The Essential Women’s Health Checklist
The latest guidelines for the tests, screenings, and exams women need at all stages of life.
When it comes to maintaining their health, women face more complexities than men. Not only do women have to account for factors like childbirth and menopause, but many common health conditions affect women differently. For example, heart disease is the leading cause of death for men and women in the U.S., but women are more likely to die after a heart attack. The good news is that women are typically proactive with preventive health visits. Still, it’s challenging to stay on top of the latest women’s health guidelines when it comes to exams and screenings.
“It can seem overwhelming, but the earlier women start with preventive care, the better,” says Dr. Mary Rosser, an OB-GYN at NewYork-Presbyterian/Columbia University Irving Medical Center and an assistant professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons. “Early patient-centered care for screening and prevention is crucial to maintain positive health outcomes. We need to address women’s overall health in a comprehensive, personalized manner, so that the care is focused on the individual patient, her risk, and her needs.”
Dr. Rosser is chair of a new American College of Obstetricians and Gynecologists (ACOG) task force created by ACOG’s president to focus on providing women more efficient, personalized care throughout their lives. The campaign is called “Revist the Visit.” She spoke with Health Matters about the exams, tests, and screenings women should prioritize at every stage of life.
Checklist for Girls in their Teens
- OB-GYN visit: Starting between 13–17 years old, girls should meet with an OB-GYN to start understanding what to expect at future visits and get information about how to stay healthy. “This is to introduce us as healthcare clinicians that care for women and everything about women,” says Dr. Rosser. Teenage patients don’t necessarily need a pelvic exam, even if they are sexually active, and they don’t need a Pap smear until age 21 since research suggests that the risks of offering cervical screening before age 21 outweigh the benefits. “Even between ages 21–25, recent guidelines show that the benefit of screening with a Pap smear is extremely low,” explains Dr. Rosser. “When you are under 25, it is common to have changes in the cells of your cervix — abnormal cells — and these usually go away by themselves. Getting an abnormal Pap smear result often leads to follow-up tests which have a small but real chance of causing complications.” This visit can also include:
- Contraceptive counseling—regardless of whether a teen is sexually active. “I like to introduce the idea of sexual activity, taking care of your body, and respecting your body first as well as how to protect yourself. We discuss contraception and what to look out for with regard to healthy relationships and intimate partner violence,” she says.
- Sexual orientation and gender desires. “It’s really important that people feel comfortable with the clinician that they choose, so that they are able to talk about their gender desires and sexual orientation if they choose to,” says Dr. Rosser.
- Human papillomavirus (HPV) vaccine: The HPV vaccine protects against developing certain cancers later in life, such as cervical cancer. The Centers for Disease Control and Prevention (CDC) recommends all boys and girls get their HPV vaccine at age 11 or 12.
- Blood pressure screening: This assesses for risk factors such as diabetes, obesity, and heart disease. “While it might seem early to discuss these issues, in my experience, it’s better to start these conversations sooner so that girls are knowledgeable about taking care of their health and their bodies,” says Dr. Rosser. “The more you talk about it, the more they will listen. Learning is repetition.”
- Lipid screening: Once, beginning in late adolescent years. This blood test checks the amount of cholesterol and triglycerides.
Expert’s Take: “These health visits are also an opportunity to talk about alcohol, drug use, and tobacco use as well as topics such as anxiety and depression,” adds Dr. Rosser.
Checklist for Women in Their 20s & 30s
- Primary care visit: Once a year. “Your 20s and 30s are a great time to either maintain where you are or identify your risk factors for different diseases, whether that’s obesity, diabetes, family history of issues like cancer and heart disease, or reducing sexually transmitted disease risk,” says Dr. Rosser.
- Pap test and pelvic exam: A Pap test is done during an OB-GYN visit to screen for cervical cancer and HPV. It’s a common misconception that women need a Pap test and pelvic exam every year, says Dr. Rosser. “It’s ingrained in us that a Pap smear and pelvic exam are synonymous with an annual visit, and it is not,” she says. “The guidelines from ACOG and other women’s health organizations generally advise a reduction in the number of tests women get over their lifetime to better ensure they receive the benefits of testing while minimizing harm.” According to the U.S. Preventive Services Task Force:*
- Women ages 21–29 should be screened for cervical cancer every three years. For women ages 21–25, the benefit of a Pap test is much less because the risk of cervical cancer is extremely low. However, for women who have not had the HPV vaccine, screening can be considered. The decision depends on a woman’s history of abnormal Pap tests and HPV and her HPV vaccine status. If you are not sure, please discuss with your OB-GYN.
- Women ages 30–65 should be screened every three years for cervical cancer alone, every five years for HPV alone, or every five years if co-testing for both.
- Clinical breast exam: This is typically done during an OB-GYN well-woman visit and starts at age 19.
- Sexually transmitted infection (STI) screening: All sexually active women younger than 25 should be tested for gonorrhea and chlamydia every year. Women 25 and older who have new or multiple sex partners or a sex partner who has an STI should also be tested for gonorrhea and chlamydia every year. There are a number of other STI screenings women might want to consider with their doctor, especially if they have multiple sex partners. “If you are sexually active, getting tested for STIs is one of the most important things you can do to protect your health,” adds Dr. Rosser. “Make sure you have an open and honest conversation about your sexual history and STI testing with your doctor and ask whether you should be tested for STIs.”
