A Guide to Millennial Women's Health by Age
Written by Melissa Schenkman, MPH, MSJ
Essential Insights for Every Decade
When it comes to women’s health, we often have far more questions than we do answers.
How often do we really need to have a PAP smear to check for cervical cancer? When are we supposed to get our first mammogram, if we are hearing about people younger than us getting breast cancer, but we do not have any family history ourselves? Is 30 too young or too old to start thinking about my fertility if I’m still single? That’s just a few of the many questions circulating among women in their 20s, 30s, and 40s around the country.
Each decade brings with it, its own unique set of conditions that should be on our radar, preventive tests and screenings we need to keep ourselves healthy, and things we need to think about and consider when it comes to having children.
How do we navigate it all? By taking the time to seek care from a women’s health specialist.
I spoke with Eva Arkin, MD, who founded a pure gynecologic practice, Premier Care for Women, that is ‘For Women by Women.’ She shares with us the key things we need to focus on as women for our overall health, our gynecologic care, and her thoughts on one of the most popular and complicated topics among millennial women today, fertility.
The Roaring Twenties: Building a Strong Foundation
Nurturing Physical Health
You may think you are too “young and healthy” to be focused on your health at this age, but not if you want to stay that way.
Your 20s are a perfect time to establish yourself as a patient at healthcare centers and practices where you feel most comfortable and to maintain regular appointments, at least yearly with your doctors. This includes finding an internist, gynecologist, dermatologist, and dentist. By attending these appointments you can keep your health in check and catch anything that comes up that is out of the ordinary for you before it were to turn into something that would have a major impact on your life.
It’s also very important to develop an exercise routine that works for you. Committing to 30 minutes of cardio and strength training a day can keep you healthy both physically and mentally.
“Women who take care of their health in a preventive manner generally continue to maintain their good habits with regards to exercise and nutrition,” Arkin said.
Eva Arkin, MD, is a board-certified obstetrician and gynecologist, who has been in practice since 1984. She started Premier Care for Women in 1995, which is a practice that’s ‘For Women By Women.‘ Today her practice is home to six female physicians who take care of all of the gynecologic primary care needs of women of all ages.
Prioritizing Mental Well-being
In your 20s, you tend to experience a lot of firsts and transitions between finishing formal schooling, starting in the workforce, and dating. All of this can put a lot of stress on you and for women impact your mental health even more than men given the societal pressures we are under that want us to simultaneously build a career while finding a life partner and raising a family.
It is incredibly important to make your mental health a priority as much as your physical health because the two are deeply connected. How connected, you ask?
A recent study published in the European Journal of Preventive Cardiology found that people under the age of 40, who had a mental disorder (which included insomnia, anxiety, depression, somatoform disorder, post-traumatic stress disorder, substance use disorder, eating disorders, bipolar disorder, schizophrenia or a personality disorder) were 42% more likely to have a stroke and 58% more likely to have a heart attack than those with no mental disorder.
So, taking care of yourself mentally through making time for self-care, talk therapy, or even medication, if that is what you decide is best for you, should also be at the top of your list.
Thriving in the Thirties: Balancing Responsibilities
Focusing on Reproductive Health
Any age above 25, Arkin tells me, is a good time to start talking with your gynecologist about fertility.
According to the American College of Obstetricians and Gynecologists, a woman's peak reproductive years are between their late teens and late 20s. By the time we turn the big 3-0, our fertility (the ability to get pregnant) starts to decline, and the decline picks up speed as you head toward age 35.
“A lot of the timing of the discussion will depend on the individual's timing of her life schedule: where she is at in her schooling and career, and where she is at in her life in terms of a partnership, and her thoughts on having a family,” Arkin said.
If you would like to have some evidence of where you fall in on the spectrum of fertility, there is a test you can take. It’s called the Anti-Mullerian Hormone Test, also known as AMH for short.
Your AMH test result is an indicator of the number of eggs you have remaining and whether your ovaries may be aging quickly. It can also help fertility specialists have a better idea of how well you would respond to injectable fertility drugs that are designed to stimulate your ovaries in the egg freezing process, should you choose to go that route or do so as part of the process of in vitro fertilization (IVF).
“The AMH is a decent test for anyone at the age of 30,” Arkin said. “However, it is just a test and not a perfect test. Many women do get pregnant regardless of their AMH result.”
Another test women should consider doing, she shared with me, is the genetic test to rule out if a woman is a carrier of any recessive genes like Tay Sachs and Cystic Fibrosis.
Interested in knowing what to do to increase your fertility and chances of getting pregnant when you are ready? You’re not alone.
