A Health Checklist for Women Over 40

Turning 40 is a milestone.  With the average life expectancy in the U.S. at about 81 years for women, the 40-year mark is just shy of the halfway point, and an ideal time to approach your future health and wellness, proactively. Just like the 10,000 mile checklist to ensure your car runs smoothly, your 40+ year body comes with a checklist of preventive suggestions to ensure smoother sailing for the next 40 years and beyond.

At this age, it becomes particularly important to shift how we think about our overall health as we enter and transition through perimenopause and menopause. While this phase of life typically comes with some health concerns more generally tied to aging, some of these health shifts are likely going to be tied to the hormonal changes you’re experiencing as you approach or continue your transition through menopause.  

This checklist includes evidence-based, medical recommendations that are both backed by science and abide by best practices that are designed to help women stay healthy after 40, from general health to hormonal health, and more.

Gynecological Heath Care for the 40+ Woman

For starters, a yearly gynecologic wellness exam is suggested.  Depending on where you live, this might be a yearly visit to an OBGYN, an internist or a family medicine provider.  Women’s wellness exams can become even more important as we age, since these appointments often evolve into discussions about the hormonal shifts that can accompany the menopausal transition. These hormonal shifts can contribute to the onset of new symptoms (such as hot flashes and increased moodiness) that absolutely should be discussed with your healthcare provider to determine what treatment options are available to help.

Hormonal Health

Many 40+ women will start to experience symptoms of hormonal changes.  The average age of menopause is 51 and menopause is defined as 12 consecutive months without a menstrual period.  Perimenopause, or the years leading up to menopause, is a common time for women to experience bothersome symptoms such as irregular bleeding, hot flashes, night sweats and vaginal changes. In many instances, treatment is indicated for these disruptive symptoms. Additionally, contraception and fertility awareness warrant discussion until menopause is established. 

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Vaginal and Cervical Health

Cervical cancer screening recommendations have changed over the last few years.  For women 40-65, screening can consist of a Pap smear every three years or a Pap smear and HPV test (co-testing) every five years.  To be clear, a yearly gynecological exam and Pap smear are not the same thing; this is a source of confusion for many.

Breast Health

Breast health is top of mind, especially since breast cancer risk increases with age.  Conducting a strict and regimented breast self-exam has been deemed “out” by ACOG (American College of Obstetricians and Gynecologists) and NAMS (North American Menopause Society), as it has been associated with increased patient anxiety and does not necessarily directly correlate with mortality or morbidity rates. Breast self-awareness, however, is “in”.  Breast self-awareness simply implies that women should check their breasts from time to time to establish a baseline familiarity.  A more formal, meticulous clinical breast exam done by a health care provider is recommended every year. For the general population who are at average risk for breast cancer, a screening mammogram is recommended.  Women ages 40 to 49 may have a mammogram every 1 to 2 years. However, not all experts agree about the benefits of having a mammogram when women are in their 40s. Mammography may be annual or every two years thereafter; be sure to talk to your healthcare provider about what they feel is best for you.

Additionally, hormonal changes that come with the transition through menopause can impact certain symptoms, like cyclical breast pain.¹ Any concerning lumps, bumps, increased or new pains, or noticeable changes should be brought to your provider’s attention, as a precaution.

Sexual Health

Sexually Transmitted Infections (STIs) are not just for teens. The risk of an STI including chlamydia, gonorrhea, genital herpes, human papillomavirus (HPV), hepatitis B and C, HIV, syphilis, and trichomonas are possible even during menopause. In general, testing may be offered in those with more than 1 partner in the last 12 months, those with a new partner within 90 days, or for those whose partners have multiple partners. Condoms are of course recommended when appropriate.

Changes in the actual sexual experience are very common during the perimenopause and menopausal transition. Due to declining levels of estrogen in the body, vaginal lubrication may be negatively impacted, causing pain during intercourse. Women may also experience vaginal irritation, burning or dryness, as the vaginal tissues become thinner and more fragile due to shifting hormones. It’s also not uncommon to experience either a significant decline in your sex drive, or an upsurgence as your testosterone levels are also volatile at this time.  It’s important to discuss any changes that are negatively impacting your sex life with your healthcare provider. Don’t be shy, we very-well may be able to help!

Schedule a General Physical

Again, this may be accomplished by either a general medical internist or an OBGYN, depending on your location and preference.  After age 40, it’s important to pay attention to specific health habits, as well as certain physical and emotional health indicators. The hormonal changes you are experiencing throughout perimenopause and beyond can impact everything from your weight to your bone density.

