Recommended Medical Tests for Postmenopausal Women
All postmenopausal women aged 65 and older should undergo bone density screening with DEXA scan, while those aged 60-64 with risk factors (weight <70 kg, no estrogen use, smoking, family history) should also be screened. 1
Bone Health Assessment
- DEXA scan at femoral neck is the gold standard for osteoporosis screening, as it best predicts hip fracture risk and is comparable to forearm measurements for predicting fractures at other sites 1
- Postmenopausal breast cancer survivors require baseline DEXA scan regardless of age, with repeat scans every 2 years if taking aromatase inhibitors or if chemotherapy-induced premature menopause occurred 1
- Minimum 2-year intervals between repeat DEXA scans are necessary to reliably detect true bone density changes due to precision limitations 2
- Shorten rescreening intervals if new glucocorticoid therapy initiated, incident fragility fracture occurs, significant weight loss (especially below 70 kg), or development of secondary bone loss conditions 2
Cardiovascular Risk Assessment
- Lipid panel monitoring is essential, as cardiovascular disease is the leading cause of death in postmenopausal women 1, 3
- Calculate 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores to guide statin therapy and lifestyle modifications 3
- Blood pressure measurement should be performed periodically 4
- Screen for diabetes mellitus as a cardiovascular risk factor 3
Cancer Screening
- Mammography every 1-2 years starting at age 40 for average-risk women 3
- Annual gynecologic assessment specifically for postmenopausal women on selective estrogen receptor modulators (tamoxifen) to monitor for endometrial changes 1
- Cervical cancer screening every 3-5 years until age 65, then discontinue if adequate prior negative screening 3
- Colorectal cancer screening starting at age 45-50 using FOBT annually, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years 1, 3
- Low-dose CT for lung cancer screening annually in women aged 50-80 with ≥20 pack-year smoking history (current or former smokers who quit within 15 years) 1, 3
Hormonal and Metabolic Testing
- TSH measurement to identify thyroid dysfunction as a reversible cause of symptoms or bone loss 5
- Pregnancy test must be performed first if any menstrual irregularity or amenorrhea present, even in perimenopausal women 5
- For women with prior hysterectomy and intact ovaries (age ≤60), measure LH, FSH, and estradiol to accurately assess menopausal status before initiating systemic therapy 5
Infectious Disease and Mental Health Screening
- HIV screening for those with high-risk sexual behavior 3
- Hepatitis screening as indicated by risk factors 3
- Depression and anxiety screening at each clinical encounter, with more probing assessment for high-risk groups (young patients, prior psychiatric history, low socioeconomic status) 1
- Substance use disorder screening 3
Symptom-Specific Assessments
- Cognitive function assessment by asking about cognitive difficulties at each visit 1
- Pain assessment using simple pain scale at each encounter 1
- Fatigue evaluation with assessment for reversible causes (anemia, thyroid dysfunction, cardiac dysfunction) 1
- Sexual dysfunction screening with assessment for reversible contributing factors 1
Common Pitfalls to Avoid
- Do not order routine laboratory tests or imaging (except mammography) for cancer recurrence detection in asymptomatic breast cancer survivors, as this has no proven benefit 1
- Do not assume chemotherapy-induced amenorrhea equals menopause in cancer survivors, as hormone levels during tamoxifen treatment are unreliable 5
- Do not perform DEXA scans more frequently than every 2 years unless specific clinical changes warrant earlier reassessment, as precision limitations make shorter intervals unreliable 2
- African-American women have higher baseline bone density and are less likely to benefit from screening at younger ages compared to white women 1