Pap Smears Matter: A Science-Backed Women’s Health Guide

Disclaimer: This article is intended for informational purposes only and does not constitute medical advice. Please consult with a licensed healthcare provider for personalized recommendations regarding Pap smear screening and other aspects of your reproductive health.

Understanding the Pap Smear

The Papanicolaou test, commonly known as the Pap smear, is a medical screening tool designed to detect abnormal cells in the cervix, which can be precursors to cervical cancer. This simple, outpatient procedure involves collecting cells from the cervix using a small brush or spatula. It takes just a few minutes and is often done during a routine pelvic exam. The goal is early detection. Identifying abnormal cells before they turn cancerous can significantly increase the chances of successful treatment and even prevention.

Pap smears are recommended primarily for individuals with a cervix, regardless of sexual orientation or gender identity. According to the American College of Obstetricians and Gynecologists (ACOG), routine screening should begin at age 21 and continue every three years for those with normal results, transitioning to every five years with HPV co-testing from age 30 to 65 (ACOG, 2021). Beyond 65, screening may cease if there is a history of consistently normal results.

 The Pros of Pap Smear Testing

1.     Early Detection Saves Lives: Cervical cancer often develops slowly and may be asymptomatic until advanced stages. The Pap smear can detect precancerous changes, allowing for intervention before cancer develops.

2.     Improved Treatment Outcomes: When caught early, cervical changes are easier and less invasive to treat. Treatments are more effective, and recovery is typically faster.

3.     Reduced Cervical Cancer Rates: According to the World Health Organization (WHO), widespread use of Pap smear testing has led to a significant decline in cervical cancer incidence and mortality in countries with established screening programs (WHO, 2020).

4.     HPV Co-testing: The Pap test can be paired with HPV testing to offer a more comprehensive screening method. Since HPV is the leading cause of cervical cancer, this dual approach increases diagnostic accuracy.

 Considering the Limitations

1.     False Positives/Negatives: Like any medical test, Pap smears are not flawless. False positives may cause unnecessary anxiety and follow-up procedures, while false negatives may delay essential care (NCI, 2022).

2.     Discomfort or Anxiety: The test can be physically and emotionally uncomfortable for some. Trauma-informed and inclusive care is crucial to ensure respectful and sensitive experiences, especially for survivors of abuse or individuals in the LGBTQ+ community.

3.     Over-Screening Risks: Too frequent testing can lead to overtreatment, which may include unnecessary procedures like colposcopies or biopsies, each carrying its own risks.

4.     Access and Equity: Not everyone has equal access to reproductive health services, including Pap smears. Disparities in healthcare access due to race, income, or geography may affect who benefits from these screenings.

 Do You Really Need a Pap Smear?

Yes - if you have a cervix and fall within the age guidelines or have specific risk factors (such as a history of HPV, smoking, or a weakened immune system), the Pap smear remains an essential preventive tool. The benefits of detecting cellular changes before they become cancerous far outweigh the drawbacks for the vast majority of individuals. However, like all healthcare decisions, this should be a personal choice made in consultation with a trusted provider, ideally one who understands your medical history, cultural context, and personal preferences.

Skipping Pap smears can result in missed opportunities for early intervention. However, over-screening can also lead to unnecessary procedures. The key lies in following established guidelines tailored to your age, risk profile, and history. Most importantly, healthcare professionals emphasize informed choice. Education, not fear, should drive your decisions.

An Empowered, Evidence-Based Approach

The Pap smear is more than a medical routine. It is a life-saving screening test that has transformed women’s health globally. While not perfect, its value lies in its proven ability to prevent cervical cancer through early detection. With clear guidelines, minimal invasiveness, and high impact, Pap smears remain a cornerstone of preventive care.

Empowering yourself with knowledge, free of shame, judgment, or misinformation, is the first step to making the best choices for your body. Whether you're due for your first test or reconsidering your schedule, the facts speak clearly: when done appropriately, Pap smears save lives.

