The Health Tests Midlife Women Should Ask for at Their Annual Physical

Every year, you probably visit your primary care physician (PCP) to get a basic snapshot of how your health looks. These appointments are important, but they usually don’t include some of the most critical tests midlife women need to get an accurate report of their well-being.

Midlife — ages 35-60, specifically — is a major hinge point for a woman. Your body reflects the health issues you’ve already faced, but it’s also a make or break moment for how your future will look. How a woman cares for herself — and the treatment she receives — at this precise moment sets the stage for her health for decades to come. That’s why it’s so important to get all the proper information now to make sure these years are spent in good health. 

While the standard, annual tests are still necessary, a woman in midlife needs more than just a blood pressure check. Hormonal changes from perimenopause and menopause touch numerous parts of a woman’s health and raise the risk of certain diseases like osteoporosis, diabetes and heart disease. 

Going in, it’s important to understand that fewer than 20% of PCPs in the USA have received formal menopause training. Translation: This knowledge gap often means well-intended doctors may not even know what tests to order to catch hormonal, metabolic and cardiovascular shifts. The result? Women leave their annual appointments without getting the one thing they went for: answers.

Below, we outline the standard tests your doctor will most likely run, and those that you should ask for:

The Standard Annual Tests 

Joyce Knestrick, family nurse practitioner and director of nursing leadership and management at the GW School of Nursing, says certain tests and checks are staples of this kind of appointment. For women in midlife, an annual physical typically includes these elements:

• Vital signs: Checks weight/BMI, heart rate and blood pressure.
• Physical Exam: Checks for physical signs of diseases or conditions. This is when your doctor will pull out the stethoscope to listen to your lungs and pull out the tongue depressor to look at your mouth and throat.
• Screenings: Checks for cancers such as colorectal, cervical and breast cancer. If you don’t get a breast exam and pelvic exam/pap smear with your gynecologist, you might get it here. Your doctor may also order a mammogram if you’re due. 
• Mental Health Questionnaire: You’ll be asked about what’s going on with your emotional and mental health. Knestrick says this is a “general ‘How are you feeling?’ conversation covering sleep, mood, energy and stress.” Your doctor will likely ask you if you’re experiencing violence or abuse, if you’re sexually active and if you’re using any substances.
• Vaccine reviews: If you’re missing key shots like Shingles, Tdap or annual flu shots you may get these.
• Basic bloodwork: This usually includes a complete blood count (CBC), which is a good measure of your overall health, and a basic metabolic panel to check how your kidneys are working. This also usually includes a lipid panel and cholesterol check.
• Your doctor may also bring up perimenopause and menopause.

Additional Tests to Ask For 

The above items are a solid start, but there are certain tests that you may want in order to get more insight into your current health, plus risk for future disease and illness. Here’s what to ask for.

Hormones

Your gynecologist is the best doctor with whom to discuss menopause-related symptoms and to explore hormone options. But your primary care doctor should always stay in the loop too — they need to know what you’re experiencing and what medications your gyno has prescribed. Your annual visit is the perfect time to bring them up to speed.

One test your primary can run is a thyroid panel to get your thyroid-stimulating hormone (TSH) levels checked. Autoimmune conditions and thyroid problems are common in midlife because hormones are going haywire, but these tests aren’t always included. Knestrick adds that “symptoms overlap heavily with ‘normal’ midlife fatigue and weight changes.” Once your primary reviews your results, you can then take them to an endocrinologist or OB-GYN for further insights.

Bones

Women are at greater risk of developing osteoporosis because bone density declines with age. Guidelines generally recommend getting DEXA scans starting at age 65, but midlife women benefit from getting them earlier.

Dr. Elizabeth Dulaney-Cripe, a board-certified orthopedic surgeon and integrative medicine physician who is founder of Valivara Health, recommends getting a baseline in perimenopause because “if we know what a patient’s bone density is earlier in life, we can identify her rate of loss in a more personalized manner.” 

This becomes even more essential if you carry certain risk factors, like a family history of osteoporosis. Women who went into early menopause, smoked, have low body weight or have taken (or are currently taking) a GLP-1 are more susceptible to bone loss. 

Many women are deficient in vitamin D, which is essential for bone health, so it’s good to have that checked as well. Low vitamin D is often a culprit when someone feels sluggish and fatigued.

