4 health decisions that really matter

You've probably already memorized the mantra for maintaining a fit and healthy body: Eat well-balanced meals and stick with a regular exercise regimen. But those aren't the only smart moves you can make to ensure a long, enjoyable life. To help guide you, we've focused on the four most important choices every woman needs to make wisely, plus four smaller decisions that also can have a big effect on your health.

1. Choosing a doctor

Listen to word of mouth. Doctors' reputations -- good or bad -- are usually dead-on, so if a friend or co-worker raves about her gynecologist, consider that a valuable recommendation, advises J. Edward Hill, M.D., a family physician in Tupelo, Miss., and president-elect of the American Medical Association. Once you've asked around for the name of a good doc, make sure he or she is part of your health-insurance plan. (Most plans make it easy to search by doctor's name on their Web sites, but always follow up with a phone call to the physician's office to be sure he or she is still a provider, since doctors leave and rejoin plans frequently.)

Be sure they're board-certified. Board certification ensures a doctor has completed training in a specialty area and has passed an examination testing his knowledge within his particular field. Also, board-certified physicians have to get recertified every six to 10 years, depending on their specialty, to make sure their knowledge stays up-to-date. To find out if your physician is board-certified, contact the American Board of Medical Specialties at (866) ASK-ABMS or do a search at abms.org.

Call the doctor's office. Pay attention to the way the office staff treats you; it can shed light on the overall practice style, says Donnica Moore, M.D., president of the Sapphire Women's Health Group, a multimedia women's health education and communications firm in Far Hills, N.J. If you are routinely put on hold for minutes at a time when you call, for example, you may have a tough time reaching the doctor when you have an emergency. When you do talk to the receptionist, ask if patients often wait; if so, inquire about the average waiting time. Before you leave for your appointment, call the doctor's office to make sure they're running on schedule.

Meet face-to-face. If possible, set up a free consultation with any new physician. "Most of the time, people can size each other up fairly well," Hill says. "The relationship between a patient and a physician is extremely personal, so this should be someone you feel you can talk to and trust." And have faith in your instincts -- if you don't get a good vibe from the physician, continue your search and find another.

Let the doctor know if she's the only one. Some women only see a gynecologist once or twice a year and not a primary-care physician. But if you don't clue in your gyno, you may not be getting the important screening tests -- such as a blood test for cholesterol and blood-pressure readings -- that you need.

2. Choosing contraception

Do your homework. "Most women spend more time planning a one-week vacation than choosing what contraception they're going to rely on," Moore says. "The good news is that there are more choices than ever, but women have a responsibility to educate themselves about their options." Investigate some of the new contraceptives on the market by starting at the Association of Reproductive Health Professionals' site at arhp.org, or visit Planned Parenthood's at plannedparenthood.org.

Assess your needs. To help narrow down the choices, Moore suggests asking yourself the following questions: Do you want a contraceptive that's reversible (e.g., a barrier method like the diaphragm, or a hormonal method, such as the pill or Depo-Provera) so you can have children in the future, or one that's permanent (such as Essure, in which a flexible, coiled-springlike device is inserted into each fallopian tube to prevent fertilization) if you're done having children or don't want any? Do you also need protection from sexually transmitted diseases? (The answer is yes if you're not in a mutually monogamous relationship.) If so, consider condoms. A diaphragm and condoms are good choices if you want methods that can be applied right before sex. (The pill is the most reliable form of contraception, but it must be in your bloodstream long before you have intercourse.) Are you prone to urinary tract infections (UTI)? If so, diaphragms, which can boost UTI risk, may not be best for you.

Use what you choose. "The biggest contraceptive failure is failure to use contraception," Moore quips. "No matter how good the method is, it doesn't work if it's in the drawer."

3. Choosing to make sleep a priority

Know the risks of sleepiness. "Some people view sleep as a waste of time, and that means it's expendable," notes Elizabeth Bouldin, M.D., medical director of the Ochsner Clinic Foundation Sleep Center in New Orleans. But skimping on sleep (most of us need between seven and nine hours a night) does a lot more damage than just making you cranky and foggy. A growing body of research shows a link between inadequate sleep and increased risk for a number of health conditions, such as type 2 diabetes, hypertension and obesity. According to the National Sleep Foundation, studies indicate a connection between lack of sleep and low levels of the hormone leptin, which regulates the metabolism of carbohydrates. When leptin is low, the body craves carbs, carbs and more carbs. "Some scientists suggest that one of the reasons we're getting fatter is that we're sleep-deprived," Bouldin says.

