Being aware of things that cause illness in your age group is a good idea. It lets you play an active role in trying to prevent problems.

This pamphlet will explain:

• Routine health care for women
• Special care you may need if your risk is high for certain problems
• Tips for healthy living

Practice preventative care to keep healthy for years to come

Preventive Care

Some health problems are more likely to occur at certain ages (see the boxes "Leading Causes of Illness in Women" and "Leading Causes of Death in Women"). Having regular checkups will help you learn what these common problems are. Your doctor also can show you ways to help prevent them. The goal of preventive care is to prevent or manage problems early.

Leading Causes of Illness in Women
Ages 13 to 18 Years	Ages 19 to 39 Years	Ages 40 to 64 Years	Ages 65 Years and Older
Acne	Asthma	Arthritis	Arthritis
Asthma	Back Problems	Asthma	Back Problems
Chlamydia	Breast disease	Back Problems	Breast cancer
Depression	Deformity or bone impairment	Breast disease	Chronic obstructive pulmonary diseases
Dermatitis	Depression	Carpal tunnel syndrome	Deformity or bone impairment
Diseases (infective, viral and parasitic)	Diabetes	Deformity or bone impairment	Diabetes
Flu	Diseases (infective, viral and parasitic)	Depression	Diseases (infective, viral and parasitic)
Headaches	Flu	Diabetes	Flu
Injuries	Gynecologic disorders	Diseases (infective, viral and parasitic)	Hearing problems
Nose, throat, ear and upper respiratory infections	Headache/migraines	Flu	Heart disease
Sexual assault	High blood pressure	Headache	High blood pressure
Sexually transmitted diseases	Injuries	Heart disease	Nose, throat, ear and upper respiratory infections
Urinary tract infections	Nose, throat, ear and upper respiratory infections	High blood pressure	Osteoporosis
	Sexual assault or domestic violence	Injuries	Skin conditions, such as dermatitis
	Sexually transmitted diseases	Menopause	Thyroid disease
	Skin rash or dermatitis	Nose, throat and upper respiratory infections	Urinary tract conditions, such as incontinence
	Substance abuse	Obesity	Vertigo
	Urinary tract infections	Skin conditions, such as dermatitis	Vision problems
	Vaginitis	Substance abuse
		Urinary tract infections
		Urinary tract conditions, such as incontinence
		Vision problems

Routine Needs

At routine visits, you will have a physical exam. Your doctor also will ask you about your health history. This is a good chance to talk to your doctor about your health concerns and any problems you may be having. Table 1 lists the tests needed for women in certain age groups.

Leading Causes of Death in Women Ages 13 to 18 Years Motor vehicle accidents Murder Suicide Cancer All other accidents Heart disease Congenital anomalies (problems from birth) Chronic obstructive pulmonary diseases (such as bronchitis or asthma) Ages 19 to 39 Years Accidents Cancer Human immunodeficiency virus (HIV) infection Heart disease Murder Suicide Cerebrovascular diseases (such as stroke) Chronic liver disease and cirrhosis Ages 40 to 64 Years Cancer Heart disease Cerebrovascular diseases (such as stroke) Accidents Chronic obstructive pulmonary disease Diabetes Chronic liver disease and cirrhosis Pneumonia and flu Ages 65 Years and Older Heart disease Cancer Cerebrovascular diseases (such as stroke) Chronic obstructive pulmonary diseases (such as asthma, bronchitis or emphysema) Pneumonia and flu Diabetes Accidents Alzheimer's disease

Special Needs

Many women have risk factors that may require further screening tests (Table 2). Some people are more likely than others to have certain health problems. Also, where you live, your lifestyle, and your personal and family medical history play a role in the type of health care you may need. For instance, if you or a first-degree relative have had breast cancer, you should have mammography done.

Immunizations

Immunizations are injections (shots) that help prevent infections. They are a routine part of preventive care. Table 1 outlines which are standard for your age group. If you have certain risk factors, you may need other immunizations (Table 2 ).

