A Q&A with Dr. Yael Swica and Tiffany White, Features Editor at First For Women
Although entering your 40s is an important milestone full of new chapters and experiences, for many women, aging is the start of health changes. Women over 40 are typically more at risk for heart disease, osteoporosis, and cancer, and so it’s important to be more cognizant of these areas of your health going forward. Fortunately, you can easily do that by being prepared with the right questions to ask the doctor when you go in for your annual check-up or gynecological exam. We asked Dr. Yael Swica, a women’s health doctor and Assistant Clinical Professor of Family Medicine at Columbia University, what questions you should be asking your doctor:
When can I stop using contraception? Which forms of contraception are best for women over 40?
Although most discussions around unplanned pregnancies are focused on teens, women in their 40s still have the same risks. In fact, 40 percent of pregnancies in older women are unplanned, according to the Guttmacher Institute, and abortion rates in England for women age 40-44 are the same as women in their teens. Clearly, the old adage of “you can’t get pregnant in your 40s” just isn’t true.
Because of that, it’s important to speak to your doctor about contraceptives. Although some doctors say it’s fine for women over 40 to continue taking birth control pills as long as they don’t smoke or have high blood pressure, it’s best to ask your doctor what options are the right fit for you.
When should I start having mammograms?
As you age, your risk for breast cancer increases, which is why most doctors recommend getting screened as early as age 45. However, it depends on your family history. If breast cancer runs in your family, you possibly might need to have a mammogram sooner rather than later. “Mammograms [should start] at 45 or 50,” Dr. Swica said. “Unless a mother or sister was diagnosed with breast cancer, in which case screening should begin 10 years prior to diagnosis.”
What can I do to keep my heart healthy?
Although women of all ages should take heart disease seriously, if you haven’t started yet, now’s the time. Heart disease is the second leading cause of death for women 45-65, and it’s the number one cause of death for those over 65. If you smoke, are overweight, or have a family history of heart disease, you’re even more at risk. Aside from the usual things you should be doing, like exercising and eating well, ask your doctor about other preventative measures you should be taking.
What kind of changes should I expect with menopause?
Most women hit menopause when they’re 50, and the effects can do a lot to your health. “The loss of estradiol [during menopause] precipitates significant changes physiologically,” Dr. Swica said. “[It] affects mood, skin and hair, cognition, metabolism, cardiovascular system, sexual functioning, and bone health.” If you’re experiencing these symptoms, your doctor might recommend hormone therapy to help ease the discomfort. And, if you’re worried about the risks, Dr. Swica says that’s the most over-asked question she gets. “The benefits outweigh the risks for most women.”
What can I do to prevent osteoporosis?
Because bone density can decrease after menopause, osteoporosis is a very real risk for women. In fact, 80 percent of people with the condition are women and most over the age of 50 will fracture a wrist or hip because of the disease. However, early onset osteoporosis can strike you depending on your health history. Consult your doctor for preventative measures, from hormone therapy to bone density tests.
Other things to keep in mind.
In case you’re wondering why questions about pap smears and ovarian cancer were left off the list, Dr. Swica believes those questions tend to get over-asked. For pap smears and pelvic exams, they’re not as needed as they once were. “Since the advent of HPV testing, there is no longer a need to do an annual pap smear or pelvic exam,” Dr. Swica said. “Pelvic exams are warranted whenever a woman has a pelvic complaint — e.g. discharge, irritation, itch, dryness, or pain with sex.” However, not all doctors agree with this. “Some doctors feel strongly about doing it while others believe that time with patients is better spent discussing other issues.”
Other things Dr. Swica recommends you should be tested for while at the doctor’s office includes colon cancer screening by age 50, cholesterol and diabetes screening, and regular cervical cancer screenings every three to five years.