Important Screening Tests for Women Aged 40-70 | Stella
Long-term health
13 mins

Important screening tests for women aged 40-70

byDr. Nick Morse

Life is busy, we get it. However, it is always worth making time to prioritize your health. Just like eating a healthy diet and getting enough exercise, scheduling regular check-ups should be an important part of your self-care routine.

But what should you be checking regularly, and why?

What is screening?

Screening is when we check a particular group of people for a health condition before they start showing any symptoms. The idea is that early detection and treatment will reduce the chances of serious disability and death.  

These regular checks are a good way to receive an early warning about certain conditions. But they don’t pick up everything. If you’ve spotted new symptoms or something just doesn’t feel right, you should still see your healthcare provider, even if you recently received a normal screening test. 

Be conscious that more screening is not always better and a positive screening test is not a diagnosis. More investigation is almost always required.  

This article gives information about screening for women, but you still need to attend these checks if you do not identify as female but were assigned female at birth (AFAB). 

An overview of women’s health screening by age

This varies from country to country, but current US recommendations are:

  • Cervical screening from age 21 until age 65
  • Breast screening from age 40-45 until age 74 for most women
  • Bowel cancer screening from age 45-75 for most women
  • Osteoporosis or bone density screening from 65, plus 50-64 if you have certain risk factors

Cervical screening

Cervical screening detects early changes that could turn into cervical cancer if left untreated. Cervical cancer is most often diagnosed between the ages of 35 and 44, but the average age of diagnosis in the United States is 50. Over 20% of cervical cancers are diagnosed after age 65.

Cervical cancer develops slowly and pre-cancerous changes are reliably detected. When screening recommendations are followed, 99% of cervical cancer is detected while it is still highly treatable.  

Screening focuses on identifying human papillomavirus (HPV) infections. HPV is extremely common. In fact, the vast majority of people who have been sexually active will have encountered this virus, which can be passed on by oral, vaginal, or anal sex. While most people will clear the infection with no further consequences, it will cause changes to the cells of the cervix in a small proportion, and it is these changes that can lead to cervical cancer. Luckily, in most cases affected cells can be treated relatively easily and completely removed.

The US Preventive Services Task Force recommends screening for cervical cancer:

  • In women aged 21 to 29 years every three years with a Pap test
  • In women aged 30 to 65 years with a Pap test alone every three years, OR HPV testing, with or without Pap testing at the same time, every five years

You no longer need cervical cancer screening:

  • From age 65 if you have three normal screening tests in a row within the past 10 years 
  • If you have a hysterectomy that includes removal of the cervix.

Will I need cervical screening during or after menopause?

You still need to have cervical screening if you are going or have gone through menopause. This is because, despite everything going on with your hormones at this time, changes to your cervix can still happen. Likewise, you need to continue having screening even if you aren’t currently having sex.

There are two situations where screening can stop. If you have three normal screening tests in a row within the past 10 years, screening can stop at age 65. If you have a hysterectomy that includes removal of the cervix, you no longer need screening.

Are Pap smears more painful after menopause?

Menopausal changes to the vagina, also known as genitourinary syndrome of menopause (GSM), can make having a Pap test tricky. The tightness, pain, and fragile tissues that can be experienced as part of GSM can make speculum exams painful or even impossible. If this is the case for you, speak to your healthcare provider for advice. HPV testing is a proven alternative and can be easier to obtain.  

If you are affected by symptoms of GSM in your day-to-day life, you may benefit from trying vaginal estrogen, which is a low-risk and effective treatment available as creams, gels, pessaries, and rings. Vaginal estrogen should not be used the night before the test because it could affect the accuracy of testing. Your doctor will be able to advise on whether or not this is a suitable option for you.

When should you see your healthcare provider?

In addition to getting recommended cervical screening, you should see your healthcare provider if you have any new or unusual symptoms. This is because cervical screening doesn’t test for all diseases and you could need further medical tests to ensure that all is well.

In particular, seek an urgent appointment if you have any:

  • Vaginal bleeding between periods
  • Bleeding after sex
  • Vaginal bleeding if it has been over a year since your last period, also known as postmenopausal bleeding
  • New or worsening abdominal pain
  • New or worsening bloating
  • Persistent changes to your bowel habits, for example, constipation or going to the toilet more often than usual
  • Bleeding from your anus
  • Blood in your urine
  • Needing to pee more often or more urgently than usual
  • Any other symptoms that are new or troubling to you

Pap smears and HPV tests are not particularly useful if you have symptoms like abnormal bleeding or pain. If this is the case, your healthcare provider will likely refer you for other tests like colposcopy – magnified examination of the cervix – or an ultrasound, depending on your symptoms.