References

·       American College of Obstetricians and Gynecologists (ACOG). (2021). Cervical Cancer Screening. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2021/04/cervical-cancer-screening

·       World Health Organization (WHO). (2020). Cervical cancer. https://www.who.int/health-topics/cervical-cancer

·       National Cancer Institute (NCI). (2022). Pap and HPV Testing. https://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet

 

50 Most Important Questions Women Should Ask Their General Practitioner (GP)

 

Women’s health is multifaceted, encompassing physical, reproductive, emotional, and mental well-being. Regular visits to a general practitioner (GP) provide an opportunity to raise concerns, undergo preventive screenings, and receive personalized guidance. However, many women may leave appointments with unanswered questions simply because they are unsure of what to ask. This comprehensive list aims to bridge that gap, helping women advocate for their own health through thoughtful, informed discussions with their healthcare providers.

I. General Health & Preventive Care

1. What screenings or blood tests should I have at my age and risk level?
   Screening protocols vary with age, family history, and lifestyle. Ask which tests are appropriate for your profile.
2. How often should I get a physical exam?
   Annual checkups are common, but frequency may differ based on personal health history.
3. What is my Body Mass Index (BMI), and what does it indicate about my health?
   Understanding BMI, while imperfect, can offer insights into weight-related risks.
4. What vaccines do I need or need to update?
   Immunizations like Tdap, flu, HPV, shingles, and COVID-19 may require review.
5. Can you explain the results of my last blood work in detail?
   Don't settle for "everything looks fine"—ask for a breakdown of each marker.
6. How can I lower my risk for chronic conditions like heart disease or diabetes?
   Lifestyle interventions are often more effective when tailored by a physician.
7. Do I need genetic testing based on my family history?
   A detailed review of familial illnesses can help assess your need for early genetic counseling.
8. What is my blood pressure trend over time?
   Patterns in blood pressure may reveal early signs of hypertension or cardiovascular issues.
9. How can I improve my immune function naturally and medically?
   Clarify misconceptions about immunity and get evidence-based suggestions.
10. Are there any signs of inflammation or nutritional deficiencies in my results?
    Chronic inflammation and vitamin imbalances often go unnoticed without thorough analysis.

II. Reproductive & Sexual Health

11. When should I start or stop getting Pap smears and HPV testing?
    Guidelines have shifted in recent years—ensure your screening is current.
12. What contraceptive options are best for my age, health, and lifestyle?
    This includes hormonal, non-hormonal, permanent, and temporary methods.
13. Can you screen for STIs even if I have no symptoms?
    Asymptomatic infections are common and easily overlooked.
14. What should I know about fertility preservation or planning for pregnancy later in life?
    Get proactive guidance if you're not ready for children yet.
15. What are the early signs of perimenopause and menopause?
    Understanding hormonal changes can prepare you for physical and emotional shifts.
16. Is my menstrual cycle normal in terms of flow, length, or symptoms?
    Irregular cycles may signal underlying issues such as PCOS or thyroid dysfunction.
17. Do I need a pelvic exam or transvaginal ultrasound for my symptoms?
    Pain, bloating, or irregular bleeding can be grounds for further evaluation.
18. Can I get an updated breast exam and guidance on self-examinations?
    While mammograms are routine, clinical and self-checks remain crucial.
19. How do I manage painful periods or heavy bleeding safely?
    Painful menstruation isn’t always "normal" and may warrant medical attention.
20. What is my risk for reproductive cancers (ovarian, uterine, cervical, breast)?
    Review personal and familial history to assess your risk profile.

III. Mental Health & Emotional Well-being

21. Can we screen for anxiety or depression even if I’m “functioning”?
    High-functioning depression and anxiety are increasingly recognized.
22. What are safe and effective options for managing mood swings or PMS?
    Treatments range from lifestyle adjustments to medication or therapy referrals.
23. How can I talk to you about trauma, abuse, or past mental health struggles?
    Trust and open communication are the foundation of comprehensive care.
24. Can I get a referral for a therapist, psychiatrist, or mental health coach?
    GPs can serve as a starting point for broader mental health care.
25. Are my sleep habits affecting my mental or physical health?
    Sleep quality is directly linked to emotional stability and immune function.
26. What is the difference between burnout and depression?
    Distinguishing between the two can lead to proper treatment.
27. Is it normal to feel this way after childbirth or miscarriage?
    Postpartum depression and grief require compassionate, timely intervention.
28. How does my hormonal health affect my mood and cognition?
    Fluctuations in estrogen and progesterone play a significant neurological role.
29. Are there lifestyle changes that can support my mental resilience?
    Nutrition, movement, and mindfulness all impact psychological health.
30. Can I safely use supplements or herbal products to support mental clarity or stress relief?
    Some supplements interact with medications—always check with a medical professional.

