Published May 12, 2023
Every patient goes through changes throughout their life that may impact their health. We can be proactive about these changes by staying up to date with important appointments and screenings.
For women, milestones like pregnancy, menopause and age deserve a little extra attention. Learn more about the key markers for women’s health.
Heart disease is the number one killer of women in the U.S. and more than one in three women is living with some form of cardiovascular disease. That’s why all women, regardless of their risk factors, should be aware of the warning signs of heart disease and heart attack. Common symptoms of heart attack include:
Patients with certain conditions are at an increased risk of heart attack and heart disease. One of the biggest risk factors is hypertension or high blood pressure.
“Hypertension can be called the silent killer because people are not always symptomatic from their high blood pressure,” said Lisa Freed, MD, director of the Women’s Heart and Vascular Program at Yale New Haven Hospital and assistant professor of Clinical Medicine at Yale School of Medicine.
More than 51% of high blood pressure deaths are in women and out of all women, more than 57% of African American women have hypertension. Other important risk factors to know include:
Cardiovascular disease is the number one killer of new moms and maternal mortality rates in the U.S. are on the rise, especially amongst African American women. Hypertension, preeclampsia, gestational diabetes, pre-term birth and placental abruption can contribute to an increased risk of heart disease later in life.
Another key milestone in a women’s heart health is menopause, which Dr. Freed said is a “pivotal life stage.” During menopause, blood pressure rises, and patients often gain weight due to hormonal changes. The hemoglobin AIC or HbA1c test, which measures blood sugar levels over three months, can rise. LDL levels can increase, and HDL levels decrease. Due to these changes, Dr. Freed said patients should “know their numbers,” especially if they have risk factors or are going through an important life stage such as pregnancy or menopause.
“People generally remember their mammogram, right? But they might not get their blood pressure checked or they might not get their lipids checked,” Dr. Freed said. “When you know it's time for your yearly mammogram, make sure that you have been to your primary care doctor and have your blood pressure checked and you have your blood work done for your lipids and your glucose.”
Other ways to stay on top of heart health include maintaining a healthy weight, eating a healthy diet, participating in moderate exercise 150 minutes a week, quitting smoking and considering a calcium score CT scan, which is a risk assessment test for the treatment of lipids.
Breast cancer impacts one in eight women in their lifetime, but screening mammograms can detect cancer early. During a mammogram, a mammography technologist places each breast on a platform and applies compression to take two photos of each breast. Some patients find the process uncomfortable, but it only takes a few seconds to obtain the images.
Average risk women should start getting screened every year at age 40, or at least every other year. Those with increased risk may benefit from getting screened earlier. Common risk factors include:
In March 2023, the FDA updated mammography regulations to require facilities that perform mammograms to notify patients if they have dense breasts. Connecticut was the first state that passed a breast density notification law in 2009.
“About half of all women have dense breasts and dense breasts limits the accuracy of the mammogram,” said Yale Medicine breast imager Regina Hooley, MD, Vice Chair for Clinical Affairs in the Department of Radiology and Biomedical Imaging at Yale School of Medicine. “A lot of people like to use the polar bear in the snow analogy. You can't see the polar bear very well when they're surrounded by snow and that's like looking at the cancer and not being able to see it on the dense breast of the mammogram. Patients have the right to know their mammogram may be limited.”
Patients with dense breasts have the choice of supplemental screening, which usually includes screening ultrasound. Those with a strong familial link to breast cancer, including ovarian, pancreatic or colon cancers across generations may also benefit from genetic counseling and possibly an MRI screening. Dr. Hooley says these additional screenings can be key for catching breast cancer early.
“There are other types of cancers in the body that when they're small, they can be very hard to treat and be very aggressive. But generally, most breast cancers detected early have a very good prognosis with treatment,” Dr. Hooley said.
It is recommended that all women start screening for cervical cancer with a Pap smear at 21 years old, though patients can start seeing a provider earlier for other gynecologic needs. The screening takes place during a pelvic exam, and a clinician obtains a surface skin sample that is then analyzed for any abnormal cells. If a patient has abnormal cells they may need further testing. If everything is normal, patients in their 20s won’t need to get screened again for another three years, while patients in their 30s don’t need to get screened again for another five years.
“We know that the majority of cervical cancers are caused by one of the most common strains of the HPV virus and the HPV virus is very easily transmitted through contact with another person,” said Northeast Medical Group Certified Nurse Midwife Leigh-Anne Sastre, MSN. “While cervical cancer is very slow growing, if we miss it, it could have devastating consequences, so it is important for your overall health to know what’s going on and to be aware of changes.”
Even if a patient is not due for a Pap smear, they should keep their yearly appointment for routine wellness visits with their OBGYN, certified nurse midwife or APRN. In addition to caring for patients during life changes like pregnancy and menopause, these providers can perform STD screenings and answer questions about topics like fertility, sex, consent and birth control. Sastre says younger patients not yet ready for a pelvic exam still benefit from a visit as well.
“Some of my favorite patients are my teenagers who are coming in and establishing care. It's nice to be able to sit down and have those open and honest conversations with no judgment involved and just be able to explain to them how their bodies work,” Sastre said.
Patients should also be on the lookout for any red flags. Abnormal discharge or odor from the vagina, abnormal bleeding or pain, bloating in the abdominal area and breast changes such as lumps, bumps or discharge should warrant a visit.
In years past, many people associated colon cancer with men. However, colon cancer is the third most common cancer in women and the third most common cause of cancer-related death in women. With rates of colon cancer on the rise among younger patients, colon cancer screening is more important than ever.
Those with an average risk should get screened every 10 years starting at 45. Those with an increased risk because they have a first-degree relative who has had colon cancer should get screened earlier.
During a screening colonoscopy, the patient is sedated and unconscious while the colon is examined using a camera at the end of a thin, flexible tube. Some patients worry about the prep the day before, which requires a liquid diet and laxatives. But colonoscopies are considered the gold standard of colon cancer screening because they are much more sensitive than other tests.
“They’re able to detect polyps even if they’re small, and we prefer to find abnormalities before they become a problem,” said Yale Medicine and Yale New Haven Health gastroenterologist Benjamin Lerner, MD, assistant professor of Medicine at Yale School of Medicine. “The major advantage of colonoscopy is that it is both diagnostic and therapeutic. It allows us to find and remove polyps before they become very large or cancerous.”
In addition to routine colon cancer screenings, lifestyle changes can help to reduce a patient’s risk of colon cancer. Those who smoke should quit, drinking should be done in moderation and patients should regularly exercise. A diet rich in fruits and vegetables, low in fat and processed meats is also beneficial.
Even if patients live a healthy lifestyle and get their routine colon cancer screenings, it’s important not to ignore any red flags.
“If you talk to any GI doctor, you'll hear unfortunate stories of patients with colorectal cancer who had been having rectal bleeding for months and assumed it was from hemorrhoids. Please don't assume your rectal bleeding is from hemorrhoids. Make sure to talk to your doctor about it. You may need a colonoscopy,” Dr. Lerner said.
Any concerning or unusual symptom should prompt a call to the doctor. Staying on top of regular doctor’s appointments can help catch warning signs that something should be investigated further. If patients have any questions, they can always reach out to their primary care doctor who may order additional tests or make the appropriate referral to a specialist.
YNHHS uses the terms "female" and "male" to reflect biological status typically assigned at birth, and "women" and "men" when referring to gender. According to the Human Rights Campaign, a doctor or midwife assigns a child's sex, male, female or intersex at birth based on their external anatomy. Gender identity is one's innermost identification of self as male, female, a blend of both or neither. Gender identification may differ from birth sex.
