What’s Up, Doc?
10 important questions a woman should ask her health care provider

By Carlotta Mast


For general health information for women:
National Women’s Health Information Center
www.4woman.gov; 800.994.9662

National Women’s Health Resource Center
www.healthywomen.org; 877.986.9472

To locate a naturopathic physician in your area:
The American Association of Naturopathic Physicians
www.naturopathic.org; 866.538.2267 When Jamie Putnam was 15, her pediatrician in Bloomfield Hills, Michigan, found a tumor at the base of her tongue during a routine checkup. The tumor was malignant, but because it was detected and removed early, the cancer never had a chance to spread. Now 28, Putnam is the healthy mother of a 17-month-old son and a firm believer in the value of regular health exams and screenings. “My doctors emphasized how lucky I was that the tumor was found at an early stage,” says Putnam, whose name has been changed to protect her privacy. “Without that routine checkup with the pediatrician, the tumor could have gone unrecognized for a long time. I am so thankful my mother always kept close tabs on our health and made sure we had a yearly exam.”

Putnam’s story illustrates the importance of regular health checkups for women of all ages.

“Prevention is an essential part of health and longevity,” says Adelaide Nardone, MD, an OB/GYN in Providence, Rhode Island. “You don’t want to treat the crisis, you want to prevent it—or at least diminish it if you see it coming. That goes for everything from cancer to cardiac disease to sexually transmitted diseases.”

The following ten questions can help a woman of any age make the most of her next checkup. Whether you’re visiting a family practitioner, an OB/GYN, or a naturopathic physician, addressing these issues will help you gain control of your health and build a positive relationship with your doctor.

1. What are my greatest health risks?
Preventing disease requires understanding your risk factors. Telling your doctor about diseases and other health problems that run in your family will help her design an approach to health and wellness that is best suited to you, says Jane Guiltinan, ND, dean of clinical affairs at Bastyr University in Kenmore, Washington, and a practicing naturopathic physician. “There are certain diseases, such as breast cancer and colon cancer, that have a genetic component to them,” Guiltinan says. “Knowing your family history can help your physician decide when to start screening for these and other genetically linked diseases.”

2. What do you need to know about me?
In addition to sharing information about your family’s medical history, remember to bring details on your own medical history, the start date of your last period, and dates of your most recent checkup and pelvic exam to your appointment. Your doctor will also want to know about your lifestyle—whether you smoke, how much you exercise, what your diet is like—as well as what medications, vitamins, and other supplements you are taking. “It is really important that the patient have a complete list of everything she is taking so her physician can check for possible interactions,” says Guiltinan.

3. What signs of disease should I watch for?
This is a particularly important question for women to ask their doctors because disease symptoms are often different in women than in men, says Saralyn Mark, MD, senior medical advisor to the Office on Women’s Health within the Department of Health and Human Services. For example, a woman with heart disease may exhibit symptoms of indigestion or have shortness of breath rather than pressurelike chest pains, Mark explains. Along with any changes in her breasts, a woman should inform her doctor of irregular menstrual flow, prolonged changes in her bowel habits, rectal bleeding, and weight gain or loss that is not linked to lifestyle changes. Because half of all new cancers are skin cancers, it’s vital for a woman to examine her skin regularly and report any new or changed moles or other irregular skin conditions to her physician. “Anything that does not feel right or go away in a short period of time should be checked out with your doctor,” Guiltinan says. “Most of the time it will turn out to be nothing, but it could help your physician detect a potentially serious problem early on.”

4. How can I lessen my risks for heart and cardiovascular disease?
“Many women think that heart disease is a problem that only affects men but, in fact, it is also the number-one killer of women,” says Rosaly Correa-de-Araujo, MD, MSc, PhD, a physician and senior advisor for women’s health at the Agency for Healthcare Research and Quality within the Department of Health and Human Services. According to the American Heart Association, more than 500,000 women die annually of cardiovascular diseases, which have claimed the lives of more women than men each year since 1984. Although heart disease hits women of all races and ethnicities, African-American women are more likely to die of heart disease than white women because they have higher rates of diabetes, obesity, and high blood pressure—three risk factors for heart disease. Socioeconomic factors also often limit African-American women’s access to good health care, Guiltinan adds.

To help keep their hearts (and the rest of their bodies) healthy, Guiltinan advises her female patients not to smoke; to maintain healthy weight, blood pressure, and cholesterol levels; and to eat a whole-foods diet that is low in saturated fat, cholesterol, and refined sugar and includes a variety of whole grains, low-fat protein, and brightly colored fruits and vegetables. Because inactive people are twice as likely to develop heart and cardiovascular disease as those who are more active, regular exercise is crucial to heart health as well. Starting at age 20, a woman should have her blood pressure checked every one to two years and her cholesterol levels tested every five years. If heart disease runs in a woman’s family or she has high cholesterol levels, her doctor may decide she needs to have these screenings done more often.