IV. Hormonal, Endocrine, and Metabolic Health

31. Should I be screened for thyroid dysfunction?
    Symptoms like fatigue, weight changes, and hair thinning may point to thyroid imbalances.
32. What are signs of insulin resistance or metabolic syndrome?
    Understanding these markers early can prevent Type 2 diabetes.
33. How do hormones affect my weight and metabolism?
    Weight gain may not always be related to diet or activity.
34. Can you evaluate me for polycystic ovary syndrome (PCOS)?
    PCOS is underdiagnosed and presents with a variety of subtle symptoms.
35. What are the early symptoms of osteoporosis, and when should I be screened?
    Bone density checks are crucial post-menopause or after long-term steroid use.
36. Is my cholesterol and lipid profile in a healthy range for my age?
    Cardiovascular risk factors should be tracked regularly.
37. Do I have hormonal imbalances that explain my fatigue or irritability?
    Hormones like cortisol, estrogen, and progesterone should be reviewed systematically.
38. Should I monitor blood sugar or hemoglobin A1c levels?
    Even without diabetes, tracking glycemic control offers important insight.
39. Are my hair loss or skin changes hormone-related?
    Hair thinning or acne can stem from endocrine disorders.
40. How does menopause affect my risk for other illnesses?
    Bone loss, heart disease, and cognitive changes are often tied to menopause.

V. Lifestyle, Aging, and Whole-Body Health

41. What dietary practices would support my specific health goals?
    Move beyond generic advice to craft an individualized nutrition plan.
42. Am I getting enough physical activity for disease prevention?
    Quality and frequency matter more than intensity alone.
43. What are realistic strategies for managing stress daily?
    Work-life balance, boundaries, and coping strategies should be medically informed.
44. How can I maintain cognitive health as I age?
    Learn about modifiable risks for dementia and brain fog.
45. What are my skin’s health risks—should I see a dermatologist?
    GPs can screen for moles, rashes, and skin changes before referral.
46. Is my sexual function healthy, and what can I do if it's not?
    Desire, lubrication, and pain should all be discussed without stigma.
47. What are signs of urinary incontinence or pelvic floor dysfunction?
    Early intervention can prevent progression or need for surgery.
48. Should I be concerned about my alcohol, caffeine, or substance use?
    Honest disclosure leads to proactive, nonjudgmental support.
49. What should I know about aging well—physically, mentally, and emotionally?
    Talk about longevity, independence, and aging with quality of life.
50. How can I prepare for each health milestone—such as menopause, retirement, or caregiving roles?
    Proactive planning supports smoother transitions through life stages.

 

Women benefit most from medical care that is collaborative, tailored, and proactive. While not every question may apply to every woman, this list encourages a mindset of self-advocacy and thorough inquiry. Building an open and trusted relationship with your GP is key to early detection, prevention, and peace of mind. Take this list to your next appointment, and don’t hesitate to ask the questions that matter most to your health and well-being.

The Argument Against Mammography

Mammography has long been considered the gold standard for breast cancer screening. Yet, over the past two decades, a growing body of scientific literature has questioned its efficacy, safety, and overall impact on women's health. This article presents a balanced, evidence-based exploration of the arguments against routine mammography, especially for asymptomatic women at average risk. It does not offer medical advice but aims to clarify the scientific, ethical, and public health considerations surrounding this widely used screening tool.

The Promise of Mammography: What It Was Designed to Do

Mammography uses low-dose X-rays to detect abnormalities in breast tissue, ideally before symptoms appear. The rationale is simple: early detection saves lives. However, the reality is more complex.

Claimed Benefits

• Reduction in breast cancer mortality: Estimated at 15–32% depending on age group and study design (Pace & Keating, 2014).
• Early-stage detection: Allows for less aggressive treatment in some cases (Liu et al., 2023).
• Peace of mind: For women who receive negative results (Yu et al., 2017).

