In your 20s and 30s, you may be building a career and possibly a family—and you’re also building a foundation for your lifelong health. At 21, you'll begin annual pelvic exams and cervical cancer screenings. 

Baselines established now for your blood pressure, lipid panel (cholesterol and triglycerides), and blood glucose level will help assess your current risk factors and provide a comparison as you age. For those looking to have a family, the 20s and early 30s are the ideal times to address pre-pregnancy counseling as well as optimize your health for fertility and pregnancy.   

Pelvic Exam

The pelvic exam checks your vulva, vagina, cervix, ovaries, uterus, rectum, and pelvis. Your practitioner is looking for signs of infection, unusual changes, or abnormalities. 

Pelvic exams may be uncomfortable, but should not be painful. Your provider will explain what they will be doing before they begin and provide reassurance throughout your visit.

Pelvic exams typically begin at the age of 21 (unless there are symptoms or concerns before then) and are repeated annually. “Screening for infections is important in your 20s,” says Dr. Beasley. “STIs in females may have no symptoms and, if left untreated, can cause long-lasting issues like infertility and chronic pelvic pain.”

Cervical Cancer Screening

This screening helps to identify changes in the cells of the cervix that could lead to cancer. Screening includes cervical cytology (Pap test or Pap smear), testing for human papillomavirus (HPV), or both. “Pap smears are essential for picking up any changes in the cervix that can lead to cervical cancer in the future,” explains Dr. Beasley. 

The FDA has approved and recommends the HPV vaccine for people of all ages. Be sure to speak with your provider to see if the vaccine could be beneficial to you.

The Pap test screens for cervical cancer and the presence of HPV are often done during a pelvic exam starting around 21. There are different screening recommendations prescribed by ACOG depending on your age and any potential risk factors, your provider will discuss the best course or screening for you. 

Clinical Breast Exam  

This is a physical exam of your breasts done by a trained practitioner. They will examine you both visually and by feeling your breasts, underarms, and the area just below your clavicle (collar bone). They’re checking for any changes or abnormalities, like a lump, pulling or dimpling of the skin. 

Breast Awareness

It is essential to know what’s normal with our breasts. This is called breast self-awareness. Breast exams can be an important part of breast awareness and breast health. When you know how your breasts usually look and feel, you’ll be better able to identify any changes or concerns that could signal a problem.  

Talk to your doctor if you notice any differences in the skin or nipples (from irritation to discharge), any pain or swelling, or any lumps or bumps that have changed or newly appeared. These might be signs of breast cancer, and it’s always best to get checked out.

Pregnancy  

The old phrase “your biological clock is ticking” is basically an insensitive way of saying that age matters when it comes to fertility. You have the highest chance of conceiving naturally in your 20s and early 30s. Healthy couples have a 25% to 30% chance of getting pregnant with each menstrual cycle. If you plan to begin trying for a baby, your physician will counsel you on preparing for pregnancy (or preconception counseling). 

Ideally, preconception counseling should start at least three months before you get pregnant. Some of the key components of this prep include genetic testing for you and your partner, ensuring you are up to date on all of your vaccines, reaching and maintaining a healthy weight, eating a healthy diet, getting regular exercise, and putting a stop to unhealthy habits (tobacco, alcohol, recreational drugs). 

Your doctor will also recommend you take prenatal vitamins while trying to conceive and continue throughout your pregnancy. Prenatals, as they’re conversationally called, nourish your body with the vitamins and minerals needed to support a healthy pregnancy. Two biggies are folic acid, which protects from neural tube defects, and iron, which helps your body make the extra blood required by you and the baby.  

Preserving Fertility

Fertility begins a rapid decline after age 37, and by 40, the chance of conceiving in a single menstrual cycle is just 10%. If you want children of your own but being pregnant is not in the foreseeable future, you might consider freezing your eggs by age 34. 

Here’s why. As you age, your eggs reduce in number and quality. A woman begins her life with a fixed number of eggs in the ovaries. That number decreases as you get older. So does the quality of the remaining eggs, making you more likely to have abnormal chromosomes. By the time you reach 37, it’s estimated you’ll have about 25,000 eggs left of the 500,000 present at the time of your first period. 

Freezing your eggs does not guarantee you a baby in the future. But it can offer a better chance for you to get pregnant down the road. The younger you are when you freeze your eggs, the higher the likelihood of pregnancy and a live birth when you choose to conceive. 

Advanced Maternal Age and Infertility

Women 35 and older who are trying to conceive or pregnant are considered at an advanced maternal age (by insurance companies). Pregnancy over age 35 could come with a higher risk for health conditions, including gestational diabetes, preeclampsia, premature birth, and low birth weight. 

The chance of miscarriage, as well as spontaneous genetic abnormalities (such as Down syndrome), also rises with age. Genetic testing is available to determine if your baby is at risk for any spontaneous genetic abnormalities.

Research shows that, when trying to conceive, more than half of healthy couples will get pregnant in the first six months. If you are younger than 35 and unable to conceive after 12 months, speak to your physician about a fertility evaluation. If you are over 35, talk to your doc after trying for six months. 

A fertility evaluation can help identify what may be affecting your fertility. From there, you will learn about your options for fertility treatments, which may include medicines, procedures, and assisted reproductive technologies (like in vitro fertilization, or IVF). According to ACOG, infertility can often be successfully treated even if no known cause is found.

Other Symptoms to Be Aware of In Your 30s

Fibroids can occur at any age but are most commonly found in women between the ages of 30 and 40. Fibroids are non-cancerous (benign) growths that develop from the muscle tissue of the uterus. Symptoms include an unusually heavy menstrual flow accompanied by intense cramps and pelvic pain. 

Another health condition that’s often diagnosed in the 30s is endometriosis. This is when tissue similar to the inner lining of the uterus grows outside the uterus. Endometriosis can cause severe pelvic pain. The pain can show up at the same time as your period, during or after sex, or when peeing or having a bowel movement. 

At this stage in your life, your period tends to have settled into her own groove and rhythm. Make sure to reach out to your provider if you are having excessive pain, or changes in your bleeding pattern.