The most important thing that I want women to enter their 40s to consider is their general health habits, I want women to go into their 40s at a healthy weight, and so I want them to start developing. The habits of exercise and a good diet the first thing that I want women to get is their annual physical exam and during that exam I'd like for them to get a pap smear and a pelvic exam. It depends on the woman as to whether you need to get annual pap smears or you could spread them out every two to three years if a woman still has her uterus and her ovaries then she needs to get a pap smear every two years but if she's had a hysterectomy for any reason she may not need a pap smears depending on the reason.
why she had the hysterectomy, I think breast cancer screening is probably one of the things that are the most important for women in their 40s, and there's a lot of confusion over it my general recommendation is that any woman coming in for an annual exam. should get a clinical breast exam which is an exam is done by me just to kind of familiarize a woman with what their breasts feel like to teach them how to do one and to make sure there are no lumps or masses and then.
Mammogram
I always recommend a mammogram for women over 40 now I know that there have been a few guidelines that have come out that have suggested that women in their 40s and 50s may not need annual mammograms and those who have confused a lot of women I really don't agree with those guidelines I agree with the cancer guidelines which start annual screening at age 40 because breast cancer if caught early is curable and it's treatable and you just don't want to miss one in a 40-year-old woman most of my patients.
Who come in who gained weight they are concerned that it's their thyroid it usually is not the actual guidelines for thyroid testing started in the 50s but women are so concerned about thyroid testing that I do start annual screening with thyroid and women in their 40s but, the thyroid is generally not the reason, why most women are gaining weight in their forties most of the time it's their metabolism is slowing down they've gotten busy they're not exercising their diets have kind of gone off-kilter and really getting them back on a healthy diet and exercise plan is the way to go to lose weight some women actually are at higher risk in their 40s of heart disease when. Heart disease actually goes up after menopause but the '40s are a great time to start mitigating those factors that increase their heart risks . Such as high cholesterol, hypertension and obesity, so hypertension is one of the most common conditions that we see in people and it often does start in women as well as the men in their 30s and their 40s so, it's important for me to make sure that women have blood pressures somewhere around 120 over 60 and when it climbs up above 140 over 90 that's when I start treatments including medications diet, and exercise part of the general health.
Swing that I do with my female patients as a general blood panel and during that panel I do test their blood sugar because diabetes risk is starting to increase in younger women and so even, when their blood sugars aren't in the diabetic range I often will counsel them to put them on diets to help they lose weight so that they don't develop diabetes later on the current guidelines are to start cholesterol testing about every 5 years or more often if needed and women and men over the age of 20 so in the 40s most of my patients get cholesterol testing just about every year and what you're looking at is a breakdown of the cholesterol you have total cholesterol which is a calculated number so if it's high it's really kind of hard to determine what that means so I kind of ignore the total cholesterol and I look at the fractions there is the triglycerides which is a blood fat that's often related to obesity or diabetes, the goal for that is a number of less than 250 if you don't have diabetes but if you have diabetes you want it less than 150 the good cholesterol or the HDL is the kind of cholesterol that you want as high as you can get it because it actually lowers your risk of heart disease in women I look for a number above 50 if it's below 50 I want them to watch their diet increase the amount of fish that they eat in order to lower that number and then the most important fraction of cholesterol is the LDL or bad,
Cholesterol is the one that is very closely related to heart disease it's related to stroke kidney and overall cardiovascular death that number needs to be less than 160 and a healthy premenopausal woman but if you have any other risk factors such as obesity hypertension diabetes you need that the number even lower such as 130 and for some women I need it as low as a hundred and in some women, I even push it as low as 70 and in those cases you often need medications what I usually find at around age 40 is that women need to make adjustments to their lifestyle what worked for us in our 20s and our 30s will not work for us in our 40s and 50s, a lot of times we need to kind of look at different ways to exercise a lot of us have kids we have busy lifestyles and we have to figure out how to integrate exercise along with raising our children and our careers I find that women's diets change as they get older so it's never too late to start healthy I've seen women go from being very unhealthy to healthy within a year or two and developing lifestyles that they can stick with through their 50s.