“From infancy throughout our lives there are guidelines to help us
maintain our good health. Dr. Julia Uffner reviews the recommendations
for screening and vaccinations for our later adult years,” — Beverly
Vaughn, MD, Medical Coordinator, Menopause and You Program
Menopause marks an important juncture in women’s lives. It is an ideal
time to visit with your healthcare provider to make sure that you are up
to date with currently recommended screening tests and also to assess
your lifestyle to maximize your health. Screening tests are designed to
diagnose disease at an early stage when treatment might be more
Breast Cancer Screening
Ideally breast cancer screening has begun before menopause but this is
often a time when women become more vigilant about testing. For the
average woman at risk, breast cancer screening should involve a monthly
self-breast exam, annual physician breast exam and annual mammography.
High risk patients may consider more frequent physician exams or
staggering examinations throughout the year between their gynecologist
and/or primary care provider and/or breast surgeon.
Cervical Cancer Screening
Cervical cancer screening or PAP tests almost always should continue
after menopause. If a woman has had a total hysterectomy with the
removal of the cervix (unless it was for cancer or a precancerous
condition) then PAP testing is not necessary. Now women over 30 can have
HPV DNA testing added to their Pap smear. If the HPV DNA is negative and
the cells in the Pap smear are normal, PAPs can be done every five
years. The other option is for the lab to look for HPV only if the PAP
is abnormal. In this case if the PAP is normal, testing should be on a
three year cycle. Women over the age of 65 who have had three successive
normal PAP smears no longer need screening. If, in the past, you have
had an abnormal sample which showed moderate or severe dysplasia, the
screening guidelines are to continue PAPs for twenty years, no matter
what your age. This is because the risk of cervical cancer is higher in
women with this history. The recommendations for extended Pap smear
screening does not imply that gynecologic exams should not continue on a
yearly basis, as there are other issues that are important to follow.
Heart and Vascular Disease
Heart disease remains the number one cause of death in women. Major risk
factors for heart disease are high cholesterol, hypertension, diabetes,
smoking, family history and lack of exercise. You are also at risk if
you had high blood pressure, pre-eclampsia or diabetes during a
pregnancy. African American and Hispanic women have the highest risk of
heart disease. Generally, for a low risk woman, we recommend total
cholesterol and/or a fasting lipid profile at least every five years. A
fasting glucose should be obtained at least every three years. Blood
pressure should be check at least yearly. If there are risk factors or
previous unfavorable values, these tests usually need to be assessed
more often. Frequently an electrocardiogram (generally done in the
doctor’s office) and at times additional cardiac testing (i.e., stress
test) are advised. If tests are not normal or risk factors are present
medication or lifestyle change will likely be recommended.
Colorectal Cancer Screening
Regular screening is essential to the early detection of colon cancer a
pre-cancerous polyps are often asymptomatic. Early detection reduces
mortality. In a woman with average risk, colon cancer screening begins
at age 50. African Americans have a higher risk of colon cancer and
screening should begin at age 45. The options for testing should be
discussed with her physician. Generally, a colonoscopy every 10 years
will be recommended though yearly testing of the stool for blood,
flexible sigmoidoscopy or double contrast barium enema every five years
are alternate strategies. High risk women (those with family history,
prior history of adenomatous polyp or cancer or long history of
inflammatory bowel disease) should be screened more frequently before
the age of 50. Suspicious symptoms like bleeding, anemia or change in
bowel habits need to be evaluated promptly.
Diabetes occurs more commonly in people who have hypertension, a family
history of diabetes, are overweight or inactive, have had previously
elevated glucose levels, including diabetes in pregnancy, are from
certain ethnic groups (African American, Hispanic, Native American,
Asian-American and Pacific Islanders), or have a history of Polycystic
Ovarian Syndrome (PCOS) and as people age. Beginning at age 45, diabetic
screening should be done at least every three years and yearly or more
often if risk factors are present. Lifestyle changes are generally
recommended for people with elevated risk.
Osteoporosis Prevention and Screening
During a menopausal woman’s visit to the doctor, an assessment of a
woman’s risk of osteoporosis should occur. Weight, activity level,
smoking, alcohol history, diet/calcium intake, family history, history
of fractures, menstrual history, medication history and history of
endocrine disorders influence this assessment. All women should have a
DEXA at the age of 65. Women with risk factors should have a DEXA at an
earlier age at the discretion of her physician. The frequency of repeat
DEXA testing will depend on the results. For almost all women, an active
lifestyle with weight bearing exercise, not smoking, adequate calcium
and vitamin D intake are recommended. For women with osteoporosis,
osteopenia (a milder form of bone loss) or significant risk factors,
specific medications to prevent or treat bone loss may be advised.
Vaccinations and Infectious Diseases
For healthy women, after the age of 50, vaccination against influenza is
recommended yearly, unless there is a contraindication like severe egg
allergy, previous serious reaction, or history of Guillan-Barre
syndrome. A vaccination for tetanus and diptheria should also be
obtained every 10 years or more often if there has been a tetanus prone
injury. If you are around small children, it is recommended that you
receive vaccination against pertussis (whooping cough). This is combined
in the tetanus and diphtheria vaccine. After the age of 60, immunization
against herpes zoster ( shingles) may be advised. Women 65 and older
immunization with the pneumonia vaccine is suggested; especially if you
have a chronic disease like asthma or diabetes. Depending on other
illnesses or exposures such as travel, other vaccinations may be
recommended. When there are risk factors, screening for HIV infection,
and tuberculosis may be warranted. The Center for Disease Control (CDC)
recently added a guideline to test all individuals born between 1945 and
1965 once for Hepatitis C.
During an exam around menopause your doctor is likely to reinforce the
need to visit other health professionals. These would include,
continuing to have dental exams every six months, recommending glaucoma
checks/eye exams every two-four years (yearly if African American or
high risk conditions), and a yearly complete skin exam either by the
primary care provider or a dermatologist. They may also screen for
depression by asking some simple questions about how you are feeling.
Health related behaviors, like seat belt use, smoking, alcohol and other
substance use, exercise, sexual activity, and existence of domestic
violence are some of the subjects that should also be discussed.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
To speak with our nurse counselor, call 1-888-876-8764 or email firstname.lastname@example.org.
Membership on the medical staff of Main Line Hospitals does not
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