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1 A Lifetime of Good Health Your Guide to Staying Healthy TDD:

2 A Lifetime of Good Health Your Guide to Staying Healthy About Us...2 Understanding Risk Factors...4 Preventive Screening Tests and Immunizations...6 Medicare-Covered Preventive Services Heart Disease and Stroke Prevention Heart Attack and Stroke Warning Signs Diabetes Coping with Many Chronic Health Conditions Physical Activity for Health Healthy Eating Fighting the Flu Cervical Health Reproductive Health Preconception Health Pregnancy Breastfeeding Menopause Finding Breast Cancer Early Urinary Tract Health Colorectal Health Healthy Eyes and Ears Healthy Bones Quitting Smoking Oral Health Healthy Skin Stress Mental Health Dealing with Violence Talking with Your Doctor or Nurse Checklist of Questions to Ask Your Doctor or Nurse Office on Women's Health, 1

3 About Us What is the U.S. Department of Health and Human Services? The U.S. Department of Health and Human Services (HHS) is the federal agency responsible for protecting the health of all Americans. Its headquarters are based in Washington, DC. HHS is the publisher of A Lifetime of Good Health: Your Guide to Staying Healthy. What is the Office on Women s Health? Established in 1991, the Office on Women s Health (OWH) is part of the Office of the Assistant Secretary of Health within HHS. OWH wrote and produced this guide. Our mission is to improve the health and well-being of all U.S. women and girls. We lead and coordinate the efforts of all the HHS agencies and offices involved in women s health. We create and sponsor innovative programs that focus on the health of women and girls. We educate health professionals, such as physicians, dentists, researchers, therapists, and nurses. Our publications, websites, and special events reach out to you, the public. We work to educate and motivate people to live healthier lives by giving them trustworthy, accurate health information. How can I get more information? We offer two award-winning comprehensive websites, and These two websites provide reliable, accurate, commercial-free information on the health of women and girls. They cover more than 800 topics on issues ranging from adolescent health to reproductive health to healthy aging. We also offer free assistance by phone through our information referral center. Call , toll free, and our trained Information Specialists can answer your calls in either English or Spanish. For individuals who are hearing impaired and use TDD, call Whichever way you use our services, you ll get: Clear answers to frequently asked questions Links to thousands of health publications Statistics on women s health 2 Call for free health publications: TDD:

4 An online glossary of health terms Daily news on women s health A National Breastfeeding Helpline with trained peer counselors Health information in Spanish How are womenshealth.gov and girlshealth.gov different from other websites on women s and girl s health? Womenshealth.gov and girlshealth.gov are sponsored by the federal government with your tax dollars. We don t represent any special commercial interests. We don t allow advertisements on our sites. We don t try to sell you products, magazines, or anything else. We screen all health information for accuracy before it ever appears on our websites or in our publications. Our Information Specialists are trained to help you, whether it s referring you to the right organization, mailing you free information, or even coaching new moms on how to breastfeed their infants. Womenshealth.gov and girlshealth.gov exist to help you and your loved ones get the reliable and accurate health information you need to get, or stay, healthy. What is Healthy People 2020? Healthy People 2020 provides science-based, 10-year goals from the U.S. government for improving health and stopping disease. Learn more at gov/hp2020. What is the Affordable Care Act? The Affordable Care Act, also called health care reform, is a new law that is helping keep Americans healthy. It helps by making health insurance available to more people, by offering screenings and tests at no out-of-pocket cost to you, and more! Learn all about it at What can I do if I don t have health insurance? If you need health insurance, visit gov to learn what options you have under the new health reform law. Office on Women's Health, 3

