Women’s twenties are typically a time of overall good health, but they are also an opportunity.
The habits that women acquire in this decade lay the foundations for their health for the rest of their lives. Experts say this includes putting yourself in the hands of appropriate healthcare professionals, knowing your family history of disease and risk factors, and taking responsibility for your medical history. But it also means establishing healthy sleep, nutrition and exercise habits, and paying attention to the use and risks of alcohol, tobacco and other substances.
Most pediatricians stop seeing patients between the ages of 18 and 21, so most women in their 20s need to find a new primary care doctor.
“There is no more important relationship, other than your loved ones, than the one you develop with a primary care doctor,” says Stacey Rosen, a cardiologist at Northwell Health in New York; “Establishing these relationships when you are young and presumably healthy is the most important thing you can do as a young person.”
This clinician may be an internal medicine doctor or an OB-GYN, but if it’s the latter, you have the right to expect more than just a pelvic exam at your visits, says Rosen: “Get a doctor you trust who knows all the parts.” of your body are connected.
Given the current shortage of primary care doctors in countries like Spain or the United States, it can be daunting to find a trusted one after leaving the pediatrician, says Yul Ejnes, an internist based in Cranston, USA. “Making that transition can be a challenge,” he says, but recommends starting by asking friends and family for recommendations. Next, spend part of the first visit telling your family and personal history, sharing current health problems, and also information about hobbies and habits.
If you don’t already have a dentist or ophthalmologist, this is also the time to look for a dentist who will give you regular check-ups and cleanings, as well as a basic evaluation of your eye health.
Two of the main healthy habits to focus on are diet and physical activity.
Healthy eating habits include consuming plenty of fruits, vegetables, and lean proteins in your daily diet and minimizing the amount of highly processed foods.
“There is an activity for cardiovascular health and another for bone and joint health, and it is advisable to do both: they are not interchangeable,” says Rosen. Half an hour each day of the week will reach 150 minutes, but it is not necessary to start there if you do very little. “Some activity is better than none.”
Next, make sure you get enough sleep.
“People in their 20s tend to think they don’t need any sleep,” Rosen says, but that’s not the case. Healthy sleep habits in your 20s become lifelong habits, and inadequate or poor-quality sleep is a “silent, unspoken cardiovascular risk,” she says.
Finally, don’t forget about skin care, including sun protection to reduce the risk of skin cancer. Everyone should apply a sunscreen of at least SPF 30 any time they are going to be exposed to direct sunlight, even in the car, on public transportation, or in an office with direct sunlight coming through the windows, says Michael Cameron, dermatologist at Mount Sinai Medical Center, in the United States.
Protecting yourself from the sun’s UV rays also slows skin aging. You can further counteract sun damage to your skin by applying an over-the-counter retinol (vitamin A) cream each night, after using a gentle cleanser, and a vitamin C serum each morning.
Much of your future health risks will depend on the genetic variations inscribed in your DNA, and now is the time to find out.
“Gathering a family history to determine whether the risk for various conditions is high, low, or medium is very important in one’s 20s,” especially while parents and possibly grandparents or even great-grandparents are alive, Rosen says.
A wide range of cancers (melanoma, colorectal, breast, ovarian, pancreatic, and many more) run in families. This decade is your best opportunity to know your risk of suffering from them, as well as diabetes, heart disease, mental illness and Alzheimer’s. The CDC and the National Library of Medicine have guidelines for collecting a comprehensive family health history.
Depending on what you learn about your family history, you may want to meet with a genetic counselor to decide whether you should be tested for genetic variants that may increase your risk for certain types of cancer. Even if you don’t opt for genetic testing, age 20 is also the time to start knowing your risk of breast cancer. It is the most common cancer in women, other than skin cancer, but the risk varies greatly depending on genetics, lifestyle and other exposures.
If you only see one doctor regularly in your 20s, it should be an OB-GYN, because many health problems that arise decades later stem from sexual and reproductive health.
“Even if it involves the reproductive organs, it can impact future heart and brain health,” Rosen says.
Irregular menstrual periods, for example, may require screening for polycystic ovary disease, which predicts a higher risk of earlier heart disease, Rosen says. The first menstruation, early or late, and the use of hormonal contraceptives can also influence future cardiovascular risk. Additionally, everything that happens during pregnancy, whether gestational diabetes, hypertension, preeclampsia, pregnancy loss, or premature birth, is linked to later risk of heart disease.
