Health Maintenance: Ages 19–39 Years

Published on 30/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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Chapter 3 Health Maintenance: Ages 19–39 Years

IMPORTANT CONSIDERATIONS (PHYSIOLOGIC CHANGES)

The 19- to 39-years group is notable for more established menstrual function, punctuated for many by one or more pregnancies. Sexuality and sexual expression patterns have generally become well established and comfortable. Health care is directed toward prevention and health promotion because health is generally good in patients during these years.

Leading Causes of Death

• Malignant neoplasms
• Motor vehicle accidents
• Cardiovascular disease
• Suicide
• Acquired immunodeficiency syndrome
• Homicide
• Cerebrovascular disease
• Diabetes mellitus and its complications

Leading Causes of Morbidity

• Diabetes mellitus
• Nose, throat, and upper respiratory conditions
• Menstrual disorders
• Musculoskeletal and soft tissue including back and upper and lower extremities
• Obesity
• Sexual assault/domestic abuse
• STD

SCREENING

History

• Reason for visit
• Health status: medical, surgical, family
• Dietary/nutritional assessment
• Physical activity
• Tobacco, alcohol, other drugs (including complementary and alternative medicines)
• Abuse/neglect
• Sexual practices

Physical

• Height
• Weight (body mass index)
• Blood pressure
• Neck: adenopathy, thyroid
• Breasts
• Abdomen
• Pelvic examination
• Skin

Laboratory

Periodic

• Pap test (physician and patient discretion after three consecutive normal test results if low risk)
• Cholesterol, high-density lipoprotein cholesterol (every 5 years)

As Indicated by Risk Factors

• Bacteriuria testing
• Fasting glucose test
• Genetic testing/counseling
• Hemoglobin
• Human immunodeficiency virus testing
• Mammography
• Rubella titer
• STD testing
• Thyroid-stimulating hormone test
• Tuberculosis skin test

Imaging

Screening mammography may be started before age 40 years for patients with a strong family history of early-onset breast cancer or heritable cancer syndromes.

COUNSELING

For those considering or at risk for pregnancy, counseling regarding preconception testing, immunization, and nutrition is always appropriate. Health care encounters during this period are also an excellent opportunity to discuss long-term health improvement strategies such as weight control, exercise, and nutrition.

Sexuality

• High-risk behaviors
• Contraceptive options

• Genetic counseling
• Prevention of unwanted pregnancy (including emergency contraceptive options)

• STD

• Partner selection
• Barrier protection

• Sexual function

Fitness

• Hygiene (including dental)
• Dietary/nutritional assessment (folic acid supplementation for those at risk for or considering pregnancy; 0.4 mg of folic acid per day has been shown to reduce the risk of neural tube defects)
• Exercise: discussion of program

Psychosocial Evaluation

• Interpersonal/family relationships
• Domestic violence (more than 1.5 million cases of domestic violence occur each year; 20% to 40% of adults report abuse or sexual victimization before age 18 years, and 10% to 25% of wives report abuse or sexual victimization)
• Job satisfaction
• Lifestyle/stress
• Sleep disorders

Cardiovascular Risk Factors

• Family history
• Hypertension
• Dyslipidemia
• Obesity/diabetes mellitus
• Lifestyle

Health/Risk Behaviors

• Injury prevention

• Safety belts and helmets
• Recreational hazards
• Firearms
• Hearing
• Breast self-examination (Although data on the efficacy of breast self-examination are lacking, the possibility of detecting breast disease makes this recommendation reasonable.)
• Breast cancer chemoprophylaxis (selective estrogen receptor modulator therapy for women older than age 35 years at high risk)
• Skin exposure to ultraviolet rays
• Suicide: depressive symptoms
• Tobacco, alcohol, other drugs

COUNSELING RESOURCES

American College of Obstetricians and Gynecologists: Breast Self-Exam. ACOG Patient Education Pamphlet AP145. Washington, DC, ACOG, 2001.
American College of Obstetricians and Gynecologists: Cholesterol and your health. ACOG Patient Education Pamphlet AP101. Washington, DC, ACOG, 2004.
American College of Obstetricians and Gynecologists: Eating disorders. ACOG Patient Education Pamphlet BP144. Washington, DC, ACOG, 2000.
American College of Obstetricians and Gynecologists: Good health before pregnancy. ACOG Patient Education Pamphlet AP056. Washington, DC, ACOG, 2007.
American College of Obstetricians and Gynecologists: Staying healthy at all ages. ACOG Patient Education Pamphlet AB006. Washington, DC, ACOG, 2006.

INTERVENTIONS: IMMUNIZATIONS

If not already accomplished, initiate human papillomavirus and hepatitis B vaccine series.

Periodic

• Tetanus–diphtheria booster (every 10 years)

High-Risk Groups

• Measles, mumps, rubella vaccine
• Hepatitis B vaccine
• Influenza vaccine
• Pneumococcal vaccine

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REFERENCES

Level II

Hahn KA, Strickland PA, Hamilton JL, et al. Hyperlipidemia guideline adherence and association with patient gender. J Womens Health (Larchmt). 2006;15(9):1009.

Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002. Adv Data. 2005;362:1.

Level III

American College of Obstetricians and Gynecologists. Guidelines for Women’s Health Care, 2nd ed. Washington, DC: ACOG, 2002.

American College of Obstetricians and Gynecologists. Primary and preventive care. Clinical Updates in Women’s Health Care. 2007;VI(2):1.

American College of Obstetricians and Gynecologists. Routine cancer screening. Committee Opinion No. 356. Washington, DC: ACOG, 2006.

American College of Obstetricians and Gynecologists. Selective estrogen receptor modulators. ACOG Practice Bulletin No. 39. Obstet Gynecol. 2002;100:835.

Lentz GM. History, physical examination, and preventive health care. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:148.

O’Brien WF. Weight control in women: A challenge to the obstetrician-gynecologist. Obstet Gynecol. 1996;88:888.

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