Health Screenings After Menopause — Mammograms, Colonoscopy, Thyroid, and More

Cancer risk generally increases with age, and several screenings become particularly important after menopause.

Breast cancer screening: mammography remains the cornerstone. Current guidelines recommend screening every 1–2 years for average-risk women, starting at age 40–50 depending on the guideline (USPSTF recommends biennial starting at 40 as of 2024; ACS recommends annual starting at 45). For women at higher risk (strong family history, BRCA mutations, prior chest radiation, dense breast tissue), additional screening with breast MRI may be recommended. If you have dense breasts (which you'll be notified about on your mammogram report), discuss supplemental screening with your provider.

Colorectal cancer screening: the recommended start age dropped to 45 (from 50) in recent guidelines. Colonoscopy every 10 years is the gold standard, but alternatives include annual fecal immunochemical test (FIT), FIT-DNA test (Cologuard) every 3 years, or CT colonography every 5 years. After age 75, screening decisions should be individualized based on life expectancy and prior results.

Cervical cancer screening: Pap smears and HPV testing continue after menopause. Current guidelines suggest co-testing (Pap + HPV) every 5 years, Pap alone every 3 years, or HPV primary screening every 5 years. Screening can stop at age 65 if you've had adequate prior negative screens and no history of high-grade cervical changes.

Lung cancer screening: annual low-dose CT scan is recommended for adults aged 50–80 with a 20+ pack-year smoking history who currently smoke or quit within the past 15 years.

Skin cancer: annual full-body skin exam by a dermatologist, especially if you have fair skin, history of sun exposure, or many moles. Monthly self-exams for new or changing lesions.

Ovarian cancer: there is currently no effective screening test for ovarian cancer in average-risk women. CA-125 and transvaginal ultrasound have not been shown to reduce mortality and can cause harm through false positives.

Cardiovascular disease is the number one killer of postmenopausal women — more than all cancers combined. Yet cardiovascular screening in women is often less aggressive than in men, despite equal or greater risk.

Blood pressure should be checked at every healthcare visit, and ideally at home regularly. Hypertension (defined as 130/80 mmHg or above by current guidelines) becomes dramatically more common after menopause — estrogen withdrawal reduces the vasodilatory effect of nitric oxide, and arterial stiffness increases. Approximately 75% of women over 65 have hypertension.

Lipid panel should be checked at least every 5 years in low-risk women, and annually for those with elevated levels or cardiovascular risk factors. Menopause typically worsens the lipid profile: total cholesterol rises, LDL increases, HDL may decrease, and triglycerides increase. These changes are directly related to estrogen withdrawal. A full panel (total cholesterol, LDL, HDL, triglycerides) plus lipoprotein(a) — Lp(a) — is recommended at least once, as Lp(a) is a strong independent cardiovascular risk factor that's genetically determined.

Fasting glucose and HbA1c should be checked regularly. Type 2 diabetes risk increases after menopause due to declining insulin sensitivity, increased visceral fat, and metabolic changes. Screening every 3 years is standard for average-risk women; annually for those with prediabetes or other risk factors.

The ASCVD (atherosclerotic cardiovascular disease) risk calculator estimates your 10-year risk of a heart attack or stroke based on age, blood pressure, cholesterol, diabetes status, and smoking. This helps guide decisions about statin therapy and lifestyle interventions.

Coronary artery calcium (CAC) scoring is an emerging tool that uses a low-dose CT scan to quantify calcium deposits in coronary arteries. It can help reclassify risk in women with borderline ASCVD scores and guide statin decisions. It's particularly useful when traditional risk calculators may underestimate risk — which they often do in women.

Osteoporosis is a silent disease — you don't feel bone loss happening. The first symptom is often a fracture. This makes proactive screening essential.

Who should be screened: all women at age 65 (universal recommendation from USPSTF and NOF), women under 65 with risk factors (early menopause before age 45, family history of hip fracture, low body weight or BMI under 20, smoking, excessive alcohol use, long-term glucocorticoid use, rheumatoid arthritis, and prior fragility fracture), and women considering HRT specifically for bone protection (baseline DEXA helps guide the decision).

What the DEXA measures: bone mineral density at the lumbar spine (L1–L4), total hip, and femoral neck. Results are reported as a T-score (comparison to peak bone mass in a healthy young woman). Normal is -1.0 or above. Osteopenia is -1.0 to -2.5. Osteoporosis is -2.5 or below.

The FRAX tool combines your DEXA results with clinical risk factors (age, weight, fracture history, family history, smoking, alcohol, glucocorticoid use, rheumatoid arthritis) to calculate your 10-year probability of major osteoporotic fracture and hip fracture. Treatment is generally recommended when 10-year hip fracture risk exceeds 3% or major osteoporotic fracture risk exceeds 20%.

Follow-up scans: every 1–2 years if you're on osteoporosis medication (to monitor treatment response), every 2–5 years for women with osteopenia who aren't being treated (to monitor progression), and can be less frequent for women with normal bone density and few risk factors.

Important technical note: always try to get follow-up DEXA scans on the same machine as your baseline, as different machines may give slightly different readings, making comparison unreliable. The change in bone density over time (not a single measurement) is the most clinically meaningful information.

Thyroid disorders become more common with age and disproportionately affect women. They're particularly important to screen for because thyroid symptoms overlap significantly with menopausal symptoms — fatigue, weight changes, mood changes, brain fog, hair loss, and heat/cold intolerance can all be caused by either.

