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Be Healthy in Your 20s, 30s, and 40s

Make a mental list of your three biggest health worries. Odds are they're very different from those of your little sister or older aunt. That's because, depending on where you are in life, your concerns understandably shift. "A 20-year-old isn't going to be thinking about breast cancer and heart disease the way a 40-something woman is. She's going to be more focused on, say, her sexual health," explains JoAnn E. Manson, MD, chief of the division of preventive medicine at Boston's Brigham and Women's Hospital. And rightly so, since your actual risk for certain problems also changes with age. Here, a guide to the issues you should hone in on now -- and expert advice for safeguarding your health through the years.

Top Health Concerns

  1. Sexually transmitted diseases. A whopping 19 million new STD infections occur each year, according to the Centers for Disease Control and Prevention (CDC) -- and nearly half of them are in those age 24 and under. "STDs like herpes and human papillomavirus (HPV) are rampant these days," says Steven R. Goldstein, MD, a professor of obstetrics and gynecology at New York University Medical Center. You may be in a monogamous relationship, but that doesn't make you immune. "Some STDs, such as chlamydia and HPV, are asymptomatic, which means you may have one and not know it," adds Dr. Goldstein. Left untreated, chlamydia can lead to pelvic inflammatory disease (a serious infection of the upper genital tract) and infertility. Certain strains of HPV can cause cervical cancer, although the virus often clears up on its own without incident.
  2. Skin cancer. "Melanoma is the leading cause of cancer death among 25- to 29-year-old women," says Elizabeth K. Hale, MD, an assistant professor of dermatology at New York University. About 900,000 twenty-somethings are diagnosed with melanoma (the most serious type of skin cancer) each year, in part, she says, because young women don't safeguard themselves as well as their older counterparts do. Plus, many women believe that by the time they're in their 20s, the harm has already been done. "But only 75 percent of sun damage occurs by age 18, which means there's still 25 percent under your control," says Dr. Hale. Any new moles -- or changes in the appearance of existing ones -- should be checked out by a dermatologist.
  3. Bone health. "A woman's peak bone mass is reached by the time she's in her very early 20s," says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation. "We used to believe it was much later -- in your mid 30s." Maintaining that peak level is crucial, because the more bone mass you have going into the next several decades, when it rapidly declines, the lower your risk for osteoporosis will be.

Your Stay-Healthy Checklist

  • Get 1,000 milligrams of calcium and 200 to 400 IU of vitamin D daily to keep your bones healthy. It's best to get your calcium from the foods you eat (three servings of low-fat dairy products will do it), or Dr. Cosman recommends taking a supplement that contains both calcium and vitamin D.
  • Do regular bone-boosting exercise. High-impact activities (like skipping rope or jumping jacks) have been shown to stress your body in such a way that they spur bone growth, says Dr. Cosman. Another good choice: running. If you're pregnant, talk to your doctor before beginning a fitness plan.
  • Be smart about sun exposure. Avoid going out between 10 a.m. and 4 p.m., and always wear a sunscreen with an SPF of 30 or higher.

Tests to Have Administered

  • An annual physical, including a blood pressure check and baseline cholesterol screening.
  • A yearly Pap smear, which helps detect cervical abnormalities, including those linked to HPV. Some ob-gyns also recommend getting a full battery of STD tests.
  • An annual skin check from your dermatologist -- more often if you have a personal history of skin cancer or a lot of moles.

Top Health Concerns

  1. Depression and stress. According to the National Institute of Mental Health, the median age of onset of depression is 32. The pressure-cooker lifestyle of this time is a major contributor, says Dr. Manson. Marriage, a kid or two, and a career that's in full swing add up to lots of obligations and through-the-roof stress.
  2. Premenstrual syndrome. "This is a peak time for PMS," says Christiane Northrup, MD, an ob-gyn and author of Mother-Daughter Wisdom (Bantam). "In your 20s, your body is more resilient, so you have an easier time clearing excess alcohol and caffeine from your system and getting by on too little sleep -- all things that are known to exacerbate PMS. But that changes in your 30s, and your body starts to say, 'Hey, keep it up and you're going to hear from me!'"
  3. Overweight and obesity. Maintaining a healthy weight is crucial at any age, but now is the time when, experts say, the scale needle really starts to climb (33 percent of women in their 30s are overweight, versus 23 percent of those in their 20s). Why? Research shows that most women never lose all of the baby weight they gained -- keeping on up to 8 pounds, on average, two-and-a-half years after delivery. Plus, in your early 30s your metabolism (the rate at which your body burns calories) begins to slow. Lack of shut-eye (due to those 1,001 daily to-dos) can also cause you to gain weight. A University of Chicago study found that sleep deprivation alters levels of the hormones in the body that regulate hunger, causing an increase in appetite.