The Scientific Case Against Routine Mammography

1. Overdiagnosis and Overtreatment

• Definition: Detection of cancers that would not have caused symptoms or death during a woman’s lifetime.
• Impact: Leads to unnecessary surgery, radiation, and chemotherapy.
• Estimates: Overdiagnosis rates range from 11% to 55% depending on methodology and population (Gøtzsche & Jørgensen, 2013; Richman et al., 2023).

“Overdiagnosis can result in intensive treatments, without improving length or quality of life.” — Yale School of Medicine, 2023

2. False Positives and Psychological Harm

• Prevalence: Up to 61% of women screened annually for 10 years will experience at least one false-positive result (Pace & Keating, 2014).
• Consequences: Anxiety, unnecessary biopsies, and reduced trust in medical systems (Yu et al., 2017).

3. Radiation Exposure

• Risk: Although low, cumulative exposure from repeated screenings may increase cancer risk.
• CDC Position: Mammograms expose women to ionizing radiation, which “could increase risk for cancer” (CDC, 2024).

4. Limited Mortality Benefit

• Findings: Some randomized trials show no significant reduction in overall mortality, especially in women under 50 (JAMA, 2014; The Conversation, 2017).
• Aggressive cancers: May not be caught early enough to alter outcomes.

5. Inequities and Access Issues

• Disparities: Screening rates vary by race, income, and geography (Susan G. Komen, 2023).
• Social determinants: Isolation, cost, and lack of transportation reduce access and increase harm (CDC, 2024).

 

International Consensus and Divergence

WHO Position (2014)

• Recommends organized screening for women aged 50–69 in high-resource settings.
• Emphasizes informed decision-making and cautions against blanket screening in low-resource areas.

European Commission (ECIBC, 2023)

• Supports organized mammography programs but highlights the need for risk stratification and supplemental imaging for dense breasts.

U.S. Preventive Services Task Force (USPSTF, 2024 Draft)

• Recommends biennial screening starting at age 40, but acknowledges harms such as overdiagnosis and false positives.

National Breast Cancer Coalition (NBCC, 2021)

• Argues that universal screening offers modest benefit and that harms outweigh benefits for many women.

 

Women's Health Correlation: Beyond Cancer Detection

Mammography is not just a diagnostic tool - it’s a cultural symbol of proactive health. But its widespread use may divert attention and resources from:

• Risk-based screening: Genetic testing, breast density evaluation, and lifestyle factors.
• Holistic care: Mental health, reproductive health, and chronic disease prevention.
• Informed consent: Many women are unaware of the risks and limitations of mammography (Yu et al., 2017).

 

Industry Commentary

While some radiology groups and manufacturers advocate for annual screening, others are calling for reform:

“We must not intervene in a healthy population if the benefits do not significantly outweigh the harms.”  - National Breast Cancer Coalition, 2021

“The message has shifted from ‘mammograms might help’ to ‘mammograms prevent cancer,’ which is misleading.” - MedShadow Foundation, 2024

 

Final Thoughts

Mammography is not inherently harmful but its routine, one-size-fits-all application may be. The argument against mammography is not a call to abandon screening, but to rethink its role in modern medicine. Women deserve transparent information, personalized care, and screening strategies that prioritize health over habit.

 

References

• CDC. (2024). Facts About Mammograms. https://www.cdc.gov/radiation-health/data-research/facts-stats/mammograms.html
• Gøtzsche, P. C., & Jørgensen, K. J. (2013). Screening for breast cancer with mammography. Cochrane Library.
• Liu, Y., Gordon, A. S., Eleff, M., Barron, J. J., & Chi, W. C. (2023). Association Between Mammography Screening Frequency and Breast Cancer Treatment and Outcomes. Journal of Breast Imaging, 5(1), 21–29. https://doi.org/10.1093/jbi/wbac071
• Pace, L. E., & Keating, N. L. (2014). A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions. JAMA, 311(13), 1327–1335. https://doi.org/10.1001/jama.2014.1398
• Richman, I., et al. (2023). Screening Mammograms Carry Risks for Older Women. Annals of Internal Medicine.
• Susan G. Komen. (2023). Comparing Breast Cancer Screening Rates Among Different Groups. https://www.komen.org/breast-cancer/screening/screening-disparities/
• WHO. (2014). WHO Position Paper on Mammography Screening. https://www.who.int/publications/i/item/9789241507936
• Yu, J., Nagler, R. H., Fowler, E. F., Kerlikowske, K., & Gollust, S. E. (2017). Women’s Awareness and Perceived Importance of the Harms and Benefits of Mammography Screening. JAMA Internal Medicine, 177(9), 1381–1382. https://doi.org/10.1001/jamainternmed.2017.2247

