Columbia University Irving Medical Center, New York, NY, USA.
Am Fam Physician. 2021 Feb 15;103(4):209-217.
Health maintenance for women of reproductive age includes counseling and screening tests that have been demonstrated to prevent disease and improve health. This article focuses mainly on conditions that are more common in women or have a unique impact on female patients. Family physicians should be familiar with evidence-based recommendations for contraception and preconception care and should consider screening patients for pregnancy intention. The American Academy of Family Physicians recommends against screening pelvic examinations in asymptomatic women; the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to make a recommendation for or against screening pelvic examinations. The USPSTF recommendations for women in this age group include screening for obesity and other cardiovascular risk factors, depression, intimate partner violence, cervical cancer, HIV, hepatitis C virus, tobacco use, and unhealthy alcohol and drug use as part of routine primary care. Breast cancer screening with mammography is recommended for women 50 years and older and should be individualized for women 40 to 49 years of age, although other organizations recommend earlier screening. Screening for sexually transmitted infections is based on age and risk factors; women younger than 25 years who are sexually active should be screened routinely for gonorrhea and chlamydia, whereas screening for syphilis and hepatitis B virus should be individualized. Immunizations should be recommended according to guidelines from the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices; immunizations against influenza; tetanus; measles, mumps, and rubella; varicella; meningococcus; and human papillomavirus are of particular importance in women of reproductive age. To have the greatest impact on health, physicians should focus on USPSTF grade A and B recommendations with patients.
育龄期女性的健康维护包括经证实可预防疾病和改善健康的咨询和筛查测试。本文主要关注在女性中更常见或对女性患者有独特影响的疾病。家庭医生应熟悉避孕和孕前保健的循证建议，并应考虑筛查患者的妊娠意向。美国妇产科学院（American Academy of Family Physicians）不建议对无症状女性进行盆腔检查筛查；美国预防服务工作组（U.S. Preventive Services Task Force，USPSTF）发现，没有足够的证据支持或反对盆腔检查筛查。USPSTF 对该年龄段女性的建议包括筛查肥胖和其他心血管风险因素、抑郁、亲密伴侣暴力、宫颈癌、艾滋病毒、丙型肝炎病毒、烟草使用以及不健康的酒精和药物使用，这些内容作为常规初级保健的一部分。推荐对 50 岁及以上的女性进行乳房 X 光筛查，对于 40 岁至 49 岁的女性，应根据个人情况进行筛查，尽管其他组织建议更早开始筛查。性传播感染的筛查基于年龄和风险因素；对于有性行为的 25 岁以下年轻女性，应常规筛查淋病和衣原体感染，而梅毒和乙型肝炎病毒的筛查应根据个人情况进行。应根据疾病控制与预防中心（Centers for Disease Control and Prevention）和免疫实践咨询委员会（Advisory Committee on Immunization Practices）的指南推荐免疫接种；推荐接种流感疫苗、破伤风疫苗、麻疹、腮腺炎和风疹疫苗、水痘疫苗、脑膜炎球菌疫苗和人乳头瘤病毒疫苗，这些疫苗对育龄期女性尤为重要。为了对健康产生最大影响，医生应关注 USPSTF 分级 A 和 B 的建议并与患者进行讨论。