5 Understanding Risk Factors Part of learning how to take charge of your health requires understanding your risk factors for different diseases. Risk factors are things in your life that increase your chances of getting a certain disease. Some risk factors are beyond your control. You may be born with them or exposed to them through no fault of your own. Some risk factors that you have little or no control over include your: Family history of a disease Sex/gender male or female Ancestry Age Health having one health problem may raise your risk of having another (for instance, having diabetes increases your chances of getting heart disease) Some risk factors you can control include: What you eat How much physical activity you get Whether you use tobacco How much alcohol you drink Whether you use illegal drugs Whether you use your seat belt In fact, it has been estimated that almost 35 percent of all U.S. early deaths in 2000 could have been avoided by changing just three behaviors: Stopping smoking Eating a healthy diet (for example, eating more fruits and vegetables and less red meat) Getting more physical activity Having more than one risk factor You can have one risk factor for a disease or you can have many. The more risk factors you have, the more likely you are to get the disease. For example, if you eat healthy, exercise on a regular basis, and control your blood pressure, your chances of getting heart disease are less than if you are diabetic, a smoker, and inactive. To lower your risks, take small steps toward engaging in a healthy lifestyle, and you ll see big rewards. Inheriting risk your family health history Rarely, you can inherit a mutated gene that alone causes you to get a disease. Genes control chemical reactions in our bodies. If you inherit a faulty gene, your body may not be able to carry out an important chemical reaction. For instance, a faulty gene 4 Call for free health publications: TDD:

6 may make your blood unable to clot. This problem is at the root of a rare bleeding disorder. More often, you can inherit genes from one or both of your parents that put you at higher risk of certain diseases. But having a gene for a certain disease does not always mean you will get it. There are many unknown factors that may raise or lower your chances of getting the disease. How do I find out my disease risks? It is important to talk to your doctor or nurse about your individual health risks, even if you have to bring it up yourself. And it s important for your doctor to know not just about your health, but your family health history as well. Come to health care visits armed with information about you, your children, siblings, parents, grandparents, aunts and uncles, and nieces and nephews, including: Major medical conditions and causes of death Age of disease onset and age at death Ethnic background General lifestyle information like heavy drinking and smoking What if I have a family history of a disease? People with a family health history of chronic disease may have the most to gain from making lifestyle changes. You can t change your genes, but you can change behaviors that affect your health, such as smoking, inactivity, and poor eating habits. In many cases, making these changes can reduce your risk of disease even if the disease runs in your family. Another change you can make is to have screening tests, such as mammograms and colorectal cancer screening. These screening tests help detect disease early. People who have a family health history of a chronic disease may benefit the most from screening tests that look for risk factors or early signs of disease. Finding disease early, before symptoms appear, can mean better health in the long run. Office on Women's Health, 5

7 Preventive Screening Tests and Immunizations Prevention is important to living long and living well. Getting preventive screenings and immunizations are among the most important things you can do for yourself. Take time to review these guidelines for screening tests and immunizations. Use the General Screenings and Immunizations for Women charts on the next few pages to remind yourself of when you need to see your doctor, based on your personal health profile. Make an appointment today! Screening tests Ages Ages Ages Ages 65 and older General health: Discuss with your doctor or Discuss with your doctor or Discuss with your doctor or Discuss with your doctor or Full checkup, including nurse. nurse. nurse. nurse. weight and height. Ask your doctor or nurse about health topics such as: Overweight and obesity Tobacco use Alcohol use Depression Thyroid (TSH) testing Skin and mole exam HIV test At least once to find out your At least once to find out your At least once to find out your Discuss with your doctor or HIV status. Ask your doctor or HIV status. Ask your doctor or HIV status. Ask your doctor or nurse. nurse if and when you need nurse if and when you need nurse if and when you need the test again. the test again. the test again. Heart health: At least every 2 years At least every 2 years At least every 2 years At least every 2 years Blood pressure test Cholesterol test Start at age 20, discuss with Discuss with your doctor or Discuss with your doctor or Discuss with your doctor or your doctor or nurse. nurse. nurse. nurse. Please note: These charts are guidelines only. Your doctor or nurse will personalize the timing of each test and immunization to meet your health care needs. Check with your insurance plan to find out which tests are covered. These charts are current as of February Call for free health publications: TDD:

