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5 Questions To Ask Your Physician For Women Over 40


  1. Prevention: What should I do about contraception?
  2. This is certainly an important question for sexually active women at any age, but the information for women in their 40's has changed in the past few years.Unfortunately, the incidence of unplanned and unwanted pregnancies has not improved enough. For women who are in their 40's and do not want to get pregnant, your choices are:
    • abstinence
    • sterilization (in you or your partner)
    • oral contraceptives: only for women who DO NOT smoke or who do not have other risk factors
    • condoms with contraceptive gel/foam/cream
    • diaphragm
    • IUD
    • contraceptive sponge
    • Depo-Provera long-acting injectable
    • Norplant System

    All women who are sexually active in a relationship that is not monogamous or with a partner whose sexual history is uncertain must also use safe sex practices to prevent sexually transmitted diseases (STD's).

  3. Screening: Are there any specific screening tests that I need now that I'm over 40? If so, when and how often?
  4. While it's easy to think that the more tests you have, the better, there are only 5 medical screening tests that have withstood the rigor of outcomes studies to be administered to every adult: height and weight measurements, cholesterol screening, fecal occult blood test (stool sample) for colorectal cancer screening, and blood pressure measurement.For women, there are an additional 3 essential tests: Pap smear, clinical breast exam, and mammograms.

  5. Diagnosis: Are there conditions that I am at increased risk for that I need to know about? How can I reduce my risk?
  6. Your physician will determine whether you are at increased risk for certain chronic illnesses based upon your own medical history, your family history, your physical exam, and the results of the screening tests discussed in section 2. Of course, individuals with certain risk factors or in other age groups may need additional diagnostic tests, so this is an important area to discuss with your physician. For example, someone with a family history of colon cancer would probably be advised to have a sigmoidoscopy (which is recommended for all adults over age 50); people of color, those who are obese, and those with a family history of diabetes should be screened for this serious illness.

    Vaccines are the classic preventive interventions. I put this in the "diagnostic category for women in their 40's, however, because you will probably only need vaccines if you are at increased risk. The specific vaccines to discuss with your physician are the vaccines for pneumonia & influenza (these are generally recommended for those over age 65 or those who are immunosuppressed), chicken pox (only for those who haven't had it or otherwise become immune), hepatitis B (for those with high risk occupations or behaviors), or Lyme disease (for those who reside in endemic areas). All adults should have a tetanus booster every 10 years.

    For most chronic illnesses, the best way to reduce your risk is with behavioral changes, both before the onset of any symptoms and after a diagnosis is already made. For example, once smokers stop smoking for 10 years, they substantially reduce their risk of lung cancer. When obese patients with diabetes or hypertension control their weight, they may no longer need medication to control these serious illnesses. Exercise is a great preventive measure for numerous illnesses, not only those related to weight control. For example, regular aerobic exercise can boost HDL levels (the "good cholesterol), reduce symptoms of depression, and boost cardiac fitness. Weight bearing exercise (e.g. walking or weight lifting) can reduce the risks of osteoporosis. Proper nutrition is critical for preventing many diseases. Reducing alcohol and caffeine consumption also reduces risk of several disorders. Practice safe sex. Your physician can make numerous behavioral and other individualized risk-reducing recommendations for you.

    While you are thinking along these lines, remember that accidents remain one of the top killers of Americans. When doing your health inventory, think about wearing seat belts consistently and gun safety.

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 All medical conditions, including wellness, can be discussed in terms of five primary areas: prevention, screening, diagnosis, treatment, and follow-up. 

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