Health Tips

• Good lifestyle choices and habits promote good health for years to come. Here are some basics:
• Eat a well-balanced diet.
• Lower the amount of fat and cholesterol in your diet.
• Keep your weight at a level that is good for your height (see the body mass index chart).
• Exercise for at least 30 minutes three times a week.
• Do not smoke cigarettes.
• Do not use drugs.
• Drink alcohol only in moderation.
• Wear sunscreen and avoid excess sun exposure to help prevent skin cancer.
• Wear a seat belt every time you drive or ride in a vehicle.
• Use a form of birth control if you are able to become pregnant but do not want to become pregnant.
• Use a latex condom every time you have sex to help prevent STDs.
• Talk to your doctor about any over-the-counter medications, herbal remedies, vitamins
• or supplements you may take.
• Do a breast self-exam once a month (see box).
• Seek help if you feel sadness that affects your daily life.
• If you are being abused, ask for help from someone you trust — a close friend, family member, doctor or nurse, counselor, or clergy member. You also can call the National Domestic Violence Hotline at 1-800-799-SAFE (7233).
• Make sure you are getting enough fluoride for your teeth.
• Have regular vision exams.
• If you have any health concerns, talk to your doctor about them. In many cases there are treatments that can help.

How To Do a Breast Self-Exam Looking The self-exam should always be done in good light. Stand or sit in front of a mirror. Place arms at your sides. Look for dimpling, puckering or redness of the breast skin, discharge from the nipples, or changes in breast size or shape. Look for the same signs with your hands pressed tightly on your hips and then with your arms raised high. Feeling Lie flat on your back. Place a folded towel or a pillow under your left shoulder. Place your left hand under or over your head. You also can feel for changes when you are standing. With your right hand, keeping the fingers flat and together, gently feel your left breast without pressing too hard. Use one of the three methods shown here. Then lower your right arm and do the exam on the other breast. Choose one of these methods Circle. Begin at the top of your breast and move your fingers slowly around the outside in a large circle. When you return to the top, move your hand a little closer to the nipple and make a smaller circle. Do this in smaller and smaller circles until you have examined all of the breast tissue. Lines. Begin in the underarm area. Slowly move your fingers down until they are below your breast. Move your fingers closer toward your nipple and go slowly back up, using the same motion. Use this up-and-down pattern all the way across your breast. Wedge. Begin at the outside edge of your breast. Slowly work your way in toward the nipple, doing one wedge-shaped section at a time. Do this until the entire breast area has been examined. Don't Forget With any pattern, be sure to examine the nipples also. Gently squeeze the nipple and check for any discharge. Examine the upper chest area and below the armpits — these places also have breast tissue. Call your doctor if you notice any lumps or changes in your breasts.

Finally ...

It is up to you to make healthy choices. If you have any health problems or concerns, talk with your doctor. Work with your doctor on a regular basis to ensure you have all the tests and immunizations for your age group and risk factors. Practice preventive care to keep you healthy for years to come.