8 General Screenings and Immunizations for Women Screening tests Ages Ages Ages Ages 65 and older Bone health: Bone mineral density test Diabetes: Blood glucose or A1c test Breast health: Mammogram (x-ray of breast) Discuss with your doctor or nurse. Start at age 45, then every 3 years. Every 1 2 years. Discuss with your doctor or nurse. Discuss with your doctor or nurse. Every 3 years Every 1 2 years. Discuss with your doctor or nurse. At least once. Talk to your doctor or nurse about repeat testing. Every 3 years Every 1 2 years. Discuss with your doctor or nurse. Clinical breast exam Reproductive health: Pap test Discuss with your doctor or nurse. Every 2 years starting at age 21. Women 30 and older, every 3 years. Pelvic exam Yearly beginning at age 21. Younger than 21 and sexually active, discuss with your doctor or nurse. Chlamydia test Yearly until age 24 if sexually active. Age 25 and older, get this test if you have new or multiple partners. Sexually transmitted infection (STI) tests Colorectal health: Many tests can screen for colorectal cancer. Discuss with your doctor or nurse. Discuss with your doctor or nurse. Discuss with your doctor or nurse. Discuss with your doctor or nurse. Every 3 years Every 3 years Discuss with your doctor or nurse. Yearly Yearly Yearly Get this test if you have new or multiple partners. Discuss with your doctor or nurse. Get this test if you have new or multiple partners. Discuss with your doctor or nurse. Talk to your doctor or nurse about which test is best for you and how often you need it. Get this test if you have new or multiple partners. Discuss with your doctor or nurse. Talk to your doctor or nurse about which test is best for you and how often you need it. Office on Women's Health, 7

9 General Screenings and Immunizations for Women Screening tests Ages Ages Ages Ages 65 and older Eye and ear health: Every 1 2 years Comprehensive eye exam Discuss with your doctor. Get a baseline exam at age 40, then every 2 4 years or as your doctor advises. Every 2 4 years until age 55, then every 1 3 years until age 65, or as your doctor advises Hearing screening Every 10 years Every 10 years Every 3 years Every 3 years Oral health: Dental and oral cancer exam Routinely; discuss with your dentist. Routinely; discuss with your dentist. Routinely; discuss with your dentist. Routinely; discuss with your dentist. Immunizations Ages Ages Ages Ages 65 and older Influenza vaccine Every fall (or winter) Every fall (or winter) Every fall (or winter) Every fall (or winter) Pneumococcal vaccine Tetanus, diphtheria, pertussis (Td,Tdap) vaccine Hepatitis B vaccine Hepatitis A vaccine Human papillomavirus (HPV) vaccine If you smoke or have a chronic health problem, ask your doctor or nurse if you need this vaccine. Get a Td booster every 10 years. Ask if you need 1 dose of Tdap instead of Td booster to prevent whooping cough. Discuss with your doctor or nurse. Discuss with your doctor or nurse. You need this vaccine if you are 26 or younger and have not already completed the vaccine series. If you smoke or have a chronic health problem, ask your doctor or nurse if you need this vaccine. Get a Td booster every 10 years. Ask if you need 1 dose of Tdap instead of Td booster to prevent whooping cough. Discuss with your doctor or nurse. Discuss with your doctor or nurse. If you smoke or have a chronic health problem, ask your doctor or nurse if you need this vaccine. Get a Td booster every 10 years. Ask if you need 1 dose of Tdap instead of Td booster to prevent whooping cough. Discuss with your doctor or nurse. Discuss with your doctor or nurse. You need 1 dose at 65 (or older) if you have never been vaccinated. You may also need a second dose. Get a Td booster every 10 years. Ask if you need 1 dose of Tdap instead of Td booster to prevent whooping cough. Discuss with your doctor or nurse. Discuss with your doctor or nurse. 8 Call for free health publications: TDD:

