Women's health guidelines

Take advantage of the power of prevention by staying current with the recommended screenings and tests appropriate to your age, gender, medical history, current health, and family history. We’ve compiled the following guidelines to help you keep track of what’s needed and when.

For women ages 20 to 49

If you are pregnant, please refer to the For pregnant women. page for pregnancy-related recommendations.

Topics you may want to discuss with your doctor:

Exercise

• Regular physical activity (at least 30 minutes per day) can reduce the risks of coronary heart disease, osteoporosis, obesity and diabetes.
• Over 40: Consult physician before starting new vigorous physical activity.
   

Nutrition

• Know your body mass index (BMI), blood pressure and cholesterol level. Modify your diet accordingly.
• Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans and whole grains every day.
• Optimal calcium intake for women between ages 25 and 50 is estimated to be 1,000 mg/day.
• Vitamin D is important for bone and muscle development, function, and preservation.
   

Sexual health

• Sexually transmitted infection (STI)/HIV prevention,¹⁶ practice safer sex (use condoms) or abstinence.
• Avoid unintended pregnancy; use contraception.
• Ongoing follow-up and monitoring must be covered without cost-sharing. Services include periodic HIV testing, serologic testing for hepatitis viruses B and C, periodic serum creatinine testing, periodic pregnancy testing, periodic screening for sexually transmitted bacterial infections, and adherence counseling.
   

Mental and substance use disorder

• Stop smoking. Limit alcohol consumption. Avoid alcohol or drug use while driving.
• Mental health and substance use disorders is defined as those conditions listed in the most recent edition of the World Health Organization (WHO) International Classification of Diseases or in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
   

Dental health

• Floss and brush with fluoride toothpaste daily. Seek dental care regularly. 

For pregnant women

Once during each pregnancy

Having a baby? Be aware that while almost all women get the "baby blues" after childbirth, as many as 10% will get postpartum depression. For more information visit our website, blueshieldca.com, or see your healthcare provider.

Recommendations for a healthy pregnancy
 

Prenatal care

Begin within 14 days of confirming pregnancy. 

Dietary supplements 

Women of childbearing age should take 0.4 to 0.8 mg of folic acid daily to decrease the risk of fetal brain and spinal cord birth defects. The recommended calcium intake for pregnant or nursing women is 1,000 milligrams daily.

Screenings and diagnostics 

Blood pressure and weight check at all visits: urine test, obstetrical history and physical, screenings for asymptomatic bacteriuria, chlamydia, gestational diabetes, Group B streptococcal bacteria, hepatitis B, syphilis, gonorrhea, hematocrit, rubella, varicella, Rh (D) incompatibility; HIV counseling and screening, ultrasonography, screening for alpha fetoprotein, chorionic villus screening (CVS) or amniocentesis (for women age 35 and older), blood tests for certain birth defects, fundal height, fetal heart tones.

Discussion topics of prenatal care visits

Prior vaccinations (including flu shots), history of genital herpes, nutrition, smoking cessation, other medication and drug use, preterm labor risk, domestic abuse, mental health as an initial intervention service after screening for interpersonal and domestic violence, and other medication and drug use.

Postpartum care

To be performed within three to seven weeks following delivery. Postpartum exam to include weight, blood pressure, breast and abdomen exam, or pelvic exam.

