Being an Adult Means Making These Doctor Appointments

By Maressa Brown

As you enter your mid to late 30s, you embark on a new chapter of preventative healthcare. Up until now, your annual appointments were likely fairly straightforward: physical, gyno exam, and dental checkups — done. Midlife is a new opportunity to take charge of your well-being. But it can also spur questions like: How often should I see my gynecologist? When — and how frequently — is it appropriate to have specific screenings, like a colonoscopy or mammogram? When do I need to bring up perimenopause with a provider?

Women’s health specialist Melissa Loseke, D.O., medical advisor for Joi Women’s Wellness, points out that women in their mid-30s and beyond are dealing with hormonal shifts and life stressors — from intense professional lives to potentially raising little kids and dealing with aging parents — that can impact their physical and mental health. “Being in tune with your body and listening to it becomes crucial,” she notes, adding that you’re your own best advocate when seeking thorough healthcare. 

While the appointments and screenings you should make will depend on your individual health and family history, there are general guidelines to keep in mind. Here, the five medical must-dos experts recommend from 35 on. 

1. Pap tests 

Annual gynecologist visits are still encouraged, says Dr. Malone, because there is a lot you might want to cover with your doctor, such as:

• STI screening and counseling

• General health counseling

• Breast cancer screening

• Contraception counseling

• A routine pelvic exam, which checks for abnormal discharge as well as polyps, ovarian cysts/masses, and fibroids

Recommendations for cervical cancer screening have changed, points out Sharon D. Malone, M.D., FACOG, and chief medical officer of Alloy, a telehealth company focused on menopause treatment. Since 2013, annual Pap tests are no longer routinely recommended because, according to the American College of Obstetricians and Gynecologists (ACOG), researchers found that yearly screenings can be associated with unnecessary follow-up tests. 

If you’re in your 20s, ACOG recommends getting a Pap, which screens for HPV (which can be a precursor to cervical cancer) every three years. From 30 to 65, you have three options:

• A Pap test and an HPV test (co-testing) every five years, recommended if you have multiple sexual partners or a history of abnormal Pap smears

• A Pap test alone every three years

• HPV testing alone every five years

If you’re over 65, have a conversation with your gynecologist to determine if continued screening is necessary, says Dr. Loseke. 

The reality is that most patients aren’t comfortable with testing every five years, given that, for decades, women have been told that they need annual Paps, says Dr. Malone. The solution: “Most doctors screen every three years with or without HPV co-testing,” she says. You still might be a candidate for annual screening if you have other risk factors (like a history of cervical cancer, HIV, or a weakened immune system).

Dr. Malone also recommends discussing perimenopause with your gynecologist around age 35. “Keep a menstrual diary as well as a list of any symptoms you may be having,” she advises. “You should know how old your mother or older siblings, if you have them, were when they went through menopause. Educate yourself about the signs of perimenopause, and ask questions.” 

2. Colonoscopy

You’ve probably heard that you need colon cancer screening, or colonoscopy, starting at age 45. But Dr. Malone notes that there are absolutely instances in which you should test sooner:

• If you have a family history of colon cancer, screening should begin at 40 OR 10 years prior to the age of diagnosis of the affected family member.

• Get one asap if you experience rectal bleeding, a change in bowel habits, or undiagnosed abdominal bleeding. 

During a colonoscopy, your gastrointestinal specialist might find precancerous polyps which will be removed to prevent development of colon cancer. 

Because colonoscopy is only recommended every 10 years for average patients, you can talk to your doctor about getting a fecal occult blood test (FOBT) between screenings, which searches for unseen blood in the stool and can detect colon cancer or polyps. “It is always my practice to screen for occult blood in the years between colonoscopies,” says Dr. Malone. Having a history of polyps will affect the frequency with which you undergo the screening — potentially every three to five years as opposed to 10.

3. Breast exams

As of this month, there’s now consensus among ACOG and a U.S. Preventative Task Force that initial screening mammograms should begin at age 40 for people who have an average risk. (This is a big shift; since 2009, the Task Force recommendation was to begin at 50.) Carriers of genetic mutations such as breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes should start screening earlier than 40.

Women of all racial and ethnic backgrounds who are at average risk for breast cancer should start getting regular mammograms at age 40, instead of treating it as an individual decision until they are 50, as previously recommended. 

From there, you’ll decide with your doctor whether to screen annually or every two years along with your doctor, says Dr. Malone. 

“Reasons to screen annually may include dense breasts on mammograms, family history of premenopausal breast cancer, or personal preference,” she explains. 

At 55, you can switch to every other year — or elect to continue annual screening, says Dr. Loseke.

Additionally, she recommends doing monthly self breast exams and getting to know your breasts well, so you can be more attuned to any suspicious changes.

4. Routine blood work and vaccines

Ideally, you’ve been getting routine blood work via annual physical exams, which can offer a baseline for future results, says Dr. Loseke. If not, you’ll do well to get on the following labs from your primary care physician, ASAP:

• A full thyroid panel (more than just TSH)

• Insulin

• Lipid panel

• Cortisol 

• FSH 

• Estradiol

• Progesterone 

• Testosterone

• Vitamin D 

• Ferritin  

Both Dr. Loseke and Dr. Malone recommend a comprehensive metabolic screen (electrolytes, cholesterol, triglycerides, kidney, and liver function tests), which should be done at least once every two years as well as a complete blood count. Your results can tell your provider a lot about your liver and kidney health, blood sugar levels, and more to guard against illness.

If you’re 45 or older, or under 45 and overweight, and have one or more risk factors for prediabetes or type 2 diabetes, you should get a hemoglobin A1C test — also known as the hemoglobin A1C or HbA1c test — to measure your average blood sugar levels over the past three months and check your risk for type 2 diabetes.

You’ll also want to make sure you’re up to date on your vaccines, such as tetanus (every 10 years), shingles (every seven years starting at age 50), and flu shots (every fall), says Dr. Malone.

5. Other exams to consider

Based on your individual risk factors and family history, you might opt for:

• Skin cancer screening, which is particularly recommended if you have had skin cancer before, have close relatives with skin cancer, or have a weakened immune system.

• An EKG (electrocardiogram) to measure the heart’s electrical activity might be recommended if you have diabetes, hypertension, high cholesterol, metabolic syndrome, early menopause (before age 45) or a family history of heart disease or stroke in family members before age 50, notes Dr. Malone. 

• A bone density test (DEXA scan), which is indicated if you’re under 65 and have certain risk factors such as long-term steroid use, low body weight, are a smoker, drink heavily, have had a fracture after age 50, or have a family history of hip fracture or osteoporosis. 

Ultimately, the best thing you can do for your health at 35 and up is provide a detailed family history, says Dr. Malone. “It helps the doctor hone in on conditions that you may be at more risk for and thus require additional screening and counseling,” she notes. “You should have an ongoing discussion with your doctor about what to expect as you transition into midlife.”