The Essential Women’s Health Checklist

Checklist for Women in Their 20s & 30s

• Primary care visit: Once a year. “Your 20s and 30s are a great time to either maintain your health or identify your risk factors for different diseases, whether that’s obesity, diabetes, family history of conditions like cancer and heart disease, or reducing sexually transmitted infection risk,” says Dr. Rosser.
   
• OBGYN visit: Once a year. It’s a common misconception that women need a Pap test and pelvic exam every year. “It’s ingrained in us that a Pap smear and pelvic exam are synonymous with an annual visit, and they are not,” she says. “There is so much more to an annual or wellness visit.”
   

• Pap test: The test screens for cervical cancer and HPV. Women ages 21 to 29 should be screened for cervical cancer every three years. For women ages 21 to 25, the benefit of a Pap test is reduced 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 to do a Pap test depends on a woman’s history of abnormal results, HPV and her HPV vaccine status. If you are not sure whether you need a cervical cancer screening, discuss the decision with your OB-GYN. Women ages 30 to 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.

• Pelvic exam: A physical exam of your external and internal genitalia. When performed, gynecologists can identify conditions such as ovarian cysts, uterine growths, and other reproductive health concerns.

  However, major medical organizations differ on whether routine pelvic exams are helpful for women without symptoms — some suggest they are only needed when you have specific concerns such as pain, abnormal bleeding, or discharge. Talk with your OB-GYN about whether a pelvic exam is right for you at each visit. Importantly, a pelvic exam is not the same as a Pap test or cervical cancer screening — you can have one without the other, or neither.

• Breast cancer risk assessment: An initial assessment for breast cancer risk will include a review of your medical history and whether you may need to begin screenings before the age of 40. 
   

• Sexually transmitted infection (STI) screening: All sexually active women 24 years or younger 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 annually. 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:  For women interested in starting a family, an OB-GYN will discuss contraception, reproductive health and reproductive planning. Assessing pregnancy history is critical for women who have been pregnant in the past. For example, 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.

  Adverse pregnancy outcomes (including preeclampsia, gestational diabetes, preterm birth, and delivery before 37 weeks) increase the risk of heart disease and high cholesterol.  The American Heart Association (AHA) recommends cardiovascular risk screening within three months postpartum for women with adverse pregnancy outcomes and continued monitoring. Doctors also may recommend cholesterol-lowering medications, such as a statin. Premature or early menopause, early first period (before age 10) and polyendocrine metabolic ovarian syndrome (PMOS) are also risk factors.

• Genetic counseling: Hereditary cancer risk assessment can be performed by OB-GYNs and updated regularly. About 10% of breast cancers and up to 25% of ovarian cancers are caused by inherited gene changes that can run in families. National guidelines recommend that your OBGYN assess whether you may benefit from genetic testing based on your personal and family history. You may qualify if you have a close relative with breast cancer before age 50, ovarian cancer at any age, male breast cancer, pancreatic cancer, high-risk prostate cancer, or if you are of Ashkenazi Jewish ancestry. If testing identifies a gene change, there are proven steps, including enhanced screening and risk-reducing options, that can significantly lower your cancer risk.
   
• 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.”
   
• ASCVD (Atherosclerotic Cardiovascular Disease) Risk Assessment. For women in their 30s, an ASCVD risk assessment is recommended to calculate the likelihood of a heart attack or stroke over the next 10 years. The AHA’s PREVENT risk calculator also estimates 30-year risk to help identify younger adults who may benefit from earlier lifestyle interventions.
   
• HPV Vaccine: The vaccination guidelines for HPV from the Centers for Disease Control and Prevention (CDC) are:
  • Routine vaccination can start at age 9 (for both boys and girls).
  • Catch-up vaccination through age 26 for previously unvaccinated persons.
  • Shared clinical decision-making for women ages 27–45 who may not have been vaccinated.

Expert’s Take: “Many women generally see their gynecologist as their primary care provider,” 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.”