Women’s bodies are miraculous and complicated, and our needs, concerns, lifestyles, and risks change as we age. These changes are often referred to as life stages, based on the reproductive cycle, beginning with menstruation and continuing through menopause. 

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In addition to reviewing lifestyle habits and mental well-being, below are a few of the most common life stage topics for 45-55 year olds to be aware of and discuss with your provider. 

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• Family History and Genetic Counseling
• Cancer Screenings
• Sexual Health (STD/STI Testing)
• Family Planning (Birth Control)
• Fertility and Egg Freezing
• Postpartum
• Perimenopause

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This is intended to be a guide. Not all topics apply to everyone.

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Family History and Genetic Counseling

Fortunately, only 5-10% of cancers are caused by inherited cancer gene mutations. These include certain breast and ovarian cancers from the BRCA1 and BRCA2 gene mutations. Those patients who carry a genetic mutation can have a much higher risk of developing cancer, so it is important to know as much as you can about your family health history. For more detailed information, see our article, Family Health History: What to Track and Why.

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For those at high risk based on family history, you may be referred to genetic counseling to decide whether testing is appropriate, and so you can work with a specialist to be monitored more closely. 

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Cancer Screenings

As you age, it becomes increasingly important to follow the recommended cancer screening guidelines. Cervical cancer screenings are pretty constant throughout your lifetime, but ages 40 and 45 introduce breast cancer screening and colon cancer screening, respectively. Other gynecological cancers, such as ovarian and endometrial, don’t have routine screening methods, but below we have noted symptoms for you to be aware of.

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Cervical Cancer Screening 

Cervical cancer screenings are critical for anyone 25-65 years of age who has an intact cervix (has not had a full hysterectomy). Nearly all cervical cancers are caused by high-risk HPV (human papillomavirus). The Primary HPV test looks for high-risk HPV (hrHPV), which can cause changes to the cervix if it persists over several years. 

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Your current and past results will determine your screening schedule. According to the self-collection guidelines from the American Cancer Society:

• If you have a history of normal results, it is recommended that you screen yourself (self-collect) with a primary HPV test every 3 years. 
• If you have a history of abnormal results in the past 2 years, in most cases, we will recommend that you screen again in 1 year to keep an eye on the infection (which can be dormant), and you can connect with a Teal provider to discuss further.

• If your results are abnormal, you should connect with a Teal medical provider to discuss whether additional tests or procedures are needed. Follow-up care is critical to ensuring HPV infections do not progress. 

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The above screening timelines are in accordance with the American Cancer Society for a self-collected Primary HPV test (including at-home screening). For detailed screening guidelines for at-home vs in-person, please see our Cervical Cancer Screening Guidelines.

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Breast Cancer Screening

Starting at age 40, or earlier if there is a family history of breast cancer or known genetic mutation, women should get an annual or biannual mammogram (every 1-2 years). A mammogram is an X-ray of the breast tissue. Providers may also use the Gail Model to find those at high risk who may need referral for genetic testing.

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Colon Cancer Screening

Colon cancer screening begins at age 45 and continues through age 75 — but may be recommended earlier based on family history. 

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Generally, this is done through stool tests and/or a colonoscopy: 

• Stool tests (FIT or Cologuard): An at-home stool test is designed to detect blood or altered DNA in the stool. Stool tests are recommended every 1-3 years.
• Colonoscopy: Procedure where a flexible tube with a camera is inserted into the rectum and colon to check for polyps or signs of cancer. Colonoscopies are recommended every 10 years if you have normal results.

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Ovarian and Endometrial Cancer 

There are no routine screening tests for ovarian or endometrial cancer, as no test has yet been shown to reliably find early-stage disease.  

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Early-stage ovarian cancer does not usually cause symptoms, and later-stage ovarian cancer more often causes nonspecific symptoms. These could include bloating, the feeling of fullness, urinary frequency/urgency, or weight loss. If you notice new and persistent symptoms, it is important to discuss them with your provider. For those known to be at high risk of ovarian cancer, providers may recommend doing regular pelvic ultrasounds and cancer antigen (CA 125) blood tests to look for abnormalities.