TSH (thyroid-stimulating hormone) is the primary screening test. It should be checked every 5 years after menopause, or more frequently if you have symptoms or risk factors. Hypothyroidism (underactive thyroid) affects up to 20% of women over 60. Hashimoto's thyroiditis (autoimmune hypothyroidism) is the most common cause. Symptoms include fatigue, weight gain, constipation, dry skin, hair loss, cold intolerance, and depression — all of which can be mistakenly attributed to menopause.

If TSH is abnormal, additional tests include free T4, free T3, and thyroid antibodies (anti-TPO, anti-thyroglobulin) to identify autoimmune thyroid disease.

Fasting glucose or HbA1c for diabetes screening should be done every 3 years for average-risk women, annually for those with prediabetes (HbA1c 5.7–6.4%), obesity, or a family history of diabetes. Insulin resistance increases after menopause, and early detection allows for lifestyle interventions that can prevent progression to diabetes.

Vitamin D level (25-hydroxyvitamin D) should be checked at least once, and monitored if supplementing. Deficiency is common (40–50% of postmenopausal women) and contributes to bone loss, mood disturbance, immune dysfunction, and possibly increased cancer risk. Aim for 30–50 ng/mL.

Vitamin B12 should be checked, especially if you take metformin or proton pump inhibitors (which impair absorption), follow a vegetarian or vegan diet, or have symptoms of deficiency (fatigue, tingling, cognitive issues).

Complete blood count (CBC) can identify anemia (which causes fatigue), infections, and blood cell abnormalities. A comprehensive metabolic panel checks kidney function, liver function, and electrolytes — all important baseline information, especially if you take medications.

The most effective approach to preventive screening is a personalized schedule developed with your provider that accounts for your individual risk factors, family history, and current health status. Here's a framework.

Annual: blood pressure check, weight and BMI assessment, review of current medications and supplements, depression and anxiety screening, discussion of new or changing symptoms, skin check (self-exam monthly, professional annually), and review of lifestyle factors (exercise, nutrition, sleep, alcohol use).

Every 1–2 years: mammogram (annually or biennially depending on risk and guideline used), lipid panel (annually if elevated or on treatment, otherwise every 2–3 years), fasting glucose or HbA1c (every 1–3 years depending on risk), DEXA scan (if on osteoporosis treatment or monitoring osteopenia).

Every 3–5 years: TSH (every 5 years, or more often with symptoms or treatment), cervical cancer screening (Pap/HPV co-testing every 5 years until age 65), vision exam (every 2–3 years after 50, annually after 65), dental exam (every 6–12 months — oral health is linked to cardiovascular health), and hearing evaluation (baseline at 50, then periodically).

Every 5–10 years: colonoscopy (every 10 years from age 45, or more frequently if polyps found), DEXA scan (for monitoring women with normal or mildly low bone density), coronary artery calcium score (once for risk stratification if cardiovascular risk is uncertain).

Once: Lp(a) level (genetically determined, doesn't change — one measurement is sufficient), hepatitis C screening (recommended for all adults), and lung cancer screening discussion (if smoking history applies).

Keep a health record: track your screening results, dates, and follow-up plans. Many patient portals make this easy. Knowing your numbers — and their trends over time — empowers you to have informed conversations with your provider and catch changes early.

Advocate for yourself: if your provider suggests skipping or delaying a screening, ask why. Understand the reasoning and make a shared decision. Your health is a partnership.

Several important screenings are frequently overlooked in postmenopausal women — either because providers don't think to order them or because women don't know to ask.

Pelvic floor assessment: despite affecting up to 50% of postmenopausal women, urinary incontinence, pelvic organ prolapse, and sexual dysfunction are rarely proactively screened for. A pelvic floor physical therapist can assess function and identify issues that are highly treatable.

Hearing evaluation: hearing loss becomes increasingly common after 50, and there's now strong evidence linking untreated hearing loss to accelerated cognitive decline and dementia. The ACHIEVE trial showed that hearing intervention reduced cognitive decline by 48% in older adults at risk. A baseline hearing assessment at 50, with follow-up every 3–5 years, is reasonable.

Mental health screening: despite the 2–4 fold increase in depression risk during the menopausal transition, routine mental health screening is inconsistently performed. The PHQ-9 (depression) and GAD-7 (anxiety) are quick, validated screening tools that should be part of every annual visit.

Sleep assessment: sleep disorders (insomnia, sleep apnea) are increasingly common after menopause and have significant health consequences. Sleep apnea, in particular, is underdiagnosed in women because it often presents differently than in men (insomnia and fatigue rather than loud snoring). If you're tired despite adequate sleep time, or if your partner reports pauses in breathing, request a sleep evaluation.

Fall risk assessment: for women over 65, a fall risk assessment (including balance testing, medication review, vision check, and home safety evaluation) can prevent the fractures that cause disability and death.

Vaccination review: ensure you're up to date on shingles vaccine (Shingrix — two doses for adults 50+), pneumococcal vaccine (at 65), Tdap/Td boosters (every 10 years), annual flu vaccine, and COVID-19 boosters as recommended.

Oral health: periodontal disease risk increases after menopause (estrogen affects gum health), and poor oral health is associated with cardiovascular disease and dementia. Regular dental care is health care.