 

Understanding Contraceptive Pills: A Comprehensive Guide for Women

 

Contraceptive pills, commonly referred to as birth control pills, are among the most widely used methods of preventing pregnancy. They offer women a convenient and effective way to control their reproductive health. However, with the vast amount of information available, it can be challenging to distinguish fact from myth. This article provides an evidence-based overview of contraceptive pills, their benefits, risks, and considerations for use.

How Contraceptive Pills Work

Contraceptive pills primarily work by regulating hormones to prevent ovulation—the release of an egg from the ovaries. They also thicken cervical mucus, making it more difficult for sperm to reach the egg, and alter the uterine lining, reducing the likelihood of implantation if fertilization occurs.

There are two main types of contraceptive pills:

1. Combined Oral Contraceptives (COCs) – These contain both estrogen and progestin. They prevent ovulation and are typically taken for 21 days, followed by a 7-day break or placebo period.

2. Progestin-Only Pills (POPs) – Also known as the mini-pill, these contain only progestin and primarily work by thickening cervical mucus. Unlike COCs, they must be taken at the same time every day for maximum effectiveness.

Effectiveness and Proper Use

When used correctly, birth control pills are over 99% effective at preventing pregnancy. However, real-world use reduces this effectiveness to around 91%, often due to missed doses, inconsistent use, or interactions with other medications. To ensure optimal effectiveness:

- Take the pill at the same time daily.

- Follow the prescribed schedule strictly.

- Use backup contraception (such as condoms) if pills are missed.

Health Benefits Beyond Pregnancy Prevention

Apart from preventing pregnancy, contraceptive pills offer several non-contraceptive benefits, including:

• Regulating Menstrual Cycles – Helps reduce irregular periods and heavy menstrual bleeding.
• Reducing Menstrual Pain – Can alleviate symptoms of dysmenorrhea (painful periods).
• Acne Management – Some COCs help reduce acne by decreasing androgen levels.
• Lowering Risk of Certain Cancers – Long-term use has been associated with a reduced risk of ovarian and endometrial cancer.
• Managing Polycystic Ovary Syndrome (PCOS) – Helps balance hormone levels and manage symptoms such as excessive hair growth and irregular periods.

 

Potential Risks and Side Effects

While generally safe for most women, contraceptive pills can have side effects. Common side effects include:

- Nausea

- Headaches

- Breast tenderness

- Mood changes

- Breakthrough bleeding (spotting between periods)

 

Serious risks, though rare, include an increased risk of blood clots, stroke, and hypertension, especially in women who smoke or have pre-existing cardiovascular conditions. Women with a history of blood clots, uncontrolled hypertension, or certain types of migraines may need alternative contraceptive methods.

 

Considerations Before Starting Birth Control Pills

Before starting contraceptive pills, it is essential to consider personal health history, lifestyle, and reproductive goals. Consulting a healthcare provider ensures that the chosen method aligns with individual health needs. Factors to discuss include:

1. Medical history and risk factors.
2. Current medications that may interact with birth control pills.
3. Preference for a daily regimen versus long-acting alternatives.
4. Plans for future pregnancy and the option of reversible contraception.

 

Alternative Contraceptive Methods

While birth control pills are effective and widely used, they are not the only option available. Other methods include:

1. Intrauterine Devices (IUDs) – Long-acting reversible contraceptives with high efficacy.
2. Implants – A small device placed under the skin that releases hormones for years.
3. Patches and Vaginal Rings – Hormonal options that do not require daily intake.
4. Barrier Methods (Condoms, Diaphragms) – Provide protection against pregnancy and sexually transmitted infections (STIs).

 

Final Thoughts

Contraceptive pills provide a reliable and convenient option for pregnancy prevention while offering additional health benefits. However, they are not a one-size-fits-all solution. Women should make informed decisions based on their individual health, lifestyle, and personal preferences. Consulting a healthcare provider can help determine the best contraceptive choice for each person’s unique needs. With the right approach, contraceptive pills can be a safe and effective tool for reproductive health management.

