We're talking about women's health for this month's Healthy Actions.

What are things that women should do at all stages of their lives to stay on top of their health?

This month's expert is Dr. Edward Ferris, Summa Health's chairman of the department of obstetrics and gynecology and medical director of women's health services.

Preventa­tive checkups and tests are important for women — and men — to stay healthy, he said. But there are plenty of people who push off going to the doctor or make excuses for not getting screenings, such as a mammogram. (I have a few friends like that. Do you?)

Checking in with your doctor is important, “even if it's just about counseling on disease prevention or the importance of self-breast exams, smoking, talking about your weight, diet, immunizations, routine screening tests or now even screening for hereditary cancers,” Ferris said.

Here are Healthy Actions from Ferris as girls and women age:


• First gynecologist visit: Ferris said he often starts to see teens around age 14 to 15. Girls usually do not need to have a pelvic exam until they're 21, unless there is a medical concern. That often takes the scary part out of the equation, he said. Some girls may need contraception for issues they're having with their periods and doctors also will “have a one-on-one, heartfelt discussion about smoking, drugs, contraception, STDs and talking to them about the importance of diet and exercise.”

“It's an important time for those younger girls, even if they're not sexually active... that seeing your OB-GYN doesn't have to be anxiety-producing experience for them to get to know us,” said Ferris.

Parents should also discuss the Gardasil immunizations to protect against HPV with the pediatrician or gynecologist, he said.


•?First pap smear: The recommendation is to get a pap smear, starting at age 21, every other year, regardless of sexual history, Ferris said.

•?Birth control: Discuss options with your doctor.

•?Pregnancy: “We start talking about pregnancies and planning for pregnancies and the importance of being on prenatal vitamins and folic acid and avoiding smoking,” Ferris said.

•?Abuse screening: Ferris said it varies by providers, but he recommends talking to woman about whether she feels safe at home. “Abuse issues are in the national forefront and it's an important topic we should be a little more forthright about discussing,” he said.

•?Exercise: Regular exercise is important.

•?Mammogram: If multiple members of your family have had breast cancer or breast cancer under the age of 50, you may need to get screened as soon as age 25, Ferris said.


• Pap smear: Every other year.

•Breast self-exam: These are a little controversial, Ferris said, but he recommends them once a month. “The common response is ‘I don't know what I'm feeling.' My answer to them is, ‘I'm not expecting you to know what you're feeling. I just want you to be familiar with what your breast tissue feels like so you can tell me if something is different.'?” A clinical exam is still important, he said.

• Pregnancy: After age 35 and especially closer to your 40s, begin discussing the risks of advanced maternal age and pregnancy with your doctor, Ferris said.

• Changing metabolism rate: “Your metabolism starts to slow down once you hit 30. After a child or two, that's when we start to see weight gain.”

• Exercise: A lot of young moms will talk about the difficulties of keeping the weight off (since they eat the leftover chicken nuggets off the plate) and having time to exercise. Find a gym with a day care or things to do outside with your kids, Ferris said. “Get back to your fighting weight in between pregnancies because holding onto the weight gained during pregnancy and then getting pregnant again will mean you have a bigger hill to climb.”

• Cholesterol, high-blood pressure screening: Begin regular screenings in consultation with your doctor.

• Dermatology screening: This is often an overlooked screening, Ferris said. Your family doctor or dermatologist can screen you for any concerns.

• Mammogram: If you have a family history of breast cancer, the recommendation is to begin at age 35. Otherwise, in general, they can start at age 40.


• Cancer awareness: “Once you get into your 40s, you have to be a little more cancer aware of breast cancer, ovarian and uterine cancer. It is more so in your 50s and beyond, or if you have family history,” Ferris said.

• Birth Control: “If you're done with child-bearing, birth control is still an issue. You can still get pregnant in your early 40s.”

•Mammogram: Guidelines vary, but in general, mammograms can begin at age 40 every one to two years and yearly at age 50, if there is no previous family history. Some patients complain that a mammogram is painful. It really depends on the patient, Ferris said. “Some women are very tolerant and others think it's the worst thing ever. Yes, mammograms can be uncomfortable. What's more uncomfortable is if you get breast cancer and you need surgery and chemo. That's going to be a lot more impactful on your life than 10 minutes of squeezing.”

• Breast self-exam: Continue once a month self-exams.

• Exercise.


• Colonoscopy: Get your baseline at age 50 or younger if there is a family history. Repeat every five to 10 years, depending on your risk. Ferris said a lot of patients fear the preparation and the procedure itself. Ferris, who recently had a colonoscopy, said the prep was easier than expected. “The colonoscopy itself is a piece of cake,” he said. “They put you under and the next thing you know, you can go about your normal activity. We went straight to lunch after. A lot of patients are really misinformed about colonoscopies and even mammograms.”

•Re-examine your diet: Your metabolism continues to slow down. You may not be eating differently, but you can't keep the weight off. You have to be disciplined about diet and alcohol. “It's very common to hear, ‘I have one or two glasses of wine every night of the week.' That's not necessarily a good thing and [the person is] usually underestimating how much and how many calories,” Ferris said.

• Calcium and vitamin D intake: Both are recommended for prevention of osteoporosis. Recommendations include 1,000 to 1,300 mg of calcium per day and 400 to 800 IU (international units) of vitamin D. If you are taking more than 500 mg per day, it should be divided doses for better absorption. There are two types of calcium: Calcium carbonate, which is best taken with food and Calcium citrate, which can be taken with food or on an empty stomach and is more expensive.

• Mammogram: After age 50, mammograms are recommended yearly.

• Menopause Awareness: The average age of menopause is 51, but can be late 40s or early 50s. The definition of menopause is once you've stopped your period for 12 straight months. Women may or may not have typical menopausal symptoms throughout, which include night sweats, insomnia, vaginal dryness, mood swings and decreased libido.

• Exercise.


• Osteoporosis and bone screening: You may need to go earlier if there is a family history or other risk factors. You may also want to do a bone-density screening.

• Colonoscopy: Repeat ever five to 10 years, depending on your risk.

•Mammogram: Yearly.

• Pap smear: Women can stop getting pap smears at age 65, if there is no recent history of an abnormal pap smear, or if the woman has had a hysterectomy for noncancerous reasons.

• Exercise.

70s and older

• Pap smears end: A yearly pelvic exam is still recommended.

• Colonoscopies end: In general, most people can stop screening at age 75.

• Mammograms end: In general, most women can stop screening at age 75, but engage in a shared decision-making conversation with a physician.

• Stability and dementia: “If you start to find that you're becoming forgetful, that's when we start to see problems with dementia and Alzheimer's,” Ferris said. “If you're concerned about anything that is more than what is normal memory loss, if your family is starting to comment that ‘we just talked about this five minutes ago,' you might look at mental acuity screenings.”

• Low-impact exercise: “Stay active,” Ferris said. “When you're in your 70s, most people aren't going to be marathoners or Crossfitters. You should still exercise and swim and do low-impact or low-intensity weights. Those are very good for overall flexibility and endurance.” Ferris also suggests keeping your mind mentally active.

• After menopause, any vaginal bleeding should be addressed: “Once your periods stop, you should never bleed again,” he said. If you have any breakthrough bleeding, contact your doctor.

Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/betty