10 General Screenings and Immunizations for Women Immunizations Ages Ages Ages Ages 65 and older Measles, mumps, rubella (MMR) vaccine Varicella (chickenpox) vaccine Meningococcal vaccine Zoster (shingles) vaccine If you have not had at least 1 dose of MMR, ask your doctor or nurse if you need this vaccine. If you have never had chickenpox or you have been vaccinated but only got 1 dose, ask your doctor or nurse if you need this vaccine. You need this vaccine if you are a young adult planning to live at college or if you have certain medical conditions. Discuss with your doctor or nurse. What is the Affordable Care Act? If you have not had at least 1 dose of MMR, ask your doctor or nurse if you need this vaccine. If you have never had chickenpox or you have been vaccinated but only got 1 dose, ask your doctor or nurse if you need this vaccine. You may need this vaccine if you have certain medical conditions. Discuss with your doctor or nurse. If you were born in 1957 or later and have not had at least 1 dose of MMR, ask your doctor or nurse if you need this vaccine. If you have never had chickenpox or you have been vaccinated but only got 1 dose, ask your doctor or nurse if you need this vaccine. You may need this vaccine if you have certain medical conditions. Discuss with your doctor or nurse. Starting at age 60, you need a single dose of this vaccine. If you have never had chickenpox or you have been vaccinated but only got 1 dose, ask your doctor or nurse if you need this vaccine. You may need this vaccine if you have certain medical conditions. Discuss with your doctor or nurse. Starting at age 60, you need a single dose of this vaccine. The Affordable Care Act, also called health care reform, makes sure that you can get the tests, vaccines, and other services that may help keep you from getting sick. And, it does this without any additional out-of-pocket cost to you! For example, depending on your age, you may have free access to things like: Blood pressure, diabetes, and cholesterol tests Mammograms and colonoscopies Counseling on quitting smoking, losing weight, eating well, treating depression, and reducing alcohol use Routine vaccinations against diseases such as measles, polio, or meningitis Flu and pneumonia vaccines Counseling, screening, and vaccines to ensure healthy pregnancies Regular well-baby and well-child visits, from birth to age 21 Learn more at Office on Women's Health, 9

11 Recommended Screenings, Tests, and Immunizations for Women with High-Risk Factors This chart lists screenings, tests, or exams you might need more often or earlier because of having high-risk factors or things in your life that increase your chances of developing a condition or disease. if it applies Does your family history include? High blood pressure High cholesterol Heart disease or heart attack Diabetes Breast cancer (in female or male relatives) Colorectal cancer or colon polyps Ovarian cancer Broken hip in either your mother or father Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Blood pressure test Cholesterol test Blood pressure test, cholesterol test Diabetes test Mammogram, clinical breast exam, genetic counseling Colonoscopy or other screening tests, genetic counseling Genetic counseling Bone mineral density test if it applies Does your family history include? Thyroid disease or thyroid cancer Gum (periodontal) disease Hearing problems or deafness Vision problems, eye disease, or blindness Cancer, heart disease, diabetes, or any health problem at an unusually young age (10 to 20 years before most people get the health problem) Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Thyroid test, genetic counseling Oral exam Hearing screening Eye exam Genetic counseling, screening tests Please note: These charts are guidelines only. Your doctor or nurse will personalize the timing of each test and immunization to meet your health care needs. Check with your insurance plan to find out which tests are covered. These charts are current as of February Call for free health publications: TDD:

12 Recommended Screenings, Tests, and Immunizations for Women with High-Risk Factors if it applies Does your family history include? Rare types of cancer, two or more relatives with the same type of cancer or with certain combinations of cancers, such as: Breast and ovarian cancers Colorectal and endometrial cancers Birth defects or genetic disorder (you or your partner) Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Genetic counseling, screening tests Genetic counseling, screening tests What is a risk factor? Risk factors are things in your life that increase your chances of developing a condition or disease. They can include things like family history, exposures to things in the environment, being a certain age or sex, being from a certain ethnic group, or already having a health condition. If you do have risk factors, your doctor or nurse will most likely want you to be screened or immunized at a younger age or more often than what is recommended. Check with your doctor or nurse to find out if you need to have specific health screenings and how often you will need them. (See the section on Understanding Risk Factors on page 4 for more information.) Office on Women's Health, 11