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Endometrial cancer typically causes abnormal uterine bleeding because it starts in the lining of the uterus. Evaluation for endometrial cancer could include a pelvic ultrasound to look for a thick lining and/or an endometrial biopsy to evaluate the uterine lining tissue.

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Sexual Health (STD/STI Testing)

It is important to discuss your sexual health with your provider to ensure you are not at risk for an unplanned pregnancy, or for sexually transmitted diseases or infections (STDs/STIs). This is a space where you can ask questions without embarrassment to get the care and recommendations that will best protect your health. 

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For those who are sexually active and at an increased risk, such as having new or multiple partners, the CDC (Centers for Disease Control and Prevention) recommends yearly STD/STI tests. This is most commonly a blood or urine test.

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Family Planning (Birth Control)

Family planning — or use of contraceptives — may be a topic that you bring to your provider, or that your provider raises to discuss protecting yourself from pregnancy and/or to help manage your menstrual cycle.

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Your provider can help determine the best method for you and will consider factors like:

• What type of birth control best fits with your lifestyle
• The best hormonal content for you
• How soon you may want to consider trying for pregnancy 

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For more information, see our article on Birth Control Methods.

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Fertility and Egg Freezing

Whether you’re in your 20s, 30s, or 40s, fertility becomes a discussion even before you begin trying to have a baby. The option of egg freezing (called oocyte cryopreservation) is something to consider discussing with your provider if you are not quite ready to become pregnant. 

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Once you are ready to start trying, there are a few considerations for your fertility journey, such as starting prenatal vitamins, using fertility tracking apps, or ovulation testing kits to increase the chances of pregnancy. 

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If you are:

• 35-39 years of age, you may be offered fertility testing if not pregnant after six months of trying
• 40 years of age or older, you should have an immediate fertility referral

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If you are having abnormal periods or not seeing signs of ovulation, you should seek an evaluation right away, regardless of age.

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Depending on the outcome of a workup, your provider can review fertility treatment options and refer you to a fertility specialist.  Once you are pregnant, you’ll have a separate series of visits with your OB/GYN until delivery.

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Postpartum

After having a baby, you will have a postpartum visit with your OBGYN 4-6 weeks after delivery. This visit is to check in on how your body is recovering from either a vaginal or Cesarean (surgical) birth. During this time, your body works to repair any injury from tears or incisions and to return to your pre-pregnancy state.

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However, the period of postpartum extends for the full year after birth as your body continues to undergo changes:

• The uterus takes up to two months to shrink back to pre-pregnancy size, and while the abdominal wall is relaxed, most of the muscle tone returns after several weeks.
• Stretch marks will fade, though some are permanent. 
• Postpartum hair loss often starts one to five months after giving birth and typically resolves naturally between 6 to 15 months postpartum. 
• Women can lose about half their pregnancy weight in the first six weeks post-delivery, then at a slower pace the following months. 
• Most women will get a period again by three months postpartum, though a percentage of those who exclusively breastfeed may not have a period for a year or more. 
• Ovulation can still occur during this time, so contraception is recommended if pregnancy prevention is a goal. 

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Perimenopause

Perimenopause refers to the time when your body begins its transition into menopause, or the end of your menstrual cycle (period). These changes typically begin in your mid-40s, but can start earlier or later. Perimenopause is different for every woman, and it may happen swiftly or over the course of many years. 

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During this time, your estrogen and progesterone levels are uneven, and this may cause symptoms like:

• Changes to your mood
• Changes to the duration or time between your menstrual cycles
• Sleep problems
• Heavy sweating or hot flashes
• Weight gain
• Vaginal dryness
• Headaches or trouble concentrating
• Joint and muscle aches
• Having to urinate more frequently 

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Depending on your experience, these symptoms can be managed by contraceptives such as birth control pills, the vaginal ring, progesterone or traditional hormonal replacement therapy. Maintaining even levels of hormones can help with most symptoms, including mood changes, night sweats, hot flashes, dryness, and menstrual issues. Lifestyle adjustments can improve weight gain, stress, and sleep. Cognitive behavioral therapy and/or antidepressants or antianxiety medications are also helpful to manage mood swings, anxiety, and depression. 

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Knowing what to look out for helps ensure this transition is as comfortable and as healthy as can be.

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