You're 36-45

Am I doing this right?

Your body is doing a lot these days and the health things you need to keep up on – from Pap smears and breast health exams to pregnancy and postpartum care – can seem complex and be overwhelming. Let’s navigate the ups and downs of this time in your life together.

  • Hitting your stride.

  • Expect more at your wellness exam.
  • How are you taking care of you?
  • Your family plan.
  • Fertility.
  • Peeing yourself is never normal.
  • Breast cancer screening.
  • Expect more at your wellness exam.

    As we age, there are more and more things to be mindful of in terms of maintaining our health—which means we get to cover more in your woman’s wellness visit. If you’re having a specific problem (like irregular bleeding, painful sex, new depression or anxiety, etc.), let’s definitely talk about it. If it’s having a big impact on your life, together we can consider changing the focus of your visit to be about the issue you’re experiencing rather than preventative health. Otherwise, addressing your concern in detail may require a follow-up to your women’s wellness visit. Speaking of follow-up, ever wonder what the difference is between a preventative health visit and an office visit? Learn more below.

  • How are you taking care of you?

    Between raising children, caring for aging parents and nurturing your career and your relationships—your life is kinda busy these days. So we’ll get to the point… All too often, women prioritize caring for others above themselves. Let’s take a minute to talk about some good ways that you can take care of you. Beyond eating healthy and being active, we really want to know what you enjoy, what makes you feel well—and are you getting enough of that in your life?

  • Your family plan.

    Your provider will probably ask whether you’re thinking about becoming pregnant—and if not, what you’re doing to prevent it. If you don’t see pregnancy in your future, is your current method of birth control the one you want to stick with through menopause? You have a lot of options and this is a great time to discuss them all—and, possibly, to consider switching to a long-acting form of contraception or a permanent solution.

  • Fertility.

    If you do see pregnancy in your future, we want to talk about that, too. Your clinician will want to know more about your pregnancy and reproductive health history—and your partner’s—in order to help you come up with the best plan for becoming pregnant and having a healthy pregnancy. Depending on your history, he or she may recommend some initial steps to look at possible hurdles and what you can do to have the best chance of overcoming them. There are some additional risks that go along with having children after 35 and this is a great time to get all your questions answered.

  • Peeing yourself is never normal.

    Women who have had children experience urinary incontinence more than women who haven’t—but we’re here to tell you that it can happen to anyone and we want to talk about it. There are a range of options to address it that have been shown to be quite effective.

  • Breast cancer screening.

    As they near age 40, many women want to discuss when they should start having mammograms to screen for breast cancer and how often. Let’s do it! Your provider can help you sort through the varying recommendations and decide what’s best for you. Gather as much family history as you can before your visit; specifically, whether you have a mother, sister, or daughter (first-degree relative) or multiple family members on either your mother’s or father’s side of the family who have had breast cancer. This will influence your clinician’s recommendations on when you should start and how often you should have mammograms.

A Simple Guide to Screenings and Prevention

Pregnancy prevention
Breast cancer screening
Cervical cancer screening
Sexually transmitted diseases
General health screenings
Vaccines

Pregnancy prevention

Revisit your birth control method. Is it still working for you? Is your family complete? Do you want to consider something else?

Breast cancer screening

Recommendations on when to begin having mammograms to screen for breast cancer vary and begin as early as age 40 for women of average risk. Talk to your provider about your risk factors and make a plan for when to start.

Cervical cancer screening

Pap smears with combined HPV testing continue until age 65. If your results are normal, your provider will likely recommend screening every three to five years, depending on what type of testing you’ve had in the past and your past results.

Sexually transmitted diseases

While the risk of sexually transmitted infection generally goes down as we age (yay!), you’ll still want to talk to your provider if you’ve had a new partner since your last screening. Women should also be tested for HIV at least once. There is no agreement among medical professionals about how often re-testing should occur; your provider may assess your risk and recommend re-testing.

General health screenings

We want to make sure all of you is healthy! These are the recommendations for general health screening in this age bracket. A primary care provider can help you stay on top these, if we’re not addressing them when you’re in to see us:

High blood pressure. The U.S. Preventative Services Task Force recommends getting your blood pressure tested every year beginning at age 40; before age 40, every two to three years is okay if you don’t have other risk factors for cardiovascular disease. Optimal blood pressure in healthy women is less than 120/80.

Diabetes. Screening for diabetes is recommended if you are overweight or obese, have high blood pressure, high cholesterol or have had diabetes during pregnancy.

Thyroid disease. Periodic screening is recommended for women beginning at age 45.

Cholesterol/lipids. Screening tests for high cholesterol are recommended periodically for all women, but may be done more frequently if you are overweight, obese or have other risk factors.

Vaccines

Don’t forget to get your seasonal flu vaccine. If you are or become pregnant, you should also have a Tdap vaccine sometime between 27 and 36 weeks. If not, you should get a “Td” (tetanus and diphtheria) booster every 10 years.

Is This Normal?

Answers you want, questions you may not want to ask

Let's Talk About It

Here are some topics your provider may bring up

  • 1 Sex drive (libido)

    Sex drive (libido)

    The desire for sex can naturally fluctuate over the years and can be affected by many things, including puberty, pregnancy, menopause, illness, medications, relationships and life circumstances, among other things. If you have questions or concerns about your sex drive, talk to your provider.

  • 2 Health and disease screening

    Health and disease screening

    Screening means looking for signs of disease or assessing risk factors for developing disease before you have any noticeable physical symptoms. Mammography is one way we screen for breast disease. Pap tests screen for cervical cancer or changes that could lead to cervical cancer. DEXA scanning screens for osteoporosis. Measuring blood pressure, weight, cholesterol and blood glucose helps us screen for risk factors that can lead to heart disease and diabetes. Learn more about recommended screening by age range.

  • 3 Self-care
  • 4 Urinary incontinence
  • 5 Abnormal bleeding
  • 6 Disease prevention

    Disease prevention

    Sometimes your risk of developing a disease–such as cancer, heart disease, or diabetes–is linked to family history or genetics. But there are often steps you can take to reduce your risk. (The fancy term for this is “modifiable risk factors.”) Examples of modifiable risk factors include not smoking, not drinking alcohol excessively, exercising regularly, eating a healthy diet, and controlling high blood pressure and cholesterol. Talk to your clinician about your health and family history and what you can do to minimize your risk.

More Resources for You

ACOG Patient Information

Information from the American College of Obstetricians and Gynecologists on a wide variety of women’s health issues.

Office on Women’s Health

Articles, fact sheets, resources and infographics on staying healthy throughout your life from the U.S. Department of Health and Human Services. Excellent breastfeeding information!

CDC.gov

The website of the Centers for Disease Control and Prevention – this is a great resource for vaccination and disease screening and prevention recommendations.

Up to Date

A searchable database of current medical information for both patients and providers.

Our Moment of Truth

Learn more about midwifery care and women's health during pregnancy and beyond on this site from the American College of Nurse-Midwives.

MiddlesexMD Blog

A good resource for articles on sex after 40. Also includes various products, but this is not a specific endorsement of those.

Voices for PFD

A great resource from the American Urogynecologic Society for women experiencing pelvic floor disorders, including bladder and bowel control issues and pelvic organ prolapse.

Hystersisters

On online resource and forum for women having bleeding issues, fibroids, pelvic pain, etc.

GoodRx

A website to compare the cost of prescription medications.

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Alyxandra O’Brien, MD - Physician and Surgeon in Gresham, OR and Portland, OR Alyxandra O’Brien, MD

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Obstetrics and Gynecology

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