Health Maintenance in Postmenopausal Women

Plesa, Monica MD
Wong, Anita MD
Katsaggelos, Ereni MD, MS

Author Information

MONICA PLESA, MD, is an associate professor in the Department of Family Medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

ANITA WONG, MD, is an assistant professor in the Department of Family Medicine at the David Geffen School of Medicine at the University of California.

ERENI KATSAGGELOS, MD, MS, is an assistant professor in the Department of Family Medicine at the David Geffen School of Medicine at the University of California.

Author disclosure: No relevant financial relationships.

This article updates previous articles on this topic by Baill and Castiglioni and Rao, et al.

Data Sources: A PubMed search was completed using the key terms cardiovascular disease and women, stroke and women, coronary heart disease and women, atrial fibrillation, hormone therapy, osteoporosis menopause screening, STI menopause, screening and elder abuse or intimate partner violence, menopause and depression or anxiety, and all topics addressed in this article. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews and used the English language and free full text available. The Cochrane database, Advisory Committee on Immunization Practices, and Essential Evidence Plus were also searched. Guidelines and recommendations from the USPSTF, American Heart Association, American Diabetes Association, American College of Cardiology, American College of Obstetricians and Gynecologists, American College of Gastroenterology, National Comprehensive Cancer Network, American Cancer Society, American Stroke Association, American College of Chest Physicians, American Academy of Sleep Medicine, Sleep Research Society, and the American Academy of Family Physicians were searched. We critically reviewed studies that used patient categories such as race, gender, and/or sexual orientation but did not define how these categories were assigned, stating their limitations in the text. Search dates: April 20, 2024, through December 11, 2024, and March 10, 2025.

American Family Physician 111(5):p 407-418, May 2025.

There are unique considerations for preventive care in postmenopausal women. Cardiovascular disease is the leading cause of death for women in the United States, and postmenopausal women should be routinely screened for risk factors such as diabetes, hypertension, and dyslipidemia. Atherosclerotic cardiovascular disease 10-year risk scores should be calculated to guide management of risk factors, including lifestyle changes and medications, particularly statins. Average-risk women should be screened for breast cancer with mammography every 1 to 2 years starting at age 40 years. Lung cancer screening with low-dose computed tomography should be offered annually to current and former smokers aged 50 to 80 years with at least a 20-pack-year history. Colorectal cancer screening is recommended in average-risk women aged 45 to 75 years. Cervical cancer screening should be performed every 3 to 5 years, and it should be discontinued in women older than 65 years with negative results on adequate prior screening. Average-risk women 65 years and older should be screened for osteoporosis with dual-energy x-ray absorptiometry. The diagnosis of osteoporosis is based on a T-score of −2.5 or less, and those with a Fracture Risk Assessment Tool score of 3% or greater for hip fracture or 20% or greater for any major osteoporotic fracture should be treated. Postmenopausal women should be routinely screened for high-risk sexual behavior, HIV, hepatitis, depression, anxiety, and substance use disorders.