Health Maintenance in Postmenopausal Women

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.