Adult Female Health Maintenance

The Adult Female Health Maintenance is part of the Family Medicine section provides High Yield information for the USMLE, COMLEX, Medical School, Residency, and in the future career as a Physician. Prepare and Learn Ahead! Educating, Preparing, and Proving high-yield content, quizzes, and medical resources to students who are interested in the medical field.

Adult Female Health Maintenance

Cancer Screening

  1. PAP smears: Have decreased cervical cancer rates! Start at age 21 or within 3 years of the onset of sexual activity. Stop at age 65 unless risk factors – new partner, recent abnormal PAPs, etc.
    1. Annually until have three normal annual PAP smears, then every 3 yrs, but no strong consensus across different expert organizations.
    2. Can be discontinued following hysterectomy for benign indication if cervix is gone, too. But continue if cervical dysplasia was present and/or if cervix remains.
    3. Most cervical cancer happens in women who haven’t been screened in 5 yrs or who didn’t follow up on an abnormal PAP
    4. HPV vaccine – recommended in kids ages 9 to 26. Does not affect PAP screening intervals.
  2. Mammogram: Most abnormalities found are NOT breast cancer! Every 2 years for women over 50, individual decision for women over 40.
    1. Clinical breast exam – insufficient evidence
    2. Breast self exam – NOT recommended.
  3. BRCA testing
    1. First degree relatives
      1. 2 with breast cancer, w/ one < 50 yrs old
      2. 1 with bilateral breast cancer
    2. First or second degree relatives:
      1. 3 with breast cancer at any age
      2. 2 with ovarian cancer
      3. Anyone with breast and ovarian cancer
      4. Male with breast cancer


Osteoporosis: HALF of all post menopausal women will have an osteoporosis related fracture! Risk increases w/ age, smoking, weight, white/asian, family history, sedentary life, low calcium intake.

  • In men: risk factors include prolonged corticosteroids, diseases that alter hormone levels (chronic kidney, lung), undiagnosed low testosterone levels
  • Screening: DEXA scan is best for predicting hip fracture. Screen women over 65, or 60 if risk factors
    • Osteoporosis = T score < -2.5, osteopenia if -2.5 < T score < -1.0.
  • Prevention: All women over 50 should take 1200 mg calcium and 400-800 mg Vitamin D Use supplements if diet isn’t enough. Do exercises.

Cardiovascular disease

Cardiovascular disease: number 1 killer of women in the US. Screening rec’s are similar as to those for men.

  • Blood pressure: all women over 18 yrs
  • Lipids: all women over 45
  • Hormone replacement is NOT recommended for prevention of chronic conditions – increased rates of adverse CV outcomes, whether estrogen solo or estrogen + progesterone.

Domestic Violence

Domestic violence: USPSTF found insufficient evidence to recommend for or against screening or that screening affects outcomes, but other groups recommend screening

  • Risk factors: Young age, low income, pregnant, mental illness, alcohol or substance use, separated or divorced, childhood abuse
  • Reporting is mandatory in some states

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