your personal and family history for breast cancer. When you should start having these exams and how often depends on your risk for breast cancer. Breast cancer screening guidelines released by USPSTF in 2009 recommend a mammogram every 2 years for women 50 to 74 years old. Some women with a high risk of breast cancer may need to start screening earlier. Some may need to be screened every year. Ask your provider how often you should have a mammogram.
• Pelvic exam by your healthcare provider: Every year if you are 21 years old or older.
• Pap test for cervical cancer and precancer changes: Every 2 to 3 years. Precancer can be treated before it becomes cancer.
  • It is recommended that you have your first Pap test at age 21. Then you should have a Pap test every 2 years until you are 30. If you have an abnormal Pap test, you may need to have the test more often.
  • If you are 30 years old or older and have had 3 normal Pap tests in a row, talk to your healthcare provider about having Pap tests every 3 years instead of every 2 years.
  • If you are over 65 years old, ask your provider if you can stop having Pap tests.
• Cholesterol test. At least every 5 years starting at age 20.
• Blood test for type 2 diabetes: At least once a year if your blood pressure, blood lipids (cholesterol), or weight are high or you have a family history of type 2 diabetes.
• Colorectal cancer screening: With 1 of these 3 methods of screening if you are 50 to 75 years old and have an average risk of colon cancer:
  • a fecal occult blood test once a year to check for blood in your stool (bowel movement)
  • a sigmoidoscopy exam every 5 years with fecal occult blood testing at least every 3 years between the 5-year exams
  • a colonoscopy every 10 years.

  A special X-ray test called a barium enema may be done every 5 years instead of colonoscopy or sigmoidoscopy. However, there is no evidence that this test is as effective as the tests listed above.

  You may need to start colorectal cancer screening earlier if someone in your immediate family has had colon cancer, especially if their cancer occurred before they were 50 years old.

• Chlamydia test: Every year if you are sexually active and 25 years old or younger or if you have a high risk of sexually transmitted disease (STD).
• Gonorrhea and syphilis tests: If you are at high risk for these sexually transmitted infections. This includes having a new sex partner or more than 1 partner, a history of sexually transmitted disease (STD), a partner with an STD, or a partner who is bisexual. You are also at risk if you do not use condoms every time you have sex.
• HIV test for the AIDS virus: Every year if you are at risk for HIV infection.
• Tuberculosis (TB) test: Every year if you have a high risk of TB; for example, because:
  • You are a health worker, drug user, or immigrant.
  • You have diabetes, HIV, or another condition that weakens your immune system.
  • You have close contact with someone infected with TB.
• Bone density test for osteoporosis: At age 65 years if your risk is normal and at 60 if you have a high risk (for example, because you smoke or do not get regular exercise). Osteoporosis is a disease that thins and weakens bones to the point where they break easily.
• Hearing test: If you are 65 or older.
• Vision test: If you are 65 or older.
• Skin: If you have any moles or abnormal areas of skin you would like your provider to check.
• Mouth: Every year for dental problems and for sores of the gums, especially if you smoke or chew tobacco or if you wear dentures.

You may need other tests as well. You and your healthcare provider need to talk about what is right for you based on your symptoms and your personal and family medical history.

What shots do I need?

The following shots are recommended for adults:

• Tetanus and diphtheria (Td) booster shot at least every 10 years. One booster shot should use the Tdap vaccine to protect you better against whooping cough (pertussis) as well as tetanus and diphtheria. Tdap is especially recommended for adults caring for babies because babies are more likely to have complications from whooping cough.
• Flu shot every fall.
• Measles, mumps, and rubella shot (MMR) if you were born after 1956 unless you have already had the shot or these diseases. Depending on when you had your measles shot, you may need a second one. If you are infected with rubella during pregnancy, it can cause severe birth defects. Ask your healthcare provider if you need the shot. The shot needs to be given before you are pregnant.
• Hepatitis A shot if:
  • You are at risk, for example, through travel or your job (including military service).
  • You have liver disease.
  • Use illegal drugs.
  • Have HIV.
• Hepatitis B shot for all adults not yet immunized against hepatitis B.
• Pneumococcal pneumonia shot if you are age 65 or older. You may need the shot at a younger age if you have a high-risk medical condition, such as diabetes or lung, kidney, or heart disease, or if you are a smoker. You may need a second pneumonia shot if you got your first shot when you were younger than 65 and it was more than 5 years ago. You should not have more than 2 pneumonia shots in your lifetime.
• Varicella (chickenpox) if you have never had chickenpox.
• Zoster (shingles) vaccine if you are 60 or older, even if you have already had shingles. The vaccine does not always prevent shingles. However, if you have had the shot and then get shingles, it can lessen the pain caused by the infection.

What other things I can do to stay healthy?

Your healthcare provider will likely suggest additional ways to stay healthy. Some of these may include:

• Breast self-exams: Ask your healthcare provider about doing breast self-exams. These exams are not as strongly recommended as they used to be. However, your provider may recommend doing them to help you be more familiar with your body. They could help you notice changes that need to be checked for breast cancer.
• Substance use: Don't use tobacco or illegal drugs. Don’t use alcohol during activities such as driving, swimming, boating, and operating machinery. Limit your alcohol to no more than 1 drink a day.
• Diet and exercise: Try to keep your weight at a comfortable, healthy level. Limit unhealthy fats and cholesterol in your diet. Choose healthy fats, such as olive oil. Eat a lot of whole grains, fruits, and vegetables. Get regular exercise according to your healthcare provider’s recommendation.
• Injury prevention: Use lap and shoulder belts when you drive. Use a helmet when you ride a motorcycle or bicycle. If you are around guns or other firearms, practice safe handling. Make sure to keep all firearms unloaded and in locked cabinets when they are not in use. Install smoke detectors in your home. Set your hot water heater to less than 120°F (49°C). Prevent falls by removing unsafe rugs.
• Dental health: Visit your dentist regularly. Brush your teeth with fluoride toothpaste daily. Also floss your teeth daily.
• Sexual behavior: Prevent sexually transmitted infections by avoiding high-risk sexual behavior. Use latex or polyurethane condoms every time you have sexual contact unless you are in a long-term relationship with just 1 partner who is not sexually active with anyone else.
• Hormone use: During or after menopause, discuss the risks and benefits of use of estrogen and progesterone replacement with your healthcare provider.