13 Recommended Screenings, Tests, and Immunizations for Women with High-Risk Factors if it applies Are you? African-American American Indian or Alaska Native Ashkenazi Jewish descent Age 65 or older Pregnant A smoker Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Eye exam, screening for sickle cell trait Flu vaccine Genetic counseling for certain disorders that are passed down in families, such as Tay-Sachs disease, if you want to become pregnant; genetic counseling for BRCA1/2 mutation if you have a family history of breast or ovarian cancer Flu vaccine, pneumococcal vaccine Flu vaccine, depression screening, prenatal tests Blood pressure test, cholesterol test, bone mineral density test, oral exam, pneumococcal vaccine if it applies Are you? Overweight Thin, weighing less than 127 pounds A college student living in a dormitory Living in long-term care A health care worker A member or former member of the military Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Body mass index, blood pressure test, cholesterol test, diabetes test Bone mineral density test Meningococcal vaccine and other vaccines TB test, flu vaccine, pneumococcal vaccine and other tests or vaccines TB test, flu vaccine, MMR vaccine, Td/Tdap vaccine, varicella vaccine, hepatitis B vaccine and other tests or vaccines Depression screening 12 Call for free health publications: TDD:

14 Recommended Screenings, Tests, and Immunizations for Women with High-Risk Factors if it applies Do you have or have you had? High blood pressure High cholesterol Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Blood pressure test, cholesterol test, diabetes test, eye exam Blood pressure test, cholesterol test, diabetes test if it applies Do you have or have you had? Ovarian cancer An abnormal Pap test Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Pelvic exam, other lab or imaging tests, genetic counseling Pap test, HPV test, HPV vaccine Heart disease Diabetes Breast cancer Blood pressure test, cholesterol test, diabetes test, other tests or exams, flu vaccine, pneumococcal vaccine Blood pressure test, cholesterol test, blood glucose and A1c tests, eye exam, urine test, other tests or exams, flu vaccine, pneumococcal vaccine Mammogram, clinical breast exam, breast self-exam, pelvic exam, other imaging or lab tests, genetic counseling Menopause before age 45 Colon polyps, colon cancer, inflammatory bowel disease An autoimmune disease (such as lupus, rheumatoid arthritis, scleroderma, multiple sclerosis, psoriasis, type 1 diabetes, inflammatory bowel disease, thyroid disease) Bone mineral density test Colonoscopy or other screening tests, genetic counseling Flu vaccine, pneumococcal vaccine, bone mineral density test, thyroid test, TB test, eye exam, other vaccines or tests Dense breasts Cervical, endometrial (uterine), or vaginal cancer Digital mammogram Pap test, pelvic exam, other imaging or lab tests, genetic counseling Steroid (glucocorticoid) treatment, such as prednisone, for more than 3 months Bone mineral density test Office on Women's Health, 13

15 Recommended Screenings, Tests, and Immunizations for Women with High-Risk Factors if it applies Do you have or have you had? Chronic lung disease (such as chronic obstructive pulmonary disease or asthma) Chronic liver disease Thyroid nodule Gum disease (periodontitis) Intellectual disability Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Flu vaccine, pneumococcal vaccine Hepatitis A and B vaccines, flu vaccine, pneumococcal vaccine, bone mineral density test Thyroid funtion or imaging tests Oral exam Vision and hearing screening, oral exam, thyroid test, TB test, hepatitis B vaccine, flu vaccine, other vaccines, tests, or exams if it applies Do you have or have you had? A broken bone as an adult HIV/AIDS Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Bone mineral density test CD4 count, viral load, drug-resistance screening, hepatitis screening, TB test, STI tests, flu vaccine, pneumococcal vaccine, hepatitis A and B vaccines, varicella vaccine, eye exam, Pap test, blood pressure test, cholesterol test, diabetes test, depression screening, exam to discuss family planning, other vaccines, tests, or exams Eye injury or disease Eye exam Ear injury or prolonged exposure to loud noise Hearing screening 14 Call for free health publications: TDD:

