Is your obstetrician/gynecologist the only healthcare provider you see on a regular basis? Many ob/gyns do double duty and provide care that goes beyond sexual health and pregnancy. But that means there’s a lot to accomplish during a wellness visit to protect your general health and to ensure that any potentially chronic conditions aren’t overlooked.
Health checks are different for women at different ages. Here’s what should be included at your next visit, according to Frederick Friedman, Jr., MD, director of obstetrics at the Mount Sinai Health System in New York City.
TIPS FOR EVERY AGE
Be sure to tell your ob/gyn that he or she is your primary care doctor and ask if he/she is comfortable in that role. This way, you’ll be sure that every facet of your care will be attended to. Your ob/gyn may not give you such a comprehensive exam if he/she believes you also have a primary care physician.
Share your health profile…in detail. Accurately fill in all the answers on those health questionnaires you’re handed at check-in, including not only your health history, but also your family medical history, so that your doctor is aware of your unique risk factors and can order appropriate tests.
Yes, you can see your ob/gyn for a “sick” visit. More than just gatekeepers, ob/gyns can treat common infections and illnesses.
SPECIFICS UP TO AGE 18
Not all tweens and teens see an ob/gyn, but you might if, for instance, you have irregular periods or hormonal imbalances or are sexually active. In addition, your ob/gyn should make sure that all your childhood vaccines are up to date and that you get an annual flu shot. Have a frank discussion about the benefits of the human papillomavirus (HPV) vaccination, which protects against cervical cancers linked to certain strains of HPV. For most preteens, the vaccination is given in two doses, six to 12 months apart. Beginning at age 15, you’ll need three doses over a six-month period, according to the Centers for Disease Control and Prevention.
Of course, your yearly wellness visit is about more than shots. Your height, weight and blood pressure will be recorded. There isn’t a one-size-fits-all formula for wellness visits, so your ob/gyn may order tests based on your exam or family history.
Your doctor may counsel you about peer pressure, contraception, STD prevention and substance abuse as well as offer tips on eating right, exercising regularly and being aware of stress and how it can affect your health. These are challenging years for many people, and your ob/gyn will look for signs and symptoms of depression, anxiety and eating disorders. It’s important that you share any concerns with your doctor so that you can address them together.
SPECIFICS AGE 18 TO 40
Your visit to your ob/gyn should start with weight, height and blood pressure checks, which can help identify many health risks early on. Expect that your doctor will also listen to your heart and lungs and order a complete blood test to get a big-picture look at your health…and a lipid test to check your cholesterol and triglyceride levels. Other blood tests might include the HbA1c, which provides a snapshot of your average blood sugar level over a three-month period, to determine any diabetes risk, possibly a thyroid-stimulating hormone test (to check your thyroid function) and one for your vitamin D status. Low blood levels of vitamin D have been linked to a growing list of diseases and conditions in recent years, and blood test results will let you know if you need supplements.
In addition to getting pelvic and breast exams, Pap and STD testing, talk to your doctor about vaccinations. Besides annual flu shots, adults need tetanus boosters every 10 years, usually given in a combination vaccine, called Tdap, that includes vaccines against diphtheria and pertussis (whooping cough). If you haven’t yet gotten the HPV vaccine, you’re eligible until age 26. Also ask your doctor whether you should have a meningococcal vaccination to guard against meningitis.
Ask for skin cancer mole checks and advice on how to protect your skin from the sun’s damaging ultraviolet rays to be a part of these visits.
Because oral cancers and precancers are increasing in frequency, ask if your ob/gyn can inspect inside your mouth in addition to checks you get at regular dental visits.
Depending on your age and family history, your ob/gyn will talk to you about screening for colon cancer as well as breast cancer and testing for very specific genetic markers of disease risk.
If you develop certain chronic conditions, such as diabetes or rheumatoid arthritis, your ob/gyn will refer you to a specialist.
SPECIFICS AGE 41 to 64
The number of annual screening tests tends to increase with age. You might benefit from tests to measure heart function, especially if your blood pressure, cholesterol or weight is in the danger zone. A woman’s risk for heart disease increases after the onset of menopause, which typically occurs around age 51.
Preventing the brittle bone disease osteoporosis takes center stage during these years. You may need to address bone density sooner rather than later you have risk factors such as a history of fractures or long-term use of bone-depleting steroids. If you’re unsure of all the preventive steps to take, talk to your doctor about ways to get more vitamin D and calcium in your diet and which weight-bearing exercises are best for you, especially around the time you start menopause. Even if you are, say, an avid runner and in superb cardiovascular shape, you can still be at risk for osteoporosis and related fractures, says Dr. Friedman. So he suggests adding resistance exercise and recommends barre classes if you don’t like to lift weights.
Talk to your ob/gyn about screening tests such as colonoscopy and preventive steps to keep borderline health conditions, such as slightly elevated cholesterol, blood sugar or blood pressure, from escalating. If you develop a chronic condition, such as diabetes, or have multiple heart disease risk factors, such as high blood pressure and high cholesterol, ask your ob/gyn to refer you to a specialist.
At age 50, ask to get the two doses of the RZV zoster vaccine that is recommended to guard against shingles.
AGE 65 AND UP
To live as long and healthy a life as possible, work with your ob/gyn to stay on top of heart health by making sure your blood pressure, cholesterol and other risk factors are under control. Eating a healthy diet that’s rich in fiber, exercising regularly, and taking any medications as directed are a big part of heart disease prevention. If you’re already seeing a specialist, be sure that your ob/gyn coordinates your care with other health professionals on your team.
At age 65, ask about getting both pneumococcal (pneumonia) vaccinations, PCV13 and PPSV23. This is also the usual age for an initial bone density screening for osteoporosis risk, but Dr. Friedman often suggests that his patients have the screening earlier because this is a perfect example of the saying, an ounce of prevention is worth a pound of cure.