Cervical and breast screening

Cervical cancer screening typically begins at age 21. Intervals depend on the test: cytology alone every three years, or HPV testing alone or with cytology at longer intervals in the appropriate age range. Screening usually continues to around 65 for women with adequate prior negative results. HPV vaccination reduces risk substantially but does not replace screening.

Breast cancer screening with mammography begins in the forties under current USPSTF guidance, with recommendations on interval and stopping age that continue to be discussed among expert bodies. Women with a strong family history, known genetic variants, or prior chest radiation may need earlier or additional imaging such as MRI.

  • Ask about breast density; dense tissue reduces mammogram sensitivity and may prompt discussion of supplemental imaging.
  • Know what is normal for your breasts and report new lumps, skin or nipple changes, or discharge promptly.
  • Discuss genetic counselling if there is a strong family history of breast or ovarian cancer.

Cardiovascular and metabolic checks

Cardiovascular disease is the leading cause of death in women in most high-income countries, yet risk is frequently underestimated by both women and clinicians. The routine checks matter as much here as anywhere.

  • Blood pressure — at least every one to two years, more often if elevated.
  • Lipid panel — periodically from young adulthood, with intervals by risk.
  • Glucose or A1C — from around age 35 with overweight or obesity, earlier with other risk factors or a history of gestational diabetes.

Several female-specific factors raise later cardiovascular risk and are commonly omitted from history taking: pre-eclampsia or gestational hypertension, gestational diabetes, preterm delivery, polycystic ovary syndrome, and early menopause before 45. Mention them explicitly — they change risk assessment.

Colorectal, bone, and other screening

Colorectal cancer — screening from age 45 for average risk, by colonoscopy or stool-based testing at recommended intervals, earlier with family history or inflammatory bowel disease.

Bone density — DXA screening is recommended for women aged 65 and older, and for younger postmenopausal women at increased risk identified by a formal risk assessment tool.

  • Lung cancer — annual low-dose CT for those in the eligible age range with a significant smoking history.
  • Hepatitis C — one-time screening for adults, with repeat testing for ongoing risk.
  • HIV and other sexually transmitted infections — at least once for adults, with frequency by risk. Chlamydia and gonorrhoea screening is recommended for sexually active women under 25 and older women at increased risk.
  • Thyroid function — tested when symptoms or risk factors are present rather than routinely for everyone.
  • Depression and intimate partner violence — screening is recommended and often the only opportunity to raise these.

What changes around menopause

The transition to menopause, typically in the late forties to early fifties, changes several risk trajectories. Oestrogen decline accelerates bone loss, LDL cholesterol tends to rise, blood pressure often increases, and body fat redistributes toward the abdomen. Sleep disruption is common and interacts with everything else.

This makes the perimenopausal years a useful moment to reassess baseline numbers rather than assuming previous results still apply.

  • Recheck blood pressure, lipids, and glucose as this transition begins.
  • Discuss bone health, including calcium, vitamin D, and loading exercise.
  • Ask about menopausal hormone therapy if symptoms are troublesome — the evidence has been substantially reinterpreted since early reporting, and benefits and risks depend on age, time since menopause, and individual history. It is a decision for a prescriber.
  • Do not attribute every new symptom to menopause; chest symptoms and unusual fatigue still need assessment.

Keeping track across life stages

Women often interact with healthcare through pregnancy or gynaecological care, which can mean general preventive items drift. Keeping your own record closes the gap.

  • Record the date and result of each screening test, including tests done at other practices.
  • Record pregnancy history including any complications — it is cardiovascular history too.
  • Record menopause timing; before 45 is relevant to bone and heart risk.
  • Keep an up-to-date medication and supplement list.
  • Document family history of breast, ovarian, and colorectal cancer with ages at diagnosis.
  • Ask at each visit what is due now and what is due next year.