Cervical cancer screening begins at age 20, with a Pap smear every three years. But exams in those other years are also an opportunity for: pelvic exams; mental health screenings; contraceptive advice; conversations about family planning and breast cancer risk; possible physical breast exams; and tests to detect sexually transmitted infections.
STI screening “should be individualized based on risk factors and the number of sexual partners a person has unprotected sex with,” says Sarah Pachtman, an OB-GYN and maternal-fetal medicine specialist at University Hospital. North Shore (United States) and HealthyMamaDoc on Instagram. Annual STI screening is prudent, but more frequent screening may make sense for some people.
If you don’t want to get pregnant, discuss your birth control options with your doctor, Pachtman says. The more effective they are and the easier they are to use, the more likely you are to use them regularly and correctly.
“Contraceptives only work if they are always used correctly,” he says. The most effective are long-acting contraceptives, such as IUDs, and Pachtman advises women to ask for pain monitoring during IUD insertion: “All pregnancies are dangerous to some degree, and taking birth control is safe.”
If you want to get pregnant, consult your gynecologist first to explain how to optimize your health before pregnancy, says Pachtman.
“A healthy lifestyle program before pregnancy is the best way to achieve a healthy pregnancy,” she says; “Everyone has something they could do better.” It’s also important to start taking prenatal vitamins, or at least a folic acid supplement, well before you start trying to conceive. “You need to have adequate levels of folic acid in your bloodstream before you miss your period to help prevent neural tube defects,” says Pachtman.
If you have an unplanned pregnancy that you intend to maintain, your first visit should be at eight or 10 weeks of pregnancy for fetal screening. Also be sure to get the recommended vaccines during pregnancy, including flu, COVID, and Tdap (a whooping cough vaccine to prevent whooping cough in the newborn), as well as the new RSV vaccine to prevent respiratory syncytial virus in the baby.
Your gynecologist or other primary care professional should also ask about your mental health and stress levels. Although there are different recommendations for screening for depression and anxiety, Pachtman does not believe they are sufficient, and asks his patients about symptoms of depression and anxiety, risk of intimate partner violence, and substance use at each visit.
Finally, there’s everything else, much of which is related to overall metabolic and heart health.
“Everything we do to optimize heart health also works for brain health, and it all starts in our teens and twenties,” Rosen says.
That means taking care of your mental health, managing stress, and seeking care for symptoms of depression or anxiety. It also means prioritizing oral health. Many people don’t realize that periodontal disease can increase cardiovascular risk, but twice-yearly dental cleanings are also an opportunity to undergo brief cancer screenings. About 75% of neck cancers start in the mouth, but it only takes a few minutes for the dentist to detect any suspicious lesions.
Blood pressure should be checked every two years, unless it is not normal (below 120/80 mmHg), in which case it is checked every year. Women’s cholesterol, or lipids, should be checked at age 20 and then every five years, but if it is not normal or there is a family history of high cholesterol, screening should be individualized.
Although diabetes screening is usually recommended starting at age 30, it is a good idea to get it earlier for those who have risk factors: being obese, having a family history of diabetes, or being Latina, Native American, or Pacific Islander, since those ethnicities are at higher risk.
“Even though it’s not based on guidelines, I wouldn’t wait until someone is 35 if they’re in a high-risk ethnic group,” Rosen says.
The human papillomavirus (HPV) vaccine prevents infections with the virus that causes five types of cancer in women (cervical, oral, vaginal, vulvar and anal cancer) and is recommended for everyone up to the age of 26 years, although it can also be administered after that age.
If you didn’t receive all recommended childhood vaccines, your 20s are an opportunity to catch up, including the hepatitis B vaccine and annual flu and COVID vaccines.
“The flu continues to cause serious illness even in young people,” says Erica Johnson, an infectious disease physician at Johns Hopkins Medicine in the United States, but that’s not the only reason to get an annual flu vaccine. “Part of the benefit of getting a flu vaccine each year is helping to build immunity against the flu that changes over time,” as the virus regularly evolves from year to year.
The most common reason gastroenterologists see women in their 20s is irritable bowel syndrome, says Rajeev Jain, a gastroenterologist at Texas Digestive Disease Consultants. Rectal bleeding or blood in your stool, or changes in bowel habits, such as chronic diarrhea or constipation or changes in the shape of your stool, mean you should see a doctor, Jain says. “Just as women should feel comfortable discussing gynecological issues, they should also feel comfortable discussing gut issues with their doctor,” he says.