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What to Ask at Your Annual Physical

By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent

When it comes to their annual physical, women should be ready to ask their doctor about a number of issues. But many of those issues will differ, depending on age.

"Most of the issues women should ask about will depend on their age, their past family history and their past medical history," said Dr. Diane Kaufman, an Ob-Gyn at Beth Israel Deaconess Medical Center and instructor at Harvard Medical School.

"From the patient's standpoint, it boils down to what kind of preventative measures should be taken and what kind of screening tests should be done," she said.

Younger Women

"For women in their teens and early 20s, questions typically revolve around contraception, avoiding sexually transmitted diseases and strategies for building bone density," Dr. Kaufman said.

Women may ask about contraception - whether they should be on it and, if so, what method might work best for them.

One question younger women may grapple with is whether they should get the Gardasil vaccine, a breakthrough in preventing disease caused by the human papilloma virus which is responsible for genital warts and cervical cancer. This is a great age for getting this vaccine series. Regular pap screening should begin at age 21.

Late 20s and 30s

For women in this age group, most questions typically revolve around family planning issues, Dr. Kaufman said.

"These women want to know the steps they should take to maximize a healthy pregnancy," she said. "We will typically talk about habits and things to avoid. They may want to take a vitamin with folic acid and avoid fish high in mercury, for example."

In addition, new preconception genetic testing is available to screen for carrier status of many life-threatening genetic disorders, she noted.

If the woman has a family history of breast cancer, she may want to ask about whether to begin mammogram screenings, according to Dr. Kaufman.

The 40s

Women in their 40s need to start getting regular mammograms to screen for breast cancer, she noted.

"Most women in this age group are done with family planning and may want to ask about long-term contraception such as having a tubal ligation, getting in IUD or having their partner get a vasectomy," she added.

Women in this age group will also want to ask more questions about exercise and diet, as this is the time that middle-aged weight gain begins, according to Dr. Kaufman.

"Heart disease also becomes more of an issue and diet and exercise plays into that as well," she said.

Cholesterol should be tested regularly especially if the woman is at increased risk for heart disease. Blood pressure should also be checked regularly.

Another common issue women in their 40s will ask about is bladder incontinence, Dr. Kaufman said.

"There are a wide range of solutions, from physical therapy, medications, devices and surgery," she said.

The 50s

A major issue for these women is coping with menopausal symptoms.

"There is a lot that can be done with diet and exercise," Dr. Kaufman said. "There are a number of strategies to deal with night sweats, hot flashes and vaginal dryness and many of them are non-hormonal."

These days, hormone replacement therapy is rarely recommended, due to the health risks associated with them. If it is used, it should be used only for a short period of time, said Dr. Kaufman.

Once they get into their 50s, women should also ask about getting a colonoscopy to check for polyps or colon cancer.

The 60s and 70s

Bladder incontinence is a major issue for these women as the problem can worsen with age. Screenings should continue for blood pressure, bone density, breast cancer, cholesterol and colorectal cancer.

In General

Women of any age should be quick to ask their doctor about any type of vaginal discharge, abnormal vaginal bleeding pattern, persistent bloating, or change in bladder or bowel that are out of the ordinary.

They should feel that their physician is a safe person to discuss domestic violence or mental health concerns with and be steered towards available resources, Dr. Kaufman says.

The 40s are also a time to begin asking about whether to set up a health care proxy should something happen to render the patient unable to make her own health decisions, Dr. Kaufman said.

Good health habits such as using seat belts, limiting alcohol use, using sunscreen, assessing calcium and Vitamin D intake, exercise habits, and diet habits should be reviewed, she added.

Office visits should include a discussion of an individual woman's past medical history, and family history should be reviewed to see if she is at increased risk for a particular disease, Dr. Kaufman said. Most patients will have their height, weight, and blood pressure measured.

"And, from a preventative point of view, every patient should get a blood pressure test, be weighed, and receive thyroid, breast and pelvic exams," she said." They should also be reminded about calcium and Vitamin C intake."

If women are on medications, whether they be prescription, over the counter or herbal medicines, they should tell their doctor about them

The doctor doing the physical should know about all mediations the patient is taking to make sure there are no risks of negative interactions or contraindications.

"The annual physical should be a complete review of systems from head to toe," Dr. Kaufman said. "Women should use their annual physical to address any personal concerns and use the opportunity to learn what they can do to maximize continued good health."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted September 2011

Contact Information

General Medicine and Primary Care
Department of Medicine
Beth Israel Deaconess Medical Center
Carl J. Shapiro Clinical Center
330 Brookline Avenue
Boston, MA 02215