Note: Screening for STIs during pregnancy occurs at specific intervals.
- Family planning: This is done during an OB-GYN visit; it brings attention to contraception, reproductive health, and reproductive planning, all of which are important for women interested in starting a family.
- For women who have been pregnant in the past, assessing pregnancy history is critical. For instance, if someone has diabetes or has had a blood pressure issue, such as preeclampsia while pregnant, it increases their risk of having heart disease in their lifetime. “Pregnancy is often a window into a woman’s future health,” says Dr. Rosser.
- Blood pressure screening: Once a year. Because heart disease is the leading cause of death for women in the U.S., Dr. Rosser advises paying close attention to blood pressure, cholesterol, weight management, and lifestyle factors like diet and exercise. “It is good to check your blood pressure several times a year, not just during the once-a-year checkup.”
- Optional: Genetic testing. “If there is a strong family history of cancer, including breast, ovarian cancer, cervical cancer, or colon cancer, then I will refer them to a genetic counselor,” says Dr. Rosser.
Expert’s Take: “Many women generally see their gynecologist as their primary care provider, especially those leaving their pediatrician and moving on in their 20s, 30s, and even 40s,” says Dr. Rosser. “This is an opportunity to use these OB-GYN visits to focus on the whole woman. It’s a paradigm shift, but we have the opportunity to leverage these visits so that we can make a difference in women’s lives with a comprehensive holistic approach.”
*These guidelines are updated regularly by different research-based organizations and vary depending on whether a woman has had a hysterectomy, a history of high-grade precancerous lesions, or is immunocompromised. For the latest guidelines, ask your OB-GYN or visit ACOG’s Women’s Preventive Services Initiative.
Checklist for Women in Their 40s & 50s
- Primary care visit: At least once a year or as often as needed.
- Routine blood tests and lipid screening: Measures blood pressure, blood sugar, cholesterol, etc. At least once a year or as often as needed.
- Pap test and pelvic exam: Screen every three years for cervical cancer, every five years for HPV, or every five years when combining both tests.
- Screens for breast cancer: Once a year, starting at age 45. Women ages 40–44 have the choice of starting annual mammograms if they wish; women 55 and older can switch to every two years if they choose.
- Colonoscopy: The American Cancer Society recommends starting screening at age 45 —earlier if you have a family history of colon cancer. For those without a history of colon cancer, it’s generally recommended to get a colonoscopy every 10 years after the initial screening.
- Lung cancer screening: The U.S. Preventive Services Task Force recommends adults 55 and older should be screened if they have smoked for 30 years and currently smoke or if they’ve quit within the last 15 years.
Expert’s Take: “African American women are more severely hit by many conditions, including heart disease, diabetes, breast cancer, and colon cancer,” says Dr. Rosser. “In fact, more than 85% of African American men and women are likely to develop hypertension in their lifetimes. I make a point to tell African American patients this not to alarm them but rather to arm them with information, so they are more aware and empowered about their health.”
Checklist for Women in Their 60s & Older
- Pap test and pelvic exam: Based on the best available guidelines, the Pap test is not routinely recommended after age 65. The decision should be made between the woman and her clinician and based on her own history.
- Routine blood tests and lipid screening: At least once a year or as often as needed. Varies for each individual and depends on family history of colon cancer and colonoscopy results. For most people who are at average risk, a colonoscopy is recommended once every 10 years after turning 45.
- Osteoporosis screening: Women 65 and older with normal bone mass should have a bone mineral density (BMD) test every 15 years. More frequent testing is recommended for women with certain risk factors for osteoporosis, such as smoking, alcoholism, history of hip fracture in a parent, or rheumatoid arthritis.
- Skin cancer screening: Once a year. More frequently if there is a family history of skin cancer or a history of prolonged sun exposure.
- Cardiology screening: At least once a year or as needed, especially if you are African American, have had preeclampsia or high blood pressure while pregnant, or have a family history of heart disease.
Expert’s Take: “If you’re over 65 and would like to continue with regular Pap smears because of HPV risk or other concerns, speak with your OB-GYN so that they can evaluate your risks and you can come up with a plan together,” says Dr. Rosser.
Dr. Rosser is a staunch supporter of women being involved at every stage of their health. “People are either really engaged in their healthcare or they are worried and nervous and may avoid certain screenings and visits,” she says. “We want to engage women in their own healthcare so they are empowered to live long and healthy lives.”
Mary L. Rosser, M.D., Ph.D., is an OB-GYN at NewYork-Presbyterian/Columbia University Irving Medical Center and an assistant professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons. She has been a practicing obstetrician-gynecologist for 23 years. Primary care and heart disease in women have always been areas of focus for Dr. Rosser. She conducted basic science research on heart disease during graduate school and was the chair of the “Women & Heart Disease Physician Education Initiative” for District II of the American College of Obstetricians and Gynecologists (ACOG). She continues to conduct clinical studies around patient awareness and understanding of heart disease and well-woman care. Dr. Rosser serves on the Medical Leadership Team of the Go Red for Women movement of the American Heart Association and is ACOG’s liaison to the American College of Cardiology.