Heart 

Cardiovascular disease is the leading cause of death for women worldwide — and risk jumps when a woman enters menopause. Women’s heart issues have historically been underdiagnosed and treated late, so it’s important to get a jump as early as you can.

One of the best ways to stay on top of your heart health is to “know your numbers.” Make sure to get a full lipid panel to check your cholesterol levels. Diabetes is a major risk factor for heart disease — and midlife hormonal changes increase the chances of developing insulin resistance, which massively ups the chances of developing diabetes. So make sure to get your fasting glucose and hemoglobin A1C levels checked. Additionally, an Apolipoprotein B-100 (Apo B) test, which measures the amount of plaque-forming protein in your blood, offers a more accurate picture of heart disease than a standard cholesterol test. 

If heart disease runs in your family, Knestrick suggests all of the above plus two specific tests: hs-C-reactive protein (CRP) and lipoprotein (a) aka Lp(a). These tests measure the amounts of two genetic markers that can increase your long-term risk for heart disease. The CRP test checks the amount of an inflammation-causing protein circulating in your bloodstream, while the Lp(a) test determines how much of a particle that carries cholesterol is present. You can then take all this information to a cardiologist.

Tests For A More Complete Picture

Every person has their own unique, genetic history. If you have specific health concerns or risk factors, it is better to discuss it with your doctor than to wait for something to happen. These include: 

Specific Cancer Screenings

If a certain type of cancer runs in your family, ask about what you need to do for prevention. Your doctor might suggest you meet with an oncologist for genetic testing or suggest more frequent screenings.

Mental Health

A quick check in about your emotional health is on the docket for your check-up, but that doesn’t minimize its importance or the magnitude it plays in a person’s quality of life. 

Midlife can be an especially difficult time for women. They are at higher risk for mental health issues, including suicide and depression, because of “the cognitive load of managing so many different responsibilities across many different domains, ” suicidologist Rheeda Walker, PhD, a professor of psychology at Wayne State University, previously told Flow Space. Women in midlife are also twice as likely to be diagnosed with depression as men — yet Knestrick says screening don’t always happen. 

Bravery and silence aren’t a solution — asking for help is. Surface any mental health concerns to your PCP. They can refer you to a psychiatrist or therapist for help.

Sleep

If you’re one of the many women plagued by midlife sleep issues, please tell your doctor. Problems sleeping are an emergency because not getting enough shut-eye harms every part of your health. Hormone loss also raises the chances of developing obstructive sleep apnea (OSA), a common sleep disorder that makes it tough to breathe while you rest, which means daytime fatigue and poor sleep. Uncontrolled OSA dramatically increases the risk of heart disease: some data has found it raises the risk of coronary heart disease by 30%, stroke by 60% and heart failure by 140%. 

If you’re experiencing sleep issues, your doc may order some additional tests to try to get to the bottom of it. They can also refer you to a sleep specialist.

What To Do Before Your Appointment

Doctors are busy and the average amount of time you get face-to-face is 15 minutes. Prepping for your appointment in advance will ensure you get all the questions you want answered. Here’s how:

1. Jot down some notes and questions. Knestrick suggests bringing a list because “a lot of these [additional tests] don’t happen unless you specifically ask.”

2. Update your chart on the portal before you go. Make sure your family history is complete and up to date. Genetics increase the risk for many age-related illnesses including diabetes, cancer, osteoporosis and heart disease. Knestrick says “if you haven’t updated your parents’ or siblings’ health changes in a few years, this is a good time.”

3. Help your doctor help you. If you have any pertinent lab tests, medical forms, or diagnostics from other doctors, make sure they’re sent to your primary doctor’s office a few days before your appointment. It will require you to make some calls, and sign medical release forms but it will give your doctor a fuller view of your health — and a better ability to assess you.

The conversation with your doctor doesn’t end when you leave your appointment. In fact, that may be just the beginning. Once your test results have come back, “ask what they mean, not just whether they’re ‘normal,’” suggests Knestrick. “Ranges for things like cholesterol or bone density often have gray areas where ‘technically normal’ still warrants a conversation about trends or prevention.” With that knowledge, you can better understand your health, address issues early and take preventative steps now, to help you live a long, vibrant life.