16 if it applies Do you have or have you had? Risk factors for hepatitis C, including having ever: Had signs of liver disease Injected illegal drugs Received blood or organ transplant before 1992 Received clotting factors made before 1987 Needed long-term dialysis Multiple sex partners (or a partner who has or had multiple sex partners) or history of not using condoms Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Hepatitis C test STI tests, HIV test, hepatitits B vaccine, HPV vaccine if it applies Do you have or have you had? Eating disorder Then ask your doctor or nurse if you need the following screenings, tests, exams, or vaccines more often or at a younger age: Blood pressure test, bone mineral density test, dental exam, mental health screening, full physical exam Flu vaccine, pneumococcal vac- cine, mental health screening, liver tests, bone mineral density test Hepatitis A and B vaccines, hepa- titis C test, STI tests, HIV test, TB test, mental health screening STI tests, HIV test, Pap test, pelvic exam, hepatitis B vaccine, HPV vaccine TB test Alcohol abuse or dependence Injection drug use or drug addiction Sexually transmitted infection Lived or worked with someone with active tuberculosis A deep or dirty wound A baby within the last year Td/Tdap vaccine Postpartum depression screening Office on Women's Health, 15

17 Medicare-Covered Preventive Services Check this chart to see what screenings and immunizations are covered under Medicare for individuals who are entitled to and enrolled in Medicare Part B coverage. Costs for these screenings and immunizations may only be partially covered. For some of these services, you might have to pay a deductible, coinsurance, and/or copayment. These amounts vary, depending on the type of services you need and the kind of Medicare health plan you have. For more information, call 800-MEDICARE or visit Did you know that Medicare covers? Bone Mass Measurements These measurements help to see if you are at risk for broken bones. Cardiovascular Screenings Doctors test your cholesterol, lipid, and triglyceride levels so they can help you prevent a heart attack or stroke. Medicare covers these measurements once every 24 months (more often if medically necessary) for people with Medicare at risk for osteoporosis. Medicare covers tests for cholesterol, lipid, and triglyceride levels every 5 years. Colorectal Cancer Screenings If you are a person with Medicare who is age 50 These tests help find colorectal or older, or is at high risk for colorectal cancer, cancer early, when treatment one or more of the following tests are covered works best. by Medicare: Fecal occult blood test Screening colonoscopy Flexible sigmoidoscopy Barium enema How often Medicare pays for these tests is different, depending on the test. You and your doctor decide which is best for you, based on your level of risk for this cancer. Diabetes Screenings Medicare covers tests to check for diabetes Diabetes means that your or pre-diabetes. These tests are available if blood glucose (sugar) is too you have any of the following risk factors: high. Your blood always has High blood pressure some glucose in it because the History of abnormal cholesterol and triglyceride levels (dyslipidemia) body uses glucose for energy. It's the fuel that keeps you Obesity going. Too much glucose in A history of high blood glucose the blood is not good for your health. Tests are also covered if you have two or more of the following characteristics: Age 65 or older Overweight Family history of diabetes (parents, brothers, sisters) A history of gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than 9 pounds 16 Call for free health publications: TDD:

