Health Maintenance in Postmenopausal Women

 

Cardiovascular disease is the leading cause of death and disability in postmenopausal women older than 50 years. Clinicians should use the pooled cohort risk assessment equations or another risk calculator every three to five years to estimate a woman's 10-year risk of atherosclerotic cardiovascular disease, including myocardial infarction and stroke. Major guidelines concur that women at average risk of breast cancer benefit from screening mammography at least every other year from 50 to 74 years of age. Several effective options for colorectal cancer screening are recommended for women 50 to 75 years of age. Cervical cancer screening should occur at three- or five-year intervals depending on the test used, and can generally be discontinued after 65 years of age or total hysterectomy for benign disease. Screening for ovarian cancer is not recommended. Clinicians should consider screening for sexually transmitted infections in older women at high risk. Postmenopausal women should be routinely screened for depression, alcohol abuse, and intimate partner violence.

Postmenopausal women have a number of unique health-promotion and disease-prevention needs. However, many effective preventive health strategies for postmenopausal women are underutilized.1 This article reviews evidence-based preventive services recommendations for asymptomatic post-menopausal women from the U.S. Preventive Services Task Force (USPSTF), which are supported by the American Academy of Family Physicians. Relevant guidelines from other professional groups are also described.

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Women at average risk of breast cancer benefit from screening mammography at least every other year from 50 to 74 years of age.

A

3841

Cervical cancer screening should be discontinued at 65 years of age.

A

52, 54

Women 50 to 75 years of age should undergo some form of colorectal cancer screening.

A

56

Women at high risk of sexually transmitted infections should receive intensive behavioral counseling and screening.

B

61, 62


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Women at average risk of breast cancer benefit from screening mammography at least every other year from 50 to 74 years of age.

A

3841

Cervical cancer screening should be discontinued at 65 years of age.

A

52, 54

Women 50 to 75 years of age should undergo some form of colorectal cancer screening.

A

56

Women at high risk of sexually transmitted infections should receive intensive behavioral counseling and screening.

B

61, 62


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

BEST PRACTICES IN PREVENTIVE MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not screen for ovarian cancer in asymptomatic women at average risk.

American College of Obstetricians and Gynecologists

Do not screen low-risk women with cancer antigen 125 or ultrasonography for ovarian cancer.

Society of Gynecologic Oncology

Do not perform screening for cervical cancer in low-risk women 65 years or older or in women who have had a total hysterectomy for benign disease.

American College of Preventive Medicine

Do not screen women older than 65 years for cervical cancer who have had adequate prior screening and are not otherwise at high risk of cervical cancer.

American Academy of Family Physicians


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN PREVENTIVE MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not screen for ovarian cancer in asymptomatic women at average risk.

American College of Obstetricians and Gynecologists

Do not screen low-risk women with cancer antigen 125 or ultrasonography for ovarian cancer.

Society of Gynecologic Oncology

Do not perform screening for cervical cancer in low-risk women 65 years or older or in women who have had a total hysterectomy for benign disease.

American College of Preventive Medicine

Do not screen women older than 65 years for cervical cancer who have had adequate prior screening and are not otherwise at high risk of cervical cancer.

American Academy of Family Physicians


Source: For more information on the Choosing Wisely Campaign,

The Authors

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I. CORI BAILL, MD, is an adjunct associate professor at the University of Central Florida College of Medicine, Orlando....

ANALIA CASTIGLIONI, MD, is an associate professor of internal medicine and medical education at the University of Central Florida College of Medicine.

Address correspondence to I. Cori Baill, MD, University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Box 317H, Orlando, FL 32827 (e-mail: i.cori.baill@ucf.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations

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