Women have different health needs at different ages. Find your age range in the table and see what tests and immunizations you should have at your age. Then, fill in the blanks on the table to help you keep track of when you last had the test and when you need your next one. If you don't remember when you were last tested or immunized, your doctor may be able to test you to see if you are immune to the disease.
Table 1. Tests and Immunizations for Women
Test/ Immunization	What and Why	When	Last Done	Next Needed
Ages 13 to 39 Years
Pap test	A sample of cells is taken from the cervix during a pelvic exam to look for changes that could lead to cancer	Yearly when sexually active or beginning at age 18 years (doctor and patient may decide to have less often if patient has three normal test results in a row)
Tetanus–diphtheria booster	A shot to immunize against the diseases tetanus and diphtheria	Once between ages 11 and 16 years then every 10 years
Hepatitis B vaccine	A shot to immunize against the disease Hepatitis B	One series for women ages 13 to 18 years, if not previously immunized
Ages 40 to 64 Years
Tests and immunizations for ages 13 to 39 years plus the following tests:
Mammography	An X-ray of the breast to look for breast cancer	Every 1 to 2 years until age 50 years; yearly beginning at age 50 years
Cholesterol testing	A blood test that checks levels of cholesterol (a substance that helps carry fat through the blood vessels) because levels that are too high can lead to hardening of the arteries	Every 5 years beginning at age 45 years
Fecal occult blood testing	A test of a stool sample for blood, which could be a sign of cancer of the colon or rectum	Yearly beginning at age 50 years
Colorectal cancer screening	Screening may be done with flexible sigmoidoscopy, colonoscopy, or double contrast barium enema (DCBE) to look for cancer	Every 5 years beginning at age 50 years (sigmoidoscopy done with fecal occult blood testing), every 10 years (colonoscopy), every 5 to 10 years (DCBE)
Fasting glucose testing	A test to measure the level of glucose (a sugar that is present in the blood and is the body's main source of fuel) because if it is too high it could signal diabetes	Every 3 years after age 45 years
Flu vaccine	A shot to help prevent the flu (influenza)	Once a year beginning at age 50
Age 65 Years and Older
Tests and immunizations for all ages plus the following tests and vaccination:
Cholesterol testing	A blood test that checks levels of cholesterol (a substance that helps carry fat through the blood vessels) because levels that are too high can lead to hardening of the arteries	Every 3 to 5 years before age 75 years
Urinalysis	A test to measure the levels of substances, such as glucose, in your urine	Yearly
Pneumococcal vaccine	A shot to help prevent pneumonia	Once

