Screening and Exams are Vital to Aging Gracefully
Midlife is a great time to focus on taking care of yourself to preserve the best possible quality of life.
It’s not unusual for women to say that they don’t think they need to see a women’s health specialist after menopause unless they have a problem. But it’s always important to be proactive about your health, which includes keeping up with pelvic exams and screenings throughout life. Risks of dangerous health problems like cardiovascular disease, breast and other cancers, and stroke actually increase with age.
Midlife is a time of transition for women in all facets of their lives. It’s a great time to focus on taking care of yourself to preserve the best possible quality of life. I actually remind my patients that they deserve more thought as they get older, not less!
Get Baseline Scores
Start focusing on health in your 30s. This is a good time to have a number of tests that will allow your doctor to establish “baseline” scores — the scores that are normal for you — including body mass index, blood pressure, cholesterol and fasting glucose levels. Knowing these values will enable your doctor to track improvements or declines over the months or years between visits.
As you age, discuss the timing of other important tests, including:
- Mammograms to screen for breast cancer
- Bone density assessment
- Colonoscopy to screen for colon cancer
- Thyroid stimulating hormone (TSH) test
- Regular pelvic exams
Manage Your Weight As You Age
Several common health problems can be controlled relatively easily by eating well, exercising regularly, taking the right vitamins and supplements, and staying actively involved in life as you age.
Weight management can be particularly challenging for women, who face a slowing metabolism with age. The body of a middle-aged to older woman just can’t withstand abuses like overeating or not exercising. Women in midlife have to exercise more and eat less just to stay the same weight. But the payoff of making small changes is great. By eating smaller portions and healthier foods, and exercising more, you can help prevent type 2 diabetes, arthritis and other weight-related problems.
Preserve Bone Mass
Osteoporosis is a disease, and like many diseases, it is preventable. To preserve bone mass:
- Avoid all tobacco products
- Limit alcohol intake
- Do weight-bearing exercises like walking
- Get adequate calcium and vitamin D
Risks of bone fragility are greatest after menopause, so supplement your diet with 1200 mg of calcium and at least 400 to 800 international units (IU) of vitamin D starting at age 50. Most physicians recommend 1000 IU per day in this part of the country, where exposure to sunlight is at a premium.
Begin bone-density screening at age 65, or sooner if you have risk factors such as a family history of osteoporosis, previous use of steroids or chemotherapy, smoking, or having already suffered a bone fracture. Screening every two to three years will detect any bone thinning. There are several online resources for determining your own risk of a fracture. They use an algorithm developed in collaboration with the World Health Organization, and consumers can easily monitor their own risk between screenings.
Recent reports have drawn attention to a class of drugs called bisphosphonates (Fosamax, Actonel, Boniva and Reclast), commonly used to slow bone loss in post-menopausal women. Some studies point to an increased risk of atypical thigh fractures in people using these drugs. The FDA has issued a statement saying that a preliminary review of the data does not show a clear connection between these drugs and fractures. A thorough study of any potential link is underway.
If you currently are taking these medications, don’t stop unless you are told to do so by a healthcare professional. Talk to your doctor if you develop new hip or thigh pain, or have any concerns about your medications, and report any side effects to your healthcare professional.
Pelvic Exams Are Still Important After Age 30
Annual pelvic exams should be part of routine healthcare throughout a woman’s life. The recommendation is that women begin seeing a gynecologist/health care provider for a Pap test at age 21 and repeated every three years until the age of 29. After age 30, Pap tests can be done every five years, as long as the concurrent HPV test is negative. Pap tests are done more frequently in women with a history of multiple sexual partners, prior abnormal Pap tests, smokers, and those with HPV or HIV infection. Women with these high risks should discuss their frequency of screening with their health care provider.
Pap smears may be discontinued at age 65-70 at physician/patient discretion if the woman is at low risk and previous tests have all been normal. Even when Pap tests are discontinued, women should continue to have pelvic exams. During the exam, your doctor will check your vagina, uterus, cervix, ovaries, bladder and rectum. After menopause, women are particularly susceptible to vaginal dryness and may have lesions in the vulvar area. Prescription creams and hormone therapy can be effective in treating many of these disorders. The entire exam takes only about 10 minutes.
Keep Your Love Life Alive
Female sexual dysfunction is more common than you might think. Several population-based surveys show that approximately 43 percent of American women have some form of sexual dysfunction, from low desire to painful intercourse. In postmenopausal women, several factors can contribute to a less-than-fulfilling sex life. Plunging estrogen levels associated with menopause can lead to decreased arousal. The testosterone so vital to male libido is also present in women; the gradual decline in testosterone levels with age can affect female libido. And vaginal dryness — now epidemic in post-menopausal women — can make intercourse painful.
Discuss your concerns during your annual visit. Your physician can help you address problems that may be compromising your sexual experiences.
Margery Gass, MD, is the new Executive Director of the North American Menopause Society. She sees patients in Cleveland Clinic’s Center for Specialized Women’s Health on the main campus.
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