Find healthy guidelines for men and women age 50 and older

Endnotes

1. All children 3 to 5 years are at risk of vision abnormalities and should be screened; specific risk factors include strabismus, refractive errors, and media opacity.
2. Annual vaccination against influenza is recommended for all persons age 6 months and older, including all adults. Healthy, nonpregnant adults under age 50 without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine, or inactivated vaccine. Other persons should receive the inactivated vaccine. Adults age 65 and older can receive the standard influenza vaccine or the high-dose influenza vaccine.
3. Risk factors for hepatitis A should be discussed with your provider. 
4. Risk factors for hepatitis B should be discussed with your provider. 
5. Measles component: Adults born before 1957 can be considered immune to measles. Adults born on or after 1957 should receive one or more doses of MMR , depending upon their immune status. Also, a second dose of MMR may be necessary if exposed, traveling internationally, and other factors. Rubella component: Women with unreliable vaccination history should check with their provider. Check with your doctor for details regarding pregnancy. 
6. Administer pneumococcal vaccine to children with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after 5 years to children with functional or anatomic asplenia or an immunocompromising condition.
7. One dose for adults at risk, including those with chronic lung diseases (including asthma and COPD); cardiovascular diseases, diabetes mellitus, chronic liver disease, chronic renal failure, sickle cell disease, and immunocompromising conditions. Vaccination is also recommended in adults who smoke cigarettes and residents of nursing homes and long-term care facilities. Vaccination is not recommended in Alaskan Native or Native American persons unless they have another risk factor present. A second pneumococcal dose may be necessary for people age 65 and older who received the vaccine more than 5 years previously and were younger than 65 at the time of the primary vaccination. A onetime revaccination is recommended after 5 years for people with certain medical conditions, including immunosuppressive conditions and people who have undergone chemotherapy. 
8. Individuals at risk for meningococcal disease include international travelers, collegebound students or anyone with a damaged or removed spleen or with terminal complement component deficiency. These individuals should discuss the risks and benefits of vaccination with their doctor. 
9. Colorectal cancer is the third leading cause of cancer death for both men and women. It is the most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. 
10. Individuals at risk for varicella infection include those who have close contact with persons at high risk for severe disease (healthcare workers and family contacts of immunocompromised persons) or are at high risk for exposure or transmission (e.g., teachers of young children; childcare employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers). 
11. Risk factors for chlamydia and gonorrhea infection include history of chlamydial or other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, commercial sex work, and drug use. 
12. Risk factors for syphilis infection include all adolescents and adults who receive health care in a high-prevalence or high-risk clinical setting, men who have had sex with men, commercial sex workers, and those in adult correctional facilities. Individuals being treated for sexually transmitted diseases may be more likely than others to engage in high-risk behavior. 
13. Osteoporotic fractures, particularly hip fractures, are associated with limitation of ambulation, chronic pain and disability, loss of independence and quality of life. Women have higher rates of osteoporosis than men at any given age. 
14. Pregnant women who are at high risk for preeclampsia should use low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation. 
15. People in contact with infants under 12 months of age and healthcare personnel can be given the Td vaccine as soon as feasible. It is recommended that Tdap should replace a single dose of Td for adults under age 65 if they have not previously received a dose of Tdap. 
16. Sexually transmitted infections, also known as sexually transmitted diseases, include chlamydia, gonorrhea, herpes, HIV, HPV, syphilis, and others. See infection-specific notes for information on risk factors for sexually transmitted infections. 
17. The Tdap (tetanus, diphtheria, acellular pertussis) booster is recommended in children ages 11 to 12 who have completed the childhood DTaP immunization series and have not yet received a tetanus and diphtheria (Td) booster dose. 
18. Children through age 9 getting flu vaccine for the first time – or who received flu vaccine – should get two doses, at least four weeks apart. 
19. Low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults Potential benefit of low dose aspirin (81 mg/d) in adults aged 50 to 59 years who have a10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.
20. For breast cancer screening, BRCA mutation referral for genetic risk assessment and evaluation for breast and ovarian susceptibility is recommended for women with family history associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes.  Please see Blue Shield of California medical policy on Genetic Testing for Hereditary Breast and/or Ovarian Cancer. 
21. Colorectal cancer screenings include fecal occult blood annually, sigmoidoscopy every five years, and colonoscopy every 10 years. Beginning age and screening interval can be reduced for patients at increased risk. Multi-targeted stool DNA testing every three years. 
22. Diabetes screening should be performed 22. for adults ages 35to 70 who are overweight and obese. Intensive behavioral counseling interventions to promote a healthful diet and physical activity for patients with abnormal blood   glucose. 
23. Selection of conditions based upon “Newborn Screening: Toward a Uniform Screening Panel and System” as authored by the American College of Medical Genetics (ACMG) and commissioned by the Health Resources and Service Administration (HRSA). 
24. Fluoride oral supplement should be discussed at preventive care visit if primary water source is deficient in fluoride. 
25. Risk factors for prostate cancer include African-American men and men with family history of prostate cancer. 
26. Behavioral counseling to prevent sexually transmitted infections is for sexually active adolescents and adults who meet the following criteria: current sexually transmitted infections, sexually transmitted infections within the past year, multiple current sexual partners, and in non-monogamous relationships if they reside in a community with a high rate of sexually transmitted infections. 
27. Intensive behavioral counseling to promote healthy diet and physical activity is recommended for all adults who have hyperlipidemia or have any known risk factors for cardiovascular and diet-related chronic disease. 
28. Falls prevention counseling for older adults to exercise, or physical therapy to prevent falls in community-dwelling adults age 65 and older who are at increased risk for falls.
29. Hepatitis B screening for non-pregnant adolescents and adults for hepatitis B virus infection at high risk for infection; pregnant women at their first prenatal visit.
30. Hepatitis C screening for adults for hepatitis C virus infection at high risk for infection.
31. Lung cancer screening for adults ages 55 to 80 who have a smoking history.
32. For self-administered hormonal contraceptives, you may receive up to a 12-month supply.
33. Tuberculosis and latent tuberculosis infection (LTBI) for asymptomatic adults at increased risk for infection.
34. Screening and counseling for interpersonal and domestic violence is a covered service for adolescents, women, and women of childbearing age at least annually, and, when needed, those who screen positive are provided or referred to initial intervention services. Mental health is an initial intervention service after screening for interpersonal and domestic violence.
35. Statin use for the primary prevention of cardiovascular disease in adults – The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are ages 40 to 75; 2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75. Statin medications are a pharmacy benefit.

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