Prevention Guidelines

Prevention Guidelines for Women 18–39

Here are the screening tests and immunizations that most women ages 18 to 39 need. This plan does not include recommendations for pregnancy. Although you and your health care provider may decide that a different schedule is best for you, this plan can guide your discussion.

Screening	Who needs it	How often
Alcohol misuse	All adults	At routine exams
Blood pressure	All adults	Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends the following screening schedules: Every 2 years if blood pressure reading < 120/80 mm Hg, or Yearly if systolic blood pressure reading of 120 to 139 mm Hg or diastolic blood pressure reading of 80 to 89 mm Hg
Breast cancer	Women ages 20 years and older* Women under the age of 20, talk with your health care provider and make an informed decision about performing monthly breast self-exams based on your family history, current medical condition, and personal values	Clinical breast exam every 3 years*
Cervical cancer	Women ages 21 and older	According to the American Cancer Society (ACS), all women should have Pap tests starting at age 21. Women between ages 21 and 29 should have a Pap test every 3 years. Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called "co-testing") every 5 years. This is the preferred approach, but it is also acceptable to continue to have Pap tests alone every 3 years. A woman who has had a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer and who has no history of cervical cancer or serious precancer should not be screened. A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.
Chlamydia	Sexually active women ages 24 and younger, and women at increased risk for infection	Every 3 years if at risk or if you have symptoms
Depression	All adults in clinical practices that have staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up	At routine exams
Diabetes mellitus, type 2	Adults with no symptoms who have sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg	At least every 3 years
Gonorrhea	Sexually active women at increased risk for infection	At routine exams
HIV	Anyone at increased risk for infection	At routine checkups
Obesity	All adults	At routine checkups
Syphilis	Women at increased risk for infection	At routine exams if at risk
Tuberculosis	Anyone at increased risk for infection	Check with your health care provider
Vision	All adults¹	At least one comprehensive exam in your 20s, and two in your 30s
Counseling	Who needs it	How often
Breast cancer, chemoprevention	Women at high risk	When risk is identified
BRCA mutation testing for breast and ovarian cancer susceptibility	Women with increased risk	When risk is identified
Diet, behavioral counseling	Adults with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease	When diagnosed
Tobacco use and tobacco-related disease	All adults	Every visit
Immunization	Who needs it	How often
Human papillomavirus (HPV)	Recommended for all females ages 11 to 26	Three doses The second dose should be given 1 to 2 months after the first dose, and the third dose should be given 6 months after the first dose
Tetanus/diphtheria/pertussis (Td/Tdap) booster	All adults	Td: every 10 years Tdap: substitute a one-time dose of Tdap for a Td booster after age 18, then boost with Td every 10 years
Chickenpox (varicella)	All adults ages 19 to 49 who have no documentation of previous infection or vaccinations	Two doses; the second dose should be given 4 to 8 weeks after the first dose
Measles, mumps, rubella (MMR) vaccine	All adults ages 19 to 49 who have no documentation of previous infection or vaccinations	One or two doses
Flu vaccine (seasonal)	All adults	Yearly
Hepatitis A vaccine	People at risk²	Two doses given at least 6 months apart
Hepatitis B vaccine	People at risk³	Three doses; second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose)
Meningococcal	People at risk⁴	One or more doses
Pneumococcal (polysaccharide)	People at risk⁵	One or two doses

*According to the ACS, women ages 20 to 39 years should have a clinical breast exam as part of their routine health exam every 3 years, and breast self-exams are an option for women starting in their 20s.

**Exceptions may exist; please discuss with your health care provider

¹Recommendation from the American Academy of Ophthalmology

²For complete list, see the CDC website

³For complete list, see the CDC website

⁴People ages 19 to 21 years and who are first-year college students or have one of several medical conditions

⁵For complete list, see the CDC website

Immunization schedule from the CDC