 

Preventive Care for Women 30 and Older: A Smart Approach to Lifelong Health

 As women enter their 30s, health priorities shift, making preventive care essential for long-term wellness. This decade is a critical time to establish proactive habits that can reduce the risk of chronic diseases, enhance overall well-being, and improve quality of life. Preventive healthcare isn't just about detecting illnesses early; it's about optimizing health and preventing conditions before they start. Here’s what every woman in her 30s and beyond should focus on to stay strong, resilient, and in control of her health.

 1. Annual Health Screenings: Know Your Numbers

Routine screenings are the foundation of preventive care. They help detect conditions before they become serious and allow for early intervention.

- Blood Pressure Check: High blood pressure increases the risk of heart disease and stroke. Get it checked annually, or more frequently if you have risk factors.

- Cholesterol Levels: Heart disease is the leading cause of death for women. A lipid panel test should be done at least every five years or more often if there’s a family history.

- Blood Sugar Test: Type 2 diabetes is on the rise, especially in women with a sedentary lifestyle or a family history. A fasting glucose test can help detect early signs.

- Pap Smear and HPV Test: Cervical cancer is preventable with regular screenings. Women should get a Pap smear every three years or an HPV test every five years, depending on their doctor’s recommendation.

- Breast Exams and Mammograms: While mammograms generally start at 40, women with a family history of breast cancer should discuss earlier screening options.

- Skin Cancer Screening: Regular skin checks, both self-exams and dermatology visits, are key for catching melanoma and other skin cancers early.

 2. Prioritizing Hormonal and Reproductive Health

Reproductive health isn’t just about pregnancy—it affects metabolism, mood, and long-term health outcomes.

- Hormonal Balance: Symptoms like irregular periods, mood swings, and fatigue may indicate hormonal imbalances. Discuss any concerns with a healthcare provider.

- Fertility Awareness: Even if children aren’t in your immediate plans, understanding fertility in your 30s is essential. Consider ovarian reserve testing if you plan to conceive later.

- Bone Health: Estrogen plays a role in bone density. Women should start monitoring calcium and vitamin D intake to prevent osteoporosis later in life.

 

 3. Preventative Lifestyle Changes That Make a Difference

Your 30s are a prime time to solidify habits that support lifelong health.

- Nutrition Optimization: A diet rich in lean proteins, healthy fats, fiber, and antioxidants supports heart health, hormone balance, and cognitive function.

- Regular Exercise: Strength training, cardio, and flexibility workouts help maintain muscle mass, boost metabolism, and prevent chronic conditions.

- Stress Management: Chronic stress increases cortisol levels, leading to inflammation and disease. Practices like mindfulness, therapy, and self-care routines help regulate stress.

- Sleep Hygiene: Poor sleep contributes to weight gain, hormonal disruptions, and increased risk of chronic illness. Prioritize 7-9 hours of quality sleep per night.

 

 4. Mental and Emotional Well-Being: More Than Just Physical Health

Mental health is just as important as physical health in preventive care.

- Depression and Anxiety Screenings: Women in their 30s often juggle careers, families, and personal growth, leading to mental health challenges. Seeking professional support when needed is vital.

- Cognitive Health: Learning new skills, engaging in social activities, and managing stress can help keep your brain sharp and reduce the risk of cognitive decline.

- Social Support: A strong social network contributes to emotional resilience and overall well-being. Prioritize meaningful relationships and seek support when needed.

 

 5. The Role of Preventive Vaccinations

Vaccinations play a crucial role in preventing serious illnesses that can impact long-term health.

- Flu Shot: Reduces the risk of complications from influenza.

- HPV Vaccine: Protects against cervical and other HPV-related cancers.

- Tdap Booster: Prevents tetanus, diphtheria, and pertussis (whooping cough).

- COVID-19 and Pneumonia Vaccines: Depending on individual risk factors, these vaccines may be recommended.

Take Charge of Your Health Today

Preventive care is an investment in your future. By scheduling regular check-ups, staying informed, and making health-conscious lifestyle choices, women in their 30s can set the stage for decades of vitality. Small, proactive steps taken today can lead to a healthier, stronger, and more empowered tomorrow. Your health isn’t just about adding years to your life—it’s about adding life to your years.