Routine Healthcare for Women

Routine checkups can find treatable problems early. For many medical problems, early treatment can help prevent more serious complications. The value of checkups and how often you have them depend mainly on your age. Your personal and family medical histories are also important.

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 discuss with your healthcare provider how often you should have physical exams and how often you need these or other tests.

• Blood pressure measurement: all women.
• Clinical breast exam by your provider: at least every 3 years if you are 20 to 39 years old and every year if you are 40 or older.
• Mammogram: as often as your healthcare provider recommends if you are 25 years old or older. When you should start having these exams and how often depends on your risk for breast cancer. All women age 40 to 70 years old, who are in good health, should be screened for breast cancer with mammography every 1 to 2 years after counseling by their healthcare provider about the possible risks and benefits of the procedure. If you are over 70, ask your provider how often you should have a mammogram.
• Pap test: at least every 3 years if you have ever had sex and have not had your uterus removed. Your provider may recommend more frequent screening if you have had any abnormal test results in the past or if you have an increased risk for cervical cancer.
• Cholesterol test: if you are age 45 or older. You may start having this test at an earlier age if you have a family history of high cholesterol.
• Fasting blood sugar for type 2 diabetes: if your blood pressure, blood lipids (cholesterol), or weight are high or you have a family history of type 2 diabetes.
• Colorectal cancer test: if you are 50 or older. Recommended tests include a yearly test for blood in the stool, called the fecal occult blood test (FOBT) or fecal immunochemical test (FIT), and one of the following tests:
  • sigmoidoscopy every 5 years
  • double-contrast barium enema every 5 years
  • colonoscopy at least every 10 years.

  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: 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 infections, including if you have a new sex partner or more than 1 partner, a history of STDs, a partner with an STD, or a partner who is bisexual.
• HIV test: if you are 13 to 65.
• Tuberculosis (TB) test: if you have a high risk of TB; for example, because you are a health worker, drug user, or immigrant, or because 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 age 60 if you have an increased 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.

Remember, these are the minimum recommendations for routine tests. You and your healthcare provider must discuss what is right for you based on your symptoms and your personal and family medical history.

Many other tests are often done at routine checkups, but there is no current evidence that they are helpful as routine screening tests for healthy women. Examples of such tests are a CBC (complete blood count), thyroid tests, and urine tests. When you have no symptoms of illness, you should discuss the pros and cons of these and other tests with your healthcare provider. Each test involves some expense.

What shots do I need?

The following shots are recommended for adults:

• Tetanus (Td) booster shot at least every 10 years. If you are under age 65, you should get the new Tdap booster to protect you better against whooping cough (pertussis) as well as tetanus. If you are 65 or older, this new vaccine has not yet been approved for your age. Because babies are most susceptible to complications from whooping cough, Tdap is especially recommended for adults caring for children, even if it has been less than 10 years since your last booster shot.
• Flu shot every fall if you are 50 or older, you have a high risk for complications from the flu, you might spread the flu to others who are at high risk, or you just want to decrease your risk of getting the flu. Women who will be pregnant during flu season should have a flu shot.
• Measles, mumps, and rubella shot (MMR) if you were born after 1956 unless you have already had the shot or the diseases. Depending on when you received your measles shot, you may need a second one. Ask your healthcare provider.
• Hepatitis A shot if you are at risk, for example, through travel or your job (including military service) or if you have liver disease, use illegal drugs, or have HIV.
• Hepatitis B shot for all teens and young adults, age 12 to 24 years, who have not had hepatitis or a hepatitis shot and for all adults who are at risk of infection. This includes, for example, women who have liver disease, women who have more than 1 sex partner or whose partner has more than 1 partner, or who have a sexually transmitted infection, abuse IV drugs, or plan to travel where hepatitis B is common.
• 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. 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.
• 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, but, if you have had the shot and then get shingles, it can reduce the pain caused by the infection.

What other things I can do to stay healthy?

You should expect your healthcare provider to advise you regularly on other ways to stay healthy. Some of these may include:

• Breast self-exams: Check your breasts every month.
• Substance use: Don't use tobacco or illegal drugs. Avoid using alcohol while driving, swimming, boating, etc.
• Diet and exercise: Try to keep your weight at a comfortable, healthy level. Limit the fat and cholesterol in your diet. Eat a lot of whole grains, fruits, and vegetables. Get regular physical activity or exercise.
• 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 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).
• 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 if you are not in a long-term relationship with just one partner who has no other partners.
• Hormone use: During or after menopause, discuss the risks and benefits of use of estrogen and progesterone replacement with your healthcare provider.