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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• Cancer Screenings
• Family Planning (Birth Control)
• Fertility
• Postpartum
• Perimenopause
• Menopause
• Sexual Health (STD/STI Testing)

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

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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, and at age 40, you started to screen for breast cancer. Now, starting at age 45, it is recommended that you also start colon cancer screening. 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

To stay current on your breast cancer screening, you should be getting an annual or biannual mammogram (every 1-2 years), which is an X-ray of the breast tissue. Depending on your history of results and breast density, you may also be getting breast ultrasounds and/or breast MRIs. Providers may also use the Gail Model or discuss genetic testing as a tool to assess breast cancer risk.

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Colon Cancer Screening

Colon cancer screenings begin at age 45 and continue through age 75 — but are recommended earlier if there is a 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.

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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, while 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.  

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Family Planning (Birth Control)

As long as you are menstruating (premenopausal), you may want to use contraceptives to protect yourself from pregnancy and/or to help manage your menstrual cycle. Your provider can help determine the best method for you and will consider factors such as:

• What type of birth control best fits with your lifestyle
• The best hormonal content for you

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

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Fertility

At 45 years of age or older, it becomes increasingly difficult to become pregnant without fertility assistance. If you are planning to have a baby, you should have both a preconception consult to discuss the health risks of pregnancy and an immediate fertility referral for an evaluation and review of treatment options. Once you are pregnant, you’ll have a separate series of visits with your OB/GYN until delivery.

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Postpartum

Postpartum refers to the period after you deliver a baby. From a medical perspective, this lasts six to eight weeks while your body recovers from a natural 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. It is an important time for both the mother and child’s well-being — for healing and for bonding. You will have a postpartum visit 4-6 weeks after delivery. 

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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, progesterones, and hormonal replacement therapies, which can help with night sweats, hot flashes, dryness, and menstrual issues. Lifestyle adjustments can improve weight gain, stress, and sleep. Cognitive behavioral therapy and/or antidepressants or anti-anxiety medications are often 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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Menopause

Once you’ve gone 12 consecutive months without a period, you’ve officially reached menopause. Women typically reach menopause in their 50s (the average age is 51). We can think of this less like an ongoing stage of life, and more like a gate we’ll eventually pass through. That said, there are health impacts on the other side, as a result of your ovaries no longer producing as much estrogen. Post-menopause, women may see changes to bone or heart health, body shape, and other signs associated with aging. 

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Within the context of your annual well-woman visit, you can talk to your provider about hormone therapies: 

• Estrogen Therapy (ET) or Estrogen Progesterone/Progestin Therapy (EPT). These therapies come in several forms, and each carries its own benefits, risks, and side effects. 
• There are also prescription-based non-hormonal therapies, like SSRIs, fezolinetant, and gabapentin, to relieve vasomotor symptoms and mood changes. 

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Incorporating an exercise routine to include a combination of aerobics, strength training, and balance workouts can reduce weight gain, stress, and increase bone density and muscle. Focusing on a healthy diet with these lifestyle changes can also help slow aging and support whole body wellness. For more information, see our Menopause Q&A.

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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 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.

For more information on testing and treatment, see our article on Sexually Transmitted Infections.

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