Forty may be the new 20 (and 50 the new 30, and so on), but bodies that are getting older still need more care than their younger counterparts.
“The second half of your life is the phase when diseases, chronic conditions, and other medical needs become much more prominent than in the first half of your life,” says Laura Purdy, MD, a virtual primary care physician and medical advisor to wisp, a telehealth company specializing in women’s health. “That’s why it’s so important to be proactive and engaged now in your own health care—including getting essential tests and screenings that help identify diseases in the earliest stages to optimize the length and quality of your life.”
Even if you enter your 40s in great health, it’s crucial to stay on top of certain tests and checkups, says Dr. Purdy, and to not ignore nagging symptoms. “Women—especially in their 40s and 50s—often brush off mild symptoms, such as fatigue or weight gain, as just an inevitable part of getting older,” she explains. “But the reality is that these symptoms could be early indications of something medical that we can treat.”
It’s important to note that the medical community sometimes disagrees about when and how often you need certain tests and screenings. Also, the recommendations for people with risk factors or family history of certain conditions may call for earlier or more frequent checks.
That’s why we consulted experts and medical association guidelines to compile a list of health checks women over 40 may need. When in doubt, discuss your concerns with your doctor. And while you’re at it, ask about whether or not you’re due for any of these check ups.
Health check-up No. 1: Height, Weight and Body Mass Index (BMI)
Your body mass index (BMI) often changes over time. Tracking it annually helps your doctor spot changes and encourages you to take positive action when needed. “Around midlife, women start gaining and storing weight around their abdomen instead in the hips and thighs,” says Dr. Purdy. “And that is significantly more dangerous in terms of heart disease.” BMI also has a direct correlation to the risk of other diseases, such as diabetes.
Health check-up No. 2: Blood Pressure Check
High blood pressure is called “the silent killer” because it is often symptomless. “But if high blood pressure is left uncontrolled, you greatly increase your risk of heart attack and stroke,” says Dr. Purdy. At a minimum, everyone should have their blood pressure checked at an annual medical exam. If you already have high blood pressure—or other risk factors for heart disease—your doctor may recommend more frequent monitoring.
Health check-up No. 3: Cholesterol Levels
If you have risk factors (such as smoking, diabetes, or high blood pressure), guidelines call for cholesterol screening every five years starting in your 20s. People with any risk factors (which includes getting older) should check their cholesterol levels each year starting at age 45. This test (also called a lipid panel) looks at levels of cholesterol in your blood—taken after you’ve been fasting for eight to 12 hours. “High cholesterol levels put you at higher risk of heart disease—which is the number one killer of women,” says Dr. Purdy.
Health check-up No. 4: Diabetes Screening
The American Diabetes Association recommends that everyone get screened annually for diabetes starting at age 35. “Prediabetes and even early diabetes often have no symptoms,” says Purdy. “And the main risk factors—being overweight or obese and physically inactive—affect the majority of adults.” If you haven’t been checked yet, ask your doctor if you should get a blood test that evaluates your blood sugar levels.
Health check-up No. 5: Mammogram
It used to be the rule that you start getting mammograms at age 40 and get one every year. “Now there are different recommendations from different, reputable groups advising that you start anywhere from 40 to 50,” says Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology and reproductive sciences, Yale Medical School and founder of MadameOvary.com. For example, the American College of Physician guidelines say that women at average risk can wait till they’re 50 to start screening and the American Cancer Society says start at 45. “I still recommend that you start getting them around age 40 and get one every year or every other year.” Women with a family history, those with the BRCA gene or other risk factors may need to start having mammograms earlier and have them more frequently. If you have breast implants, make sure to talk to your doctor about specific screenings you might need as a result.
Examining your breasts is still an important part of your self-care. “It’s good for women to be aware of what their breasts feel like and what’s normal for them, so that they can notice if something changes,” says Dr. Minkin. “If we’re able to find and remove a tumor when it’s small and caught early, treatment can be more successful.”
