Health Exams

Women's Health Examination Checklist

Your 'to do' list probably ranges from running the kids to after school activities to grocery shopping for tonight's dinner, but does it include a visit to your healthcare provider?

Our Women's Health Examination Checklist has combined screening information from the Mayo Clinic and the U.S. Department of Health and Human Services to help you start including these exams in your schedule, no matter how busy you are. Screening tests can find diseases early when they are easier to treat. This timetable is a general recommendation - your doctor may suggest different tests or frequencies based on your medical history. A preventive health plan should also include talking with your doctor about alcohol and drug use, smoking cessation, nutrition, exercise, and mental health.

SCREENING	BEGINNING AGE	HOW OFTEN
Blood pressure	18 years	Every 2 years
Cholesterol levels	20 years	Every 5 years
Colon examination	50 years (or earlier if at high risk--e.g. family history of colon cancer)	Every 1 to 5 years (depending on the screening test used and personal risk)
Clinical breast examination	20 to 39 years 40 years and older	Every 3 years Yearly
Breast self-examination	20 years	Monthly
Mammogram	40 years and older (or earlier if at high risk--e.g. family history of breast cancer)	Every year
Pap smear	21 years (or earlier if sexually active)	Every 1 to 3 years (can discontinue after age 65 if never had an abnormal pap smear and no new sexual partners. Also may discontinue if have had a total hysterectomy.)
Skin examination	18 - 39 years 40 years and older	Every 3 years by a doctor plus a monthly self-exam (check for changing color, size, and shape of moles, etc). Every year by a doctor plus a monthly self exam (check for changing color, size, and shape of moles, etc).
Dental examination	18 years	Yearly
Eye examination	18 years or if visual problems arise	At least once between 18 and 39; Every 2 to 4 years between 40 and 64; every 1 to 2 years after age 65
Sexually transmitted infections	25 years or younger if you are sexually active (if you are older, check with your doctor to see whether you should be tested)	As directed by your doctor
Bone density measurement	65 years and older	As directed by your doctor (but usually at least once by the age of 65, unless at an increased risk due to fractures, family history of osteoporosis, or long term treatment with corticosteroids)
Diabetes	45 years (or earlier if overweight and have additional risk factors such as pre-diabetes, high blood pressure, high cholesterol, vascular disease, physically inactivity, gestational diabetes, delivery of a baby weighing more than 9 pounds, or a family history of diabetes. High risk ethnic groups such as African Americans, Latinos, Native Americans, Asian Americans, or Pacific Islanders should also be screened before age 45.)	Every 3 years (higher risk individuals should be screened more frequently)
Weight	18 years	Every 6 months
Thyroid Test	35 years	Every 5 years

Blood Pressure
Monitoring blood pressure helps prevent heart attacks, strokes, and kidney damage. To measure your blood pressure, your healthcare provider will wrap an inflatable cuff around your arm. As the air is slowly released from the cuff he will use a stethoscope to measure your systolic pressure (the pressure in your heart as it pumps blood out) and your diastolic pressure (the pressure when your heart is at rest and is filling with blood). Generally, a systolic pressure greater than 140 or a diastolic pressure above 90 is considered too high. If you have other health conditions such as diabetes or chronic kidney disease, your blood pressure goals may be lower.
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Cholesterol Levels
Cholesterol is a fatty substance that builds up inside blood vessels and contributes to the risk for heart attacks and strokes. A blood test can measure low-density lipoprotein (LDL) or "bad cholesterol" and high-density lipoprotein (HDL) or "good cholesterol." Total cholesterol levels should be below 200 mg/dL. LDL level goals vary depending on your risk for or presence of cardiovascular disease. For most healthy adults a goal LDL is below 130 mg/dL. HDL levels also vary depending on your sex and other health conditions that you may have, however levels above 40 mg/dL are desired. Triglyceride levels--another fatty substance in the blood-- should also be monitored and the recommended level is less than 150 mg/dL.
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Colon Examination
There are a few different screening tests available that can find cancer of the colon (large intestine). One procedure involves a flexible tube with a tiny camera on its end (endoscope) that is inserted into the rectum and colon to look for lesions, polyps, or other problems. If your doctor is performing a sigmoidoscopy, he will examine the rectum and last 27 inches of the colon. If he is performing a colonoscopy, he will examine the entire rectum and colon using the endoscope. Another procedure that can be used to screen for colon cancer is an x-ray procedure known as a barium enema. A substance called barium, a solution of a metallic element, is injected into the colon through the rectum, allowing visualization of the colon on x-rays. A fecal occult blood test, the only non-invasive procedure to test for colon cancer is used to check a stool sample for blood. Your doctor will determine which test is best for you based on your risk factors. The most recent medical guidelines suggest for those over 50 years of age:

• an annual fecal occult blood test (FOBT; a noninvasive blood test of a stool sample) and/or
• a flexible sigmoidoscopy at least every 5 years, or
• a colonoscopy every 10 years, or
• a double-contrast barium enema every 5-10 years.

