Milestones in Women’s Health

What? First Human Papillomavirus Vaccination

When? Between 9-14 Years Old

About 14 million Americans become infected with the human papillomavirus each year. In women, this virus can lead to cancers of the cervix, vagina, vulva, anus, and the back of the throat. The human papillomavirus vaccination has caused HPV infections and cervical precancers to significantly drop since it was introduced. For those ages 9-14, the HPV vaccination is a two-dose series, with the second dose 6-12 months after the first dose. In order to receive this vaccination series, a teenage girl can visit her pediatrician or family medicine provider’s office, or, in certain states, this vaccination can be administered by a local neighborhood pharmacist.

What? First Cholesterol Check

When? 20 Years Old

Heart disease is the leading cause of death for women in the United States, accounting for about one in every five female deaths. High LDL, sometimes referred to as “bad” cholesterol, levels are a key risk factor for heart disease. Heart disease can sometimes go undiagnosed until an emergency occurs, such as a heart attack or stroke. 

The American Heart Association recommends that all adults 20 years and older have their cholesterol checked every four to six years. This test is typically performed by a primary care/family medicine provider. If cholesterol levels are not within range, lifestyle modifications and/or medication may be recommended, and levels will be checked more often. Appropriately managing cholesterol levels can help decrease a women’s risk of heart disease and life-threatening complications.

What? First Pelvic Exam and Pap Smear

When? 21 Years Old

A young woman’s first pelvic exam and pap smear are typically done at age 21, or sooner if she is experiencing symptoms such as unexplained pain in the pelvic area, unusual vaginal discharge, or extended vaginal bleeding. This exam can be performed by a gynecologist, a women’s health nurse practitioner or physician’s assistant, or a family medicine provider. The exam will start out with an external exam, in which the health care provider looks at the area outside of the vagina. 

During the external exam, the health care provider may also perform a clinical breast exam, examining the breasts for changes in size or shape, puckering, dimpling, or redness. Then, the health care provider will move onto the internal portion of the exam and the pap smear. A pap smear is a test that looks for cervical precancers. Precancers are cell changes on the cervix that may lead to cancer if not treated appropriately. 

During this test, a speculum, an instrument made of metal or plastic, is gently placed in the vagina using a lubricant. The speculum is then gently opened to allow the health care provider to see the cervix. After visually examining the vagina and cervix, the health care provider will take a sample of cells from the cervix using a tiny brush. These cells are then sent to a lab in order to test them for any precancerous changes. If a young woman is sexually active, the health care provider can also take additional swabs from the cervix and/or vagina in order to test for sexually transmitted infections. Finally, the health care provider will remove the speculum and insert two gloved fingers into the vagina. Then, with his or her other hand, he or she will apply gentle pressure to the lower abdomen in order to examine the internal female organs. 

If results of the pap smear are normal, it is recommended to repeat testing every three years. A woman’s health care provider will recommend how often to get pelvic exams based on the woman’s particular health situation.

What? First Mammogram

When? 45 Years Old (Or Sooner If Risk Factors Present)

Breast cancer is the most common cause of new cancers in women worldwide, accounting for 25.4% of new cancer cases diagnosed in females in 2018. The American Cancer Society recommends that women begin annual screening mammograms at age 45. Annual mammograms may be started sooner if changes are noted on a clinical breast exam or a woman has increased risk factors for breast cancer, such as a close familial history of breast cancer, known BRCA1 and/or BRCA2 gene mutations, or being of Ashkenazi Jewish heritage. This test is performed by a radiologic technician and results are read by a radiologist. Results may be reported directly to the patient, or, if abnormalities are seen, the patient may be called back for a follow-up appointment and/or referred to a breast specialist. During the test, the breasts are placed one at a time between two flat plastic plates and an X-ray is taken of the flattened breast. Flattening the breasts allows the most amount of tissue to be viewed. Some women may experience brief discomfort and aching during or after a mammogram. However, regular breast screening is important as it can help detect cancer at an early and more treatable stage.

What? First DEXA Scan

When? 65 Years Old

As women go through menopause, the ovaries begin to produce less and less estrogen. Estrogen, among many other functions, helps to protect against bone loss. Menopausal women experience a period of rapid bone loss starting one year before the final menstrual period and lasting about three years total. This can lead to osteoporosis, a condition in which the bones become thin and brittle, making fractures more likely. Osteoporosis is five times more common in women than in men. Thus, the National Osteoporosis Foundation recommends that women age 65 or older have a bone mineral density scan, typically a DEXA scan, performed in order to assess bone density and fracture risk. The test is non-invasive and typically takes less than fifteen minutes. It is performed by a radiologic technician, and the results are read by a radiologist and communicated to the patient’s primary care provider. Repeat testing is recommended every 15 years for those with normal bone mass or mild bone loss. For those with osteoporosis, treatment may be recommended, and repeat bone mineral density testing will take place every one to two years.

Keeping track of these essential women’s health milestones can be difficult, but they are important! In addition, having a primary care provider for annual wellness visits can help a woman stay on top of what tests, exams, and vaccinations to receive and when. For women, a primary care provider could be a family medicine provider, internal medicine provider, or a gynecologist. Primary care providers are trained in treating a wide range of medical conditions, and you can count on them to help manage your health. By working with a primary care provider and keeping up with important tests, exams, and vaccinations, you can help promote a healthier future for yourself!


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