Table 2. Tests and Immunizations for High-Risk Women
You should have this test or immunization	If you:
Test
Blood count (anemia)	Are of Caribbean, Latin American, Asian, Mediterranean or African descent; have a history of heavy menstrual flow
Bacteriuria testing	Have diabetes mellitus
Colorectal cancer screening	Have colorectal cancer or adenomatous polyps in first-degree relative younger than 60 years or in two or more first-degree relatives of any ages; have a family history of familial adenomatous polyposis or hereditary nonpolyposis colon cancer; have a history of colorectal cancer, adenomatous polyps or inflammatory bowel disease
Cholesterol testing	Have lipid disorders in your family, have a family history of coronary heart disease before age 55 years, have a history of coronary heart disease
Fasting glucose testing	Are obese; have a first-degree relative with diabetes; are a member of a high-risk ethnic group (African American, Hispanic, Native American, Asian or Pacific Islander); have given birth to a baby weighing more than 9 pounds at birth or have had gestational diabetes; have high blood pressure; have a high-density lipoprotein cholesterol level of at least 35 mg/dL; have a triglyceride level of no more than 250 mg/dL; have a history of impaired glucose tolerance or impaired fasting glucose
Genetic testing or counseling	Have been exposed to agents known to harm a fetus; are planning a pregnancy and are age 35 years or older; have someone in your family (including you) who has a history of a genetic disorder or birth defect; have a partner with a history of a genetic disorder or birth defect; are of African, Acadian, Eastern European Jewish, Mediterranean or Southeast Asian descent
Hepatitis C virus (HCV) testing	Have injected illegal drugs, received treatment (clotting factor concentrate) for a blood disorder before 1987, are on long-term hemodialysis, received blood from a donor who later tested positive for HCV infection, have persistently abnormal alanine aminotransferase levels, received a blood transfusion or organ transplant before July 1992, are exposed to HCV-positive blood at work
Human immunodeficiency virus (HIV) testing	Are seeking treatment for other STDs; inject drugs; have a history of prostitution; have a past or present sexual partner who is HIV positive, bisexual or injects drugs; have lived for a long time or were born in an area with a high number of HIV infection cases; had a blood transfusion between 1978 and 1985; have invasive cervical cancer; are pregnant (women may think about having this test if planning to become pregnant)
Lipid profile assessment	Have high cholesterol, have a parent or sibling with blood cholesterol of at least 240 mg/dL, have a first-degree female relative with coronary artery disease before age 65 years or a first-degree male relative with coronary artery disease before age 55 years, have diabetes, smoke
Mammography	Have had breast cancer, have a first-degree relative (mother, sister or daughter) or multiple other relatives who have a history of premenopausal breast or breast and ovarian cancer
Rubella titer assessment	Are childbearing age and have no proof of immunity
Sexually transmitted disease (STD) testing	Have had more than one sexual partner or a partner who has had more than one sexual partner, have had sexual contact with someone with an STD, have a history of repeated episodes of STDs, have attended a clinic for STDs (sexually active teens and other high-risk women may be tested for gonorrhea and chlamydia as part of routine care)
Skin exam	Work or play in the sunlight often, have a family or personal history of skin cancer, have precancerous lesions
Thyroid stimulating hormone testing	Have a strong family history of thyroid disease, have an autoimmune disease
Tuberculosis skin testing	Have HIV infection, have close contact with persons known or thought to have tuberculosis, have medical risk factors known to increase risk of disease if infected, were born in a country with high rates of tuberculosis, abuse alcohol, inject drugs, live in a long-term care facility (including a nursing home, prison or jail, or mental health institution), are a health professional working in a high-risk care facility, are medically underserved or low income
Immunizations
Chickenpox (varicella) vaccine	Are susceptible to chickenpox, are a health care worker, have household contact with people who are immunocompromised, are a teacher or daycare worker, live or work in a long-term care facility or institution (including college, the military or prison), travel outside of the United States, are a nonpregnant woman of childbearing age
Flu vaccine	Want to reduce the chance of catching the flu, live in a long-term care facility, have chronic cardiopulmonary disorders, have a metabolic disease (such as diabetes or renal problems), are a health care or daycare worker, will be in your second or third trimester of pregnancy during flu season (pregnant women with medical problems may want to be vaccinated before flu season)
Hepatitis A vaccine	Travel outside of the United States; use illegal drugs; work with nonhuman primates; have chronic liver disease; have a blood disorder; have had sex with a man who has had sex with other men; are not immune to measles, mumps or rubella; work in food service, health care, or daycare
Hepatitis B vaccine	Use IV drugs or have sex with someone who uses IV drugs, receive clotting factor concentrates, are exposed to blood or blood products at work, are a patient or employee in a dialysis unit, have chronic kidney or liver disease, have household or sexual contact with a carrier of hepatitis B virus, have had sex with more than one person, have had sex with a sexually active bisexual or homosexual man, travel outside of the United States, live or work in an institution for the developmentally disabled or in a prison or jail
Measles–mumps–rubella vaccine	Were born in 1957 or later and have no proof of being immune or being vaccinated, were vaccinated in 1963–1967, are a health care worker, are starting college, travel overseas, have recently given birth and are rubella negative
Pneumococcal vaccine	Have a chronic illness, are exposed to pneumonia outbreaks, are immunocompromised, are pregnant and have a chronic illness

Body Mass Index Chart The body mass index (BMI) compares a person's height to their weight to see if they are overweight. Having a BMI of 20 to 24 is normal, and 25 to 29.9 is overweight. A woman with a score of 30 or higher is obese. To calculate your BMI, find your height in inches in the "Height" column below. Then look across the row to find your weight in pounds. The number at the top of that column is your BMI.

Glossary

Chlamydia: A sexually transmitted disease that can cause pelvic inflammatory disease, infertility and problems during pregnancy.

Cholesterol: A natural substance that serves as a building block for cells and hormones and helps to carry fat through the blood vessels for use or storage in other parts of the body.

Dermatitis: Inflammation of the skin.

Depression: A treatable medical disorder characterized by loss of interest in things you used to enjoy and feeling sad for periods of at least two weeks.

Diabetes: A condition in which the levels of sugar in the blood are too high.

Immunization: An injection to help your body produce antibodies to fight the infection. The antibodies protect a person from developing the infection.

Mammography: An X-ray of the breast, used to detect breast cancer.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.