Health check-up No. 6: Pap Smear/HPV test
You should have been getting these tests regularly since your 20s to help screen for cervical cancer. The American Cancer Society recommends you get a combination HPV (human papilloma virus) test and Pap smear every five years, or a Pap smear alone every three years until age 65. “HPV is responsibly for the majority of cervical cancers,” says Dr. Minkin. “If you test positive for HPV or have an abnormal Pap smear, your doctor will do further testing.” But if you’re HPV negative and have a normal Pap smear, you can wait five years to repeat the screening.
Health check-up No. 7: Hormone Tests
As you move through your 40s and into your 50s, chances are you’ll experience the hormonal fluctuations typical of perimenopause. You may even have symptoms like hot flashes, mood swings or irregular periods thanks to ever-changing levels of hormones such as estrogen and progesterone. “But because hormone levels are all over the place during perimenopause, there’s very little point to testing them,” says Dr. Minkin.
Testing FSH levels (follicle stimulating hormone) can tell you something about your ovarian reserve, or how many eggs you have left. “That can be helpful information if you’re in your 40s and trying to get pregnant,” she says. “But otherwise, there’s no need to do it because it can’t necessarily predict when you’re going to go through menopause.”
Health check-up No. 8: Thyroid disease screening
Guidelines from the U.S. Preventive Services Task Force don’t recommend routine screening for asymptomatic adults (except during pregnancy). But many primary care physicians disagree and regularly screen female patients—especially those in their 40s and 50s—as part of the blood work done during an annual exam. “The early symptoms of hypothyroidism [such as weight gain, fatigue or irregular periods] are ones women are inclined to write off and not even tell their doctor about,” says Dr. Purdy. Screening can help catch these cases and then treat them to improve women’s quality of life and overall health.
Health check-up No. 9: Eye Exam
All adults should get a baseline comprehensive eye exam at age 40. If you have no risk factors for eye disease (such as having diabetes or a family history of eye problems), the American Optometric Association recommends seeing an eye doctor at least every two years until age 64, then annually after that. If you wear contacts or glasses, however, you need to see an eye care provider every year—at any age—to check the health of your eyes and update your prescription.
Health check-up No. 10: Dental Exam
Most adults should see their dentist for a teeth cleaning and dental exam every six months. Regular exams allow your dentist to detect any issues—such as cavities, gum disease and oral cancer—before they turn into bigger problems. If you have dental concerns, such as bleeding gums, pain, or tooth sensitivity, you may need to see your dentist sooner than six months.
Health check-up No. 11: Colorectal Cancer Screening
Incidence of colon cancer has risen in younger adults, prompting a shift in the screening guidelines for the disease. The recommendations now call for people of average risk (and no family history of colon cancer) to start screening for colorectal cancer at age 45. Colonoscopy is still the gold standard screening, but experts advise that the most important thing is to get some kind of screening. Less invasive, stool-testing options (like Cologuard®) and virtual colonoscopies are good screening options for those who don’t want to or can’t get a colonoscopy. Talk to your doctor about which type of test is best for you, when to start, and how often to screen.
Health check-up No. 12: Skin Cancer Check
There’s some debate about the value of annual full-body skin exams for all adults. The U.S. Preventive Services Task Force doesn’t recommend them, the Skin Cancer Foundation and American Academy of Dermatology do. But if you have any risk factors for skin cancer (such as fair skin, blond or red hair, tanning bed use, a history of severe sunburns, or a family history of skin cancer), dermatologists recommend you get a full-body skin check at least annually. “Skin cancer is the most common type of cancer in the U.S., but it is highly curable when it’s caught at the earliest stages,” says Joel Cohen, M.D., director of AboutSkin Dermatology in Denver, Colorado.
Health check-up No. 13: Depression Screening
Your mental health is just as important as your physical health. More doctors are recognizing that fact and checking in on their patients’ emotional wellbeing. Your gynecologist or primary care doctor should ask you about your mood, how you’re sleeping and how you’re coping with everyday stressors during your annual check up. They may also ask you to fill out a depression-screening questionnaire to better assess your mental health. Depending on the results, your primary care provider may refer you to a psychologist or mental health counselor. If you have concerns about your own mental wellbeing, talk to your doctor and ask for suggestions of how you can get help.