Establish a Baseline for Your Health

Your height, weight, and body mass index (BMI) should be checked at each exam. Obesity is an epidemic in the U.S. and increases the risk for many chronic medical diseases. While age can certainly be a driver behind weight gain, the hormonal changes that accompany menopause may play a role, too.² Good diet and exercise habits can help you stick to or even improve upon your health baseline as you age.

Vaccines

Vaccines remain an important part of our health beyond our childhood and adolescent years. A flu shot is recommended yearly. In addition to taking routine precautions to protect yourself from influenza, there are several other vaccines that should be prioritized. A booster to the Tdap vaccine is recommended every 10 years and a shingles vaccine is recommended after turning 50. Although most women in their 40s may have already been exposed to HPV, the HPV vaccine is now approved until age 45, so if recommended by your physician, this would be an additional important vaccine to check off your list.

Eyes, Ears, Teeth…

Seeing, hearing and chewing are luxuries you wouldn’t want to live without. To help maintain your eyesight, hearing and dental health, women should receive a baseline eye exam at age 40, followed by one every 2-4 years during the age range of 40-54, and one every 1-3 years during the age range of 55-64. A hearing test is recommended every 10 years. You should also plan to continue routine dental visits every 6-12 months for an oral exam and cleaning.

Prioritize Your Heart Health

Surprisingly, the leading cause of death for both men and women in the U.S. is cardiovascular disease (CVD).  Blood pressure (BP) should be checked every 1-2 years to screen for hypertension.  In fact, the steady increase in BP that happens over time is pronounced around the time of menopause, making it even more important to monitor.

Cholesterol screening is usually recommended by age 45 for women with no known risk factors for coronary heart disease.  Once initiated, screening should be completed every 5 years. Diet, exercise and other lifestyle habits can be modified and optimized at any time to minimize risk of CVD. Of significant mention is tobacco use; likely the single important preventable risk factor for cardiovascular disease in women. If you smoke, it’s important to discuss methods for quitting with your healthcare provider as soon as possible.

Consider Additional Health Screenings and Consulting with Specialists

While routine general health visits and screenings are important to carry on throughout our lives, there are several other areas that we should focus on after age 40, mainly due to the changes that are going on in our bodies. Specific areas of our health may be impacted by the hormonal fluctuations commonly experienced during menopause, including thyroid health, gastrointestinal health and bone health.

The Thyroid Gland

Screening recommendations for thyroid disease vary.  Screening might include initiation anytime from age 35 to 50, to not at all in asymptomatic adults.   Anecdotally, many women request thyroid studies in their forties due to perimenopausal weight gain.

Diabetes Screening

As a general rule, women older than 44 years should be screened for diabetes every three years.  Those who are at higher risk due to obesity, history of diabetes during pregnancy or family history of diabetes may be screened earlier or more often. Testing might include a fasting glucose level and/or hemoglobin A1c.

Mental Health

Depression screening is now recommended for all adults by the United States Preventive Services Task Force (USPSTF). A simple questionnaire is most commonly used for these types of screenings.

During perimenopause and menopause mood swings and irritability can also intensify, leaving women feeling unnerved that they just “don’t feel like themselves.” Rest assured, it’s not uncommon for mood swings to feel a bit more intense during this transition; your moods and disposition are highly influenced by your hormones. If you feel your emotions are negatively interfering with your life and relationships, consider reaching out to your health care provider or therapist for assistance.

Total Body Skin Check

Women aged 40+ who also have fair skin, previous sun overexposure, or a strong family history of skin cancer, are urged to visit a dermatologist annually for a total body skin check. This is to look for any suspicious moles or other growths that could become a cause for concern.

Colon Cancer

Newer recommendations suggest a baseline colonoscopy at age 45, but this has not been widely adopted just yet. If you are between the ages of 50 to 75, you should discuss a screening for colorectal cancer, which could include a stool DNA test every (3) years, a colonoscopy every 10 years or one of a variety of other testing options. It’s best to speak with your doctor to determine what, if any, testing method is right for you and when.        

Bone Health

Peak bone mass occurs approximately at age 30. In addition, the risk of osteoporosis increases as women transition through menopause, since the drops in estrogen can negatively affect bone density.³ All of this means it’s important to have a yearly exam be done in order to ensure adequate calcium and vitamin D intake and exercise frequency.   A bone density test (DEXA) is suggested by age 65 or earlier if significant risk factors exist.   And all women over age 50 with fractures should have a bone density screening.

Be mindful of this health check list at age 40 and beyond.  You know what they say in the women’s health world these days; forty is the new 30! 

Resources

1. https://www.health.harvard.edu/pain/breast-pain-not-just-a-premenopausal-complaint

2. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menopause-weight-gain/art-20046058

3. https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/