Clinical Breast Examination and Breast Self Examination
A doctor will visually examine your breasts for any change in size or contour, dimpling of the skin, or spontaneous nipple discharge. He will also feel for skin changes and lumps in your breasts and around the armpits, where lymph nodes are located. It is also wise to perform monthly self-examinations in between doctor visits. Your doctor or nurse can instruct you how to do this or you can find more information (including a video) on the Susan G. Koman Breast Cancer Foundation Web site at http://www.komen.org/bse/.
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Mammogram
A mammogram is simply a breast x-ray. During a mammogram, a radiology technician presses each breast between plastic plates so that all of the breast tissue can be viewed. Some women report mild discomfort during the procedure because the breast is compressed between the plastic plates; however, the discomfort does not last once the test is completed. Mammograms are vital because they can locate a lump too small to be found during a breast self-examination.
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Pap Smear
To test for cervical cancer, your healthcare provider will insert a speculum (an instrument used to open the walls of the vaginal canal in order to examine the interior) into your vagina and gently swab cells from your cervix. The sample is then examined at a laboratory for cancer or other abnormalities.
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Skin Examination
A head-to-toe examination of your skin, your body's largest organ, can detect skin cancer. Your doctor will be on the lookout for changes in the shape or color of moles or other lesions. In between visits to your doctor, you should perform regular self-examinations, especially if you have risk factors for skin cancer, such as repeated sun or tanning bed exposure.
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Dental Examination
A dentist can check your teeth for cavities and gums, tongue, lips, and soft tissues inside your mouth for other oral problems, such as gingivitis (gum disease).
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Eye Examination
During an eye examination, a doctor examines your eye movement, peripheral (side) vision, sharpness of vision, and pressure inside your eyeball. He can also determine if you need glasses or contacts. Eye examinations are important to identify glaucoma (increased eye pressure), cataracts (clouding of the eye lens), or macular degeneration (changes in the retina).
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Sexually Transmitted Infections
Blood tests for sexually transmitted infections such as Chlamydia, herpes and human immunodeficiency virus (HIV) are important if you are at risk. Talk to your doctor about which tests may be needed, especially if you have or have had multiple sexual partners or do not always practice safe sex.
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Bone Density Measurement
A radiology technician uses equipment to scan your lower back and hip region with x-rays or sound waves to find areas where there is loss of bone mass (osteoporosis). The risk of osteoporosis increases with age and leads to fractures and other complications.
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Diabetes
High glucose (sugar) levels in the blood can be an indication of diabetes. A fasting blood glucose test can be done to determine if you have diabetes. Diabetes is likely if the fasting glucose level is 126 mg/dL or greater, but the test should be repeated on a separate day to confirm that you have diabetes unless absolute symptoms of diabetes are present. Alternatively, an oral glucose tolerance test can be performed to detect the presence of diabetes. If you have pre-diabetes, high cholesterol, high blood pressure or obesity, you should be regularly screened for diabetes.
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Weight
Your height and weight can be measured to determine your body mass index (BMI). If your calculated BMI is in the overweight (BMI 25-29 kg/m²) or obese (BMI greater than 30 kg/m²) range, then you are more likely to have high blood pressure, Type 2 diabetes and are at greater risk for developing other diseases.
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Thyroid Test
A simple blood test can help determine whether or not someone's thyroid gland is functioning normally by measuring the amount of Thyroid Stimulating Hormone (TSH) that is present. A higher than normal level of TSH in the blood indicates an under-active thyroid gland. Symptoms may include weight gain, increased fatigue, increased sensitivity to cold, muscle aches and pains. An under-active thyroid gland can lead to problems such as goiter (enlarged thyroid gland), heart problems, and mental health problems. A lower than normal level of TSH in the blood indicates and overactive thyroid gland. Symptoms may include weight loss despite an increased appetite, nervousness, tremor, and increased sensitivity to heat. An overactive thyroid gland can also lead to heart problems, eye problems, and brittle bones. Since the symptoms of thyroid disorders can be vague, it is important to be tested regularly. Doctors recommend women over the age of 35 get a thyroid test at least every 5 years.
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References

U.S. Department of Health and Human Services Agency for Healthcare Research and Quality Women: Stay Healthy at Any Age--Checklist for Your Next Checkup. AHRQ Publication No. APPIP03-0008, January 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/ppip/healthywom.htm. Accessed April 17, 2006 and February 2008.

U.S. Department of Health and Human Services, Office on Women?s Health: General Screenings and Immunizations for Women. Updated Nov 2007. Available from http://womenshealth.gov/screeningcharts/general/. Accessed February 2008.

MayoClinic.com: Health screening guidelines. Available at: http://www.mayoclinic.com/health/health-screening/WO00112. Accessed April 17, 2006 and February 2008.

MayoClinic.com: Hyperthyroidism (Overactive thyroid gland). Updated June 8, 2006. Available from http://www.mayoclinic.com/health/hyperthyroidism/DS00344/DSECTION=6. Accessed February 2008.

MayoClinic.com: Hypothyroidism (Underactive thyroid gland) Updated June 12, 2006. Available from http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=7. Accessed February 2008.

Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486-2497.

American Diabetes Association. Standards of Medical Care in Diabetes 2008. Diabetes Care 2008; 31:s12-s54.

Clinician s Handbook of Preventive Services, 2nd Edition. Available at: http://text.nlm.nih.gov/tempfiles/is/tempBrPg60409.html. Accessed September 24, 2001 and February 2008.

Last Updated: February 2008

This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.