Your Stay-Healthy Checklist

  • Get plenty of sleep. Most of us clock a mere 6.8 hours a night on weekdays. The hard truth is that we need more. "Sleep is crucial for women in their 30s," says Dr. Northrup. "It will do more for your mental health and body weight than almost anything else."
  • Relax! You can reduce anxiety simply by breathing properly, says Dr. Northrup. That means inhaling and exhaling deeply through your nose.
  • Strength train. In your 30s, your body begins to lose muscle and replace it with fat. Start lifting weights to reverse the process, and you'll get a big metabolic boost. That's because muscle burns four times as many calories as fat does. Twenty minutes of strength training, two or three times a week, is what most experts recommend.

Tests to Have Administered

  • A yearly physical, including a blood pressure check and cholesterol screening. Also, talk to your doctor about your stress levels or any feelings of depression you may have. (In this case, don't wait for your annual checkup to roll around.)
  • An annual Pap smear and clinical breast exam. You should give yourself monthly breast self-exams (BSEs) as well. For a how-to, log on to komen.org/bse. "Breast cancer isn't a major concern in your 30s, but you do want to become increasingly vigilant," says Dr. Manson.
  • A yearly skin check from your dermatologist.

Top Health Concerns

  1. Perimenopause. This refers to the 6 to 13 years leading up to menopause -- and most women notice the symptoms in their early to mid 40s. "During that time, your metabolism slows even more, and levels of estrogen and progesterone begin to fluctuate," says Dr. Goldstein. This can lead to changes in your cycle, as well as to symptoms like irritability, memory changes, and sleep problems.
  2. Heart disease. Your odds of getting this condition don't peak for a decade or so, but now is the time to take preventive action. "More than half of women over age 45 have high blood pressure, which increases your cardiovascular disease risk." says Nieca Goldberg, MD, chief of women's cardiac care at Lenox Hill Hospital, in New York City. What's more, "as your estrogen levels naturally decline, your cholesterol tends to go up and you become more prone to hypertension."
  3. Type 2 diabetes. Your risk for this health problem increases now as well. According to the CDC, 1.7 percent of Americans age 20 to 39 have the disease. Between the age of 40 and 59, that number jumps to 6.6 percent. Often called "adult onset" diabetes, it can result from being overweight, having poor diet and exercise habits, or having high blood pressure and cholesterol.
  4. Breast cancer. Women in their 40s account for about 18 percent of all breast cancer diagnoses; 77 percent, by comparison, occur in those over 50. So while your risk isn't enormous, it's there, says Dr. Manson -- particularly if you have a family history, are overweight, or have a poor diet.

Your Stay-Healthy Checklist

  • Curb refined-carb intake. A diet loaded with white bread, crackers, and sugary snacks increases glycemic stress in the body by causing blood sugar levels to spike and plummet repeatedly. This can wear on your system, setting the stage for heart disease, diabetes, and cancer.
  • Drink less, move more. Research shows that having more than one alcoholic drink a day ups your breast cancer risk. Exercise, on the other hand, lowers your odds of getting the disease, so incorporate walking into your day.
  • Watch your waistline, literally. "Gaining weight, particularly around your middle, is a marker for type 2 diabetes and heart disease," says Dr. Goldberg.

Tests to Have Administered

  • An annual physical, which tests blood pressure and cholesterol. Starting at age 45, you should also get a fasting blood glucose screening, which tests for diabetes.
  • Annual mammograms; monthly BSEs.
  • A yearly Pap smear.
  • An annual skin check.
  • A thyroid function test.

Freelance writer Shaun Dreisbach is based in Essex, Vermont, and has two children.

Originally published in American Baby magazine, February 2007.