Here are Arkin’s recommendations for increasing your fertility:
Stay in good health.
Exercise. Stay in good shape and avoid obesity.
Have good nutrition.
Use some vitamin supplementation.
Take the birth control pill.
“The birth control pill for most women has immense protective effects for the gynecologic organs for future fertility,” Arkin said. “It’s also the best prevention for diseases like endometriosis.”
Preventive Care and Health Screenings
Now is the time to start getting PAP tests every three years for cervical cancer solely, and every five years for Human Papilloma Virus (HPV) alone. It’s also important to get sexually transmitted infection (STI) testing if you're sexually active.
Every year you should have your blood pressure screened to head off the development of heart disease early on, a disease that is the leading cause of death for women. Another test to have on your radar is genetic screening for cancer if you have a strong family history of ovarian, breast, or cervical cancer.
In the case of colon cancer, if you have a family history of colon cancer or colon polyps, you will be eligible for and need to get your first colonoscopy in your 30s as a preventive measure.
For all of these reasons, it is important to ask your family members about their health history, so you ultimately know yours and get the best preventive care for you.
Remember as Arkin says: “Women who start out with healthy habits continue to maintain those habits and tend to have a longer lifespan with a better quality of life.”
Flourishing in the Forties: Embracing Change
Navigating Perimenopause and Menopause
Once you hit your forties, it’s time to navigate the uncharted territory between having a period, and then gasp…no longer having a period. Your gynecologist can guide you through it all.
“For women in their 40s, health care issues include irregular periods, continuing period issues, endometriosis, fibroids, and perimenopause,” Arkin said. She has also found that “there are more aggressive and earlier cases of colon cancer which need early screening for diagnosis and early treatment.”
As a result, the guidelines for colonoscopy screening for both women and men have changed. In 2021, the American Cancer Society lowered its recommended age for a first colonoscopy screening to begin at age 45.
Maintaining Bone and Heart Health
Most people reach their peak bone mass by age 30, after that your bone mass begins to decrease, which is why it is so important to do your best to continue to maintain it, especially in your 40s.
Ways to prevent bone loss and ultimately the development of osteopenia (a reduction in bone density that is not severe enough to be osteoporosis) and/or osteoporosis (when the creation of new bone can’t keep up with the loss of old bone, making your bones weak and easier to fracture):
Take 1000 mg of Calcium daily
Take 600-800 IUs of Vitamin D daily
Do weight-bearing exercise (for example, walking and weight lifting)
Do not smoke
Drink no more than one alcoholic drink per day, if at all.
Eat plenty of protein
Maintain a healthy body weight
To maintain good heart health in your 40s, make sure you have your blood pressure, cholesterol, and blood sugar/A1C (the level is an indicator of type 2 diabetes) checked regularly. All are risk factors for heart disease.
As is also the case for maintaining bone health, smoking and being overweight have detrimental effects, so it’s best not to do so and maintain a healthy weight. Other ways you can keep your heart healthy are by:
Exercising 30-60 minutes a day
Getting good quality sleep
Managing stress
Eating a heart healthy diet ( vegetables, fruits, beans or other legumes, lean meats and fish, low-fat or fat-free dairy foods, whole grains, healthy fats, such as olive oil)
What Women of All Ages Should Be Doing
Annual Exams
It’s crucial that women of all ages get their annual gyn exams, Arkin tells us.
This means a pelvic exam, clinical breast exam, and can include a PAP test and STI testing, depending on the patient’s needs each year. Equally as important is establishing yourself with a primary care physician.
“Even young women can be susceptible to many gastrointestinal (GI) diseases, such as inflammatory colitis, as well as many gynecologic issues such as fibroids and endometriosis; other issues are the rare cases of early breast cancer in young women and even endocrine disorders,” Arkin said.
“Taking care of early signs and symptoms of any early disease can alter the "course" of that disease entity.”
Prioritizing Your Care
Let’s be honest. We are all busy people, and since women have the caregiver role in some form from the time we are in our 20s onward, our health can often take a backseat to others. Do not let it.
While millennials often first turn to Dr. Google to remedy their symptoms, the only way to truly get the preventive care you need and to stay healthy long term is by making the time to seek care from people who specialize day in and day out in caring for women’s health.
“In this day and age, millennial women have access to so much information on the web. There are many different websites and apps that they can go to with regards to information on their health, but unfortunately, most women have no idea which sites or apps have truly accurate information. ”They tend to believe information just because it is on a ‘site’ or ‘app,’” Arkin said.
What do we really need? A board-certified physician. “They have all the qualifications to get the answers to all [millennial womens’] questions from all the valid sites,” Arkin reminds us.
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