What's more, not getting enough z's may also weaken your immune system, putting you at greater risk for colds, flu and infection. And driving while sleep-deprived slows your reaction time and ups your risk of accidents.

Practice good sleep habits. To nab a better night's sleep: Cut back on caffeine within six hours before bed, and if you smoke, quit, since both caffeine and nicotine are stimulants that can impair your rest. Only get into bed to sleep -- not to balance your checkbook, watch television or eat. If you don't start to drift off within about 15 minutes, leave your bed and do something relaxing, such as reading or listening to music (as long as neither is stimulating). Turn all clocks -- especially glowing digital ones -- away from you; counting down the hours before you need to get up will just add to your anxiety. And if you're stressed about something or worried you'll forget an item on your to-do list, jot down your thoughts in a journal so you don't ruminate on them. 4. Choosing the right tests

Pap smears and HPV testing "The Pap test can detect cell changes in the cervix that may be precancerous, and if those cells are removed or destroyed, it will prevent their progression to cancer," explains Debbie Saslow, Ph.D., director of breast and gynecological cancers at the American Cancer Society. If your Pap results come back abnormal, you should get retested or take a DNA test that detects the presence of 13 strains of the sexually transmitted human papillomavirus (HPV). Keep in mind that even if you do have HPV, your chances of developing cervical cancer are less than 1 percent. In the majority of cases, HPV infections clear up on their own, especially in young women, Saslow says.

Also be aware of the new Pap smear guidelines: If you're 30 or older and have had three normal Pap smears for three years in a row, ask your doctor whether you can get tested every two or three years. This is safe because cervical cancer is so slow-growing, says Saslow. If you're under 30, however, get a Pap every year. Along with each Pap, you also have the option of getting an HPV DNA test.

It's still important for all women to see a gynecologist annually for preventive care, which may include breast and pelvic exams and tests.

Sexually transmitted disease testing All women under 25 should be tested annually for chlamydia -- one of the most common STDs -- which, in 75 percent of cases, has no symptoms, according to Mitchell Creinin, M.D., director of family planning at the University of Pittsburgh. If left untreated, chlamydia can lead to pelvic inflammatory disease, which may cause infertility. If you've had unprotected sex and/or don't know your partner's complete sexual history, talk to your gynecologist about also getting tested for gonorrhea, HIV, syphilis, and hepatitis B and C, which are not part of a routine screening.

Manual breast exams Schedule this crucial annual exam after you've had your period (breasts will be less tender and lumpy) and make sure your doctor covers the entire area, says Marisa Weiss, M.D., president and founder of breastcancer.org, a nonprofit organization in Narberth, Pa. Your physician should feel each breast for painful areas or a discernible lump. "Doctors should also feel the lymph node region below the collarbone and in both armpits," Weiss says. "Most cancers tend to occur in the upper outer quadrant of the breast that reaches into the armpit, most likely because of the gland tissue located in that region."

In addition, your doctor should check for visible orange-peel-like dimpling of the skin, a nipple that has recently retreated inward, bloody discharge and uneven breasts (if one has suddenly grown much larger, it could signal an infection or possible cancer). If your doctor misses an area, don't be shy about asking her to go over the spot.

Cholesterol check The buildup of plaque in the vessels carrying blood to the tissues begins in the late teens and early adulthood. In fact, getting your cholesterol level measured at age 22 predicts the risk of a heart attack for the next 30-40 years, according to the National Heart, Lung, and Blood Institute. And if your cholesterol is found to be borderline high (200-239 mg/deciliter) or high (240 mg/deciliter or above), you have time to make lifestyle changes, such as eating healthfully and exercising regularly, so you'll have a better chance of preventing heart disease later in life.

Diabetes check If you're under 45 years old and have at least one risk factor for diabetes, such as being overweight or obese or having a parent or sibling with the condition, ask your doctor for a blood-glucose test. If you're diagnosed with pre-diabetes (a new classification defined by blood-glucose levels above normal but not high enough to be diagnosed as diabetes) or type 2 diabetes, you can improve your health and control blood glucose with a healthy diet and regular exercise (both cardio and weight training), which improve your insulin sensitivity; in some cases, though, medication is required.

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