Breast screening

Breast screening involves a mammogram, which is a kind of X-ray that can sometimes pick up early signs of breast cancer, when the cancer is too small to feel or see. This is particularly important for breast cancer since earlier diagnosis can hugely improve your chances of successful treatment.

Epidemiologists, doctors, and medical professional organizations disagree on the exact recommendations for breast cancer screening. But most experts recommend that people at average risk – with no strong family history or strong personal risk factors – should:

  • Start mammograms between age 40 and age 45
  • Repeat mammograms every one to two years
  • Stop mammograms after age 74

Why are mammograms important after menopause?

Breast cancer becomes more common with age. This means that it is important to keep up with your mammograms as you get older. This is still true if you have breast tenderness or discomfort related to menopause. While the test may be uncomfortable, it is really worthwhile.

You should also be aware that some forms of hormone therapy (HT) may slightly increase your risk of breast cancer. 

Read more about HT, breast cancer, and your family history.

When should you see your healthcare provider?

Whether or not you’ve had a normal mammogram, you should still see your healthcare provider if you notice any changes to your breasts. To check your breasts:

  • Feel your chest, both breasts and armpits. You are looking for any changes. This includes lumps, thickenings, sore areas, or changes in texture
  • Look at your breasts in the mirror. Look out for any rashes, dimples, puckering, and changes to size or shape. 

Checking monthly is a good idea, but avoid checking them when you are on your period – if you still have periods. 

Read the Cleveland Clinic’s full guide to checking your breasts.

Bowel cancer screening

Bowel cancer becomes more common as we age, so it is important to complete your screening tests when recommended. Screening has been shown to reduce your risk of dying from bowel cancer.

The US Preventive Services Task Force recommends that people with average risk – with no strong family history or strong personal risk factors – should be screened between the ages of 45 and 75:

  • By coloscopy every ten years 
  • By other direct visualization tests, such as sigmoidoscopy or CT-colonoscopy, every five years
  • By stool-based testing, such as a FIT test, every year

Screening earlier or in a different way might be recommended for you if you are at higher risk of bowel cancer, for example, due to your family or personal medical history.

Bowel screening can usually be completed using a home test kit known as the fecal immunochemical test (FIT). You collect a small amount of feces and this is then sent off to the lab where it is checked for blood. Even tiny amounts can be detected. 

As bleeding can be a sign of cancer and precancerous growths called polyps, anyone with a positive test will be invited for further investigations. Bowel cancer can be treated more effectively if it is caught early, and polyps can often be removed as a same-day procedure.

When should you see your health provider?

You should see your health provider urgently if you notice:

  • A change in your bowel habits, for example, looser or more frequent feces
  • Bleeding from your anus
  • Persistent abdominal pain, swelling or bloating
  • Unexplained weight loss
  • Any other new or worrying symptoms

This is true even if you have had a recent negative screening test. While screening is helpful, it is not 100% accurate and there are many other possible causes for these symptoms that require different tests, sometimes urgently.

Osteoporosis screening

When estrogen levels decline during menopause, you are at greater risk of thinning bones or osteoporosis. 

It is recommended that all women over 65 have a bone density screening every two years. Testing is also recommended for people who are considered to be at high risk of osteoporosis, including:

  • People with a strong family history of osteoporosis
  • Those who have gone through early menopause
  • People who have a personal history of a fracture of the hip, spine, wrist, or arm from trauma that would not have predictably resulted in a fracture
  • People on long-term steroid use
  • Those with low weight/body mass index, and certain medical conditions

Healthcare providers use a screening tool called FRAXplus to calculate your personal risk. 

Bones are tested with a specific type of X-ray called a DEXA scan. This looks at the bones in your hips and your spine and calculates your bone mineral density. 

When should you see your healthcare provider

Most people with thinning of the bones aren’t aware of the problem until they have a fracture. Ask your healthcare provider if you should be screened before the age of 65 and they will advise if this is right for you.

Other tests

There are certain non-cancer screening tests that are recommended for everyone. These include:  

  • Blood lipids
  • Thyroid function

Depending on your medical history, your healthcare provider may advise other screening tests. Examples include:

  • Lung cancer screening if you have a history of smoking
  • Regular eye and foot checks if you have diabetes

Your healthcare provider will be able to advise you which tests you need and when.

Final word

Screening is a valuable part of your healthcare and it is important to stay up-to-date. However, if you have any new or unexplained symptoms, it is equally important to get them checked out properly by your healthcare provider as screening tests only look for a handful of specific illnesses.

Speak to your healthcare provider for further information.

Find out more about menopause on our blog or in our symptoms library.