5. How can I prevent or detect breast cancer?
Excluding skin cancers, breast cancer is the most common form of cancer in American women and the second major cause of cancer-related death (after lung cancer). Because 70 percent of breast cancer cases are self-detected and early diagnosis is crucial to the treatment and cure of this disease, Nardone encourages all women to examine their breasts regularly to detect any abnormal lumps, discharge, or other change. “By age 20, all women should be getting a yearly breast exam and be doing monthly self-exams,” says Nardone. Although most lumps are noncancerous, bring them to your doctor’s immediate attention. Starting at age 40, women should have a mammogram performed every one to two years. In addition to mammograms, some doctors are now using thermography, an FDA-approved adjunct to mammography that uses digital infrared imaging to detect new blood vessels and chemical changes typically associated with the growth of a cancer tumor in the breast.

6. How often do I need to have a Pap test?
A Pap test can detect cervical cancer before it spreads to other parts of your body. If caught early, cervical cancer can be treated more easily and has a higher cure rate. Pap tests can also detect infections and inflammations, as well as abnormal cells that can change into cancer cells. The American Cancer Society recommends that women receive their first Pap test three years after they begin sexual activity, or at age 21, whichever comes first. Experts recommend waiting three years following initiation of sexual activity because transient human papillovirus (HPV) infections and insignificant cervical-cell changes are common, and it takes years for significant abnormalities or cancer to develop. Cervical cancer is also extremely rare in women under age 25. Once a woman turns 30, if she is monogamous and has had three consecutive normal Pap tests with negative results and has had no prior history of cervical dysplasia, cervical cancer, or HIV, her doctor may recommend that she receive a Pap test every two to three years, Nardone says. “But,” she adds, “this doesn’t negate the need for an annual checkup and pelvic exam.” For more details on Pap tests and other important screening tests for women, see “Health Tests for Women.”

7. How can I protect my reproductive health?
Sexually active women 25 and younger should be screened annually for chlamydia, a serious sexually transmitted disease (STD) that can harm a woman’s uterus, ovaries, and fallopian tubes. Approximately 3 million Americans contract chlamydia each year, and three of every four reported cases occur in people under age 25. Once a woman becomes sexually active, she should talk to her doctor about preventing STDs and get information on her contraceptive options, Nardone says. A woman who is beginning to think about having children should ask about how to optimize her fertility and have a healthy pregnancy. A simple thing a woman can do to enhance her reproductive health, Nardone adds, is to increase her daily intake of folic acid to 400 mcg before she conceives, which may help prevent neural tube disorders in the fetus.

8. How can I deal with depression and stress?
Dealing with depression is particularly crucial for women, who are twice as likely to suffer from depression as men, Mark says. If you’ve felt sad, worthless, or hopeless and have had little energy or interest in doing things you normally enjoy for two consecutive weeks, talk to your doctor about being screened for depression. Addressing depression is especially important for elderly women, who often suffer from this problem but can “feel ashamed or embarrassed to bring it up with their physicians,” Guiltinan says. Screening for depression is the first step toward providing appropriate treatment.

Controlling and limiting stress is also important for women because stress is three times more likely to send women into depression than men. If not managed appropriately, stress can also contribute to physical illness, including heart disease. “Stress can have many different symptoms,” Correa-de-Araujo says. “For instance, you can have a headache, difficulty sleeping or concentrating, a short temper, or even an upset stomach,” all of which can signal stress. Eating a balanced, whole-foods diet, exercising, and prioritizing work and family responsibilities are good steps toward eliminating stress, adds Correa-de-Araujo.

9. How can I keep my bones healthy and strong?
Preventing osteoporosis, a disease that thins and weakens the bones, requires a woman to get enough calcium throughout her entire life. Because women reach their peak bone-mineral density by age 35, Guiltinan says it’s crucial for a woman to ask her doctor how much calcium she needs while she’s young and still has an opportunity to strengthen her bones. “Typically a woman will get about 600 mg of calcium a day [through her diet], which is well below the recommended dietary allowance of 1,200 mg,” Guiltinan says. A woman also needs a daily intake of 400 to 800 IU of vitamin D, which helps calcium absorption. Weight-bearing exercises—such as running, walking, or lifting weights—can also help to strengthen bones, says Debi Smolinski, ND, chair of the women’s integrative medicine department at Southwest College of Naturopathic Medicine and a physician at Southwest Naturopathic Medical Center in Tempe, Arizona.

10. What foods and supplements will maintain and improve my health?
Eating a well-balanced diet is one of the best ways to ensure good health and prevent disease, including heart disease and type 2 diabetes, Smolinski says. “But don’t eat the same things every day,” Smolinski advises. “Different foods have different nutritional qualities.” In addition to a calcium supplement that contains vitamin D, Guiltinan recommends her patients take a daily multivitamin. “For a normal, healthy woman who eats a good diet, that is probably all she needs,” Guiltinan says. If a woman has special needs, her doctor can customize a supplement program for her. “For example,” Guiltinan says, “if someone has a family history of heart disease or high cholesterol levels, I may advise her to take some antioxidants, such as vitamins A, C, and E.” By supplementing a balanced diet with essential vitamins and minerals women are taking one more step toward being the healthiest they can be.

Freelance writer Carlotta Mast has a new respect for regular health checkups since becoming a mother last year.