18 Diabetes Screenings (continued from page 16) Flu Vaccines These shots help prevent influenza or flu virus. Glaucoma Tests These tests help find the eye disease glaucoma. Hepatitis B Vaccines This vaccine (given in 3 doses) helps protect people from getting hepatits B. Medical Nutrition Therapy Services Nutrition therapy helps you choose the right foods to eat for your health condition. Pap Test and Pelvic Exam (includes clinical breast exam) These exams check for cervical and vaginal cancers. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer. Based on the results of these tests, you may be eligible for up to two screenings every year. Talk to your doctor for more information. Medicare covers these vaccines once a flu season in the fall or winter for all people with Medicare. You need a new flu vaccine each new flu season. Medicare covers these tests once every 12 months for people with Medicare who are at high risk for glaucoma. Medicare covers these vaccines for people with Medicare at high or medium risk for hepatitis B. Medicare may cover medical nutrition therapy if you have diabetes or kidney disease, and your doctor refers you for the service. Talk to your doctor for more information. Medicare covers these exams every 24 months for all women with Medicare, or once every 12 months for women with Medicare at high risk. Physical Exam (one-time Welcome to Medicare physical exam) All adults should visit their health care provider from time to time, even if they are healthy. The purpose of these visits is to: Screen for diseases Assess risk of future medical problems Encourage a healthy lifestyle Update vaccinations Maintain a relationship with a doctor in case of an illness Pneumococcal Vaccine This vaccine helps prevent pneumococcal infections (like certain types of pneumonia). Screening Mammograms A mammogram is a type of x-ray to check for breast cancer. Medicare will cover up to eight face-to-face visits during a 12-month period. These visits must be ordered by your doctor and provid- ed by a qualified doctor or other Medicare- recognized practitioner. Smoking Cessation (counseling to quit smoking) Counseling is available for people with Medicare who smoke and who are diagnosed with a smoking-related illness or are taking medicines that may be affected by tobacco. Medicare covers a one-time review of your health and for education and counseling about preventive services, including certain screenings, vaccines, and referrals for other care if needed. Medicare will cover this exam only within the first 12 months you have Medicare Part B coverage. Medicare covers this vaccine for all people with Medicare Part B. Most people only need this vaccine once in their lifetime. Talk with your doctor. Medicare covers mammograms once every 12 months for all women with Medicare age 40 and older. Office on Women's Health, 17

19 Heart Disease and Stroke Prevention Many women may not be aware that heart disease and stroke are major threats to their health. But heart disease is the most common cause of death among women in the United States, and stroke is the third most common cause of death. Heart disease and stroke also are major causes of long-term disability. The most common form of heart disease is coronary artery disease (CAD). In CAD, plaque builds up on the walls of the arteries that carry blood to the heart. Over time, this buildup causes the arteries to narrow and harden. This keeps the heart from getting all the blood it needs. Blood clots may develop. If a clot mostly or completely blocks blood flow to the heart, it causes a heart attack. If a clot mostly or completely blocks blood flow to the brain, it causes a stroke. Stroke happens when the brain doesn t get enough blood. Without enough blood, brain cells start to die. The good news is that you can take steps to lower your chances of having a heart attack or stroke, or other heart problems. Here are some things you can do: Don t smoke. Smoking hurts your heart and increases your risk of stroke. If you smoke, try to quit. 18 Call for free health publications: TDD:

20 Get more exercise. Try to do at least 2 hours and 30 minutes of aerobic exercise each week, and muscle-strengthening exercises on at least 2 days each week. Eat heart-healthy foods. Focus on eating fruits and vegetables, whole grains, fat-free or low-fat dairy products, fish, beans, peas, nuts, and lean meats. Eat less salt. Use spices, herbs, lemon, and lime instead of salt to flavor your food. If you drink alcohol, don t have more than one drink each day. Too much alcohol raises your blood pressure and can raise your risk of stroke and other illnesses. Get a blood pressure test. If it is high, talk to your doctor about how to lower it. Get your cholesterol tested. If it is high, talk to your doctor or nurse about losing weight (if you re overweight), getting more exercise, eating foods low in cholesterol and saturated fat, and possibly taking medicine to help. Get tested for diabetes. If you have diabetes, keep an eye on your blood glucose levels. High blood glucose levels can play a role in cardiovascular disease (see box). Take your medicine. If your doctor has prescribed medicine to help you, take it exactly as you have been told to. Understanding heart disease Cardiovascular disease includes high blood pressure, stroke, heart failure, and coronary artery disease (CAD). CAD is caused by a narrowing of the arteries near the heart due to fatty buildups of plaque. It's likely to produce angina (chest pain), heart attack, or both. Office on Women's Health, 19

Prevents future health problems. You receive these services without having any specific symptoms.

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