Life is busy, we get it. However, it’s always worth making time to prioritise your health. Just like eating a healthy diet and getting enough exercise, scheduling regular check-ups should be an important part of your self-care routine.
But what should you be checking regularly, and why? Dr Lucy Wilkinson – Stella’s clinical advisor – explains.
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What is screening?
Screening is when we check a particular group of people for a health condition. The idea is to spot potential problems before you start showing any symptoms, allowing for early treatment.
This is one of the most effective things that modern medicine has achieved. For example, cervical screening (also known as the smear test) has been saving at least 2000 lives every year since it was introduced to the UK in the 1980s.
These regular checks are a good way to receive an early warning about certain conditions. But they don’t pick up everything. If you’ve spotted new symptoms or something just doesn’t feel right, you should still see your doctor, even if you have had a normal screening test.
This article gives information about screening for women, but you still need to attend these checks if you do not identify as female but were assigned female at birth (AFAB). If you’re not automatically called for these checks but think you should have been, let your doctor know.
An overview of women’s health screening by age
This varies from country to country, but current UK recommendations are:
- Cervical screening from age 25
- Breast screening from age 50 for most women
- Bowel cancer screening from age 60 for most women
- NHS health check from age 40
- Other tests depending on your own medical history
Cervical screening (smear test)
Cervical screening is a life-saving way to detect early changes that could turn into cancer if left untreated. Cervical cancer is the most common cancer in women under 35 and has a good prognosis if caught early enough.
Screening currently focuses on identifying human papillomavirus (HPV) infections. HPV is extremely common. In fact, the vast majority of people who have been sexually active will have encountered this virus, which can be passed on by oral, vaginal or anal sex. While most people will clear the infection with no further consequences, it will cause changes to the cells of the cervix in a small proportion, and it’s these changes which can lead to cervical cancer. Luckily, in most cases affected cells can be treated relatively easily and completely removed.
Currently, all women in the UK are invited for cervical screening from age 25 onwards. You should have this done every three years up until the age of 49 and then every five years from 50 onwards. Once you hit 65, the NHS recommends that screening only needs to continue if one of your last three smears was abnormal.
Will I need cervical screening during or after menopause?
You still need to have cervical screening if you are going (or have gone) through menopause. This is because, despite everything going on with your hormones at this time, changes to your cervix can still happen. Likewise, you need to continue having smears even if you aren’t currently having sex.
The only exception to this is if you have had a hysterectomy including removal of the cervix. If this is the case, you no longer need cervical screening.
Are smears more painful after menopause?
Menopausal changes to the vagina can make having a smear test tricky. The tightness, pain and fragile tissues that can be experienced as part of genitourinary syndrome of menopause (GSM) can make speculum exams painful or even impossible. If this is the case for you, speak to your doctor for advice.
Likewise, if you’re affected by symptoms of GSM in your day-to-day life, they may recommend trying vaginal oestrogen, which is a low-risk and effective treatment available as creams, gels, pessaries and rings. These can sometimes be used short-term in the weeks before your test is due, although should be avoided the night before the test in case it affects your result. Your doctor will be able to advise on whether or not this is a suitable option for you.
Start your free online menopause assessment to see if HRT is right for you
When should I see a doctor?
As well as attending your regular smear tests, you should see a doctor if you have any new or unusual symptoms. This is because screening doesn’t test for all of the causes of abnormal bleeding, and you could need further medical tests to ensure that all is well.
In particular, seek an urgent appointment if you have any:
- Vaginal bleeding between periods
- Bleeding after sex
- Vaginal bleeding if it’s been over a year since your last period (also known as postmenopausal bleeding)
- Abdominal pain
- Bloating
- Changes to your bowel habits (for example, going to the toilet more often than usual)
- Bleeding from your back passage
- Blood in your urine
- Needing to pee more often or more urgently than usual
- Any other symptoms that are new or troubling you
Smear tests are excellent for screening, but they’re often not particularly useful if you have symptoms like abnormal bleeding or pain. If this is the case, your doctor is likely to refer you on for other tests like colposcopy or an ultrasound, depending on your symptoms.
Breast screening (mammograms)
You will be invited for your first mammogram by the time you reach age 53. You will then be recalled every three years until the age of 71. After this point you will not be recalled automatically, but can request to be booked in for screening every three years.
If you have a family history of breast cancer or another risk factor, screening might begin earlier for you. If you think this could be the case, ask your doctor.
Mammograms are a kind of X-ray which can pick up early signs of breast cancer, sometimes when the cancer is too small to feel. This is particularly useful as the earlier breast cancer is caught, the better the prognosis.
Why are mammograms important after menopause?
Breast cancer becomes more common with age. This means that it’s important to keep up with your mammograms as you get older. This is still true if you have breast tenderness or discomfort related to menopause. While the test may be uncomfortable, it’s really worthwhile.
You should also be aware that some forms of HRT can increase your risk of breast cancer.
Learn more about the risks and benefits of HRT.
When should I see a doctor?
Whether or not you’ve had a normal mammogram, you should still see a doctor if you notice any changes to your breasts.
These include:
- Breast lumps
- Changes to the size or shape of your breasts
- Skin changes including dimpling or eczema on or around the breast
- Bleeding or discharge from the nipple
- Lumps in your armpit
- Pain or discomfort
Read the NHS guide to checking your breasts.
Bowel cancer screening
Bowel cancer becomes more common as we age, so it’s important to attend screenings when called. Screening has been shown to reduce your risk of dying from bowel cancer.
The age that you’ll be invited for NHS bowel cancer screening varies depending on whereabouts you live:
- 60 if you live in England. But the programme is expanding, and by 2025 everyone aged over 50 will be invited to take part.
- 50 if you live in Scotland
- 55 if you live in Wales
- 60 if you live in Northern Ireland
Follow-up screening tests then happen every two years. You might be invited for screening earlier or in a different way (by colonoscopy) if you are at higher risk of bowel cancer – for example, due to your family or personal medical history.
Using a home test kit known as the faecal immunochemical test (FIT), you collect a small amount of poo. This is then sent off to the lab where it is checked for blood. Even tiny amounts can be detected.
As bleeding can be a sign of cancer and precancerous growths called polyps, anyone with a positive test will be invited for further investigations. Bowel cancer can be treated more effectively if it’s caught early, and polyps can often be removed as a day case procedure.
When should I see a doctor?
You should see your doctor urgently if you notice:
- A change in your bowel habit (for example, looser poo or going to the loo more often)
- Abdominal pain
- Bleeding from your back passage
- Abdominal swelling or bloating
- Weight loss
- Any other new or worrying symptoms
This is true even if you have had a recent negative screening test. While screening is helpful, it does not cover all bases. There are many other possible causes for these symptoms that require different tests, sometimes urgently.
The NHS health check
This is a general checkup offered by the NHS for everyone aged over 40. The idea is to give you an overview of your health including:
- Cholesterol
- Blood pressure
- Heart and cardiovascular health
- Kidney function
- Blood sugar levels
- Weight and body mass index
You’ll also be given advice on how to stay healthy in the long term and tackle any risk factors that are present. This could include advice on weight, blood pressure and diabetes among others. Any issues or new conditions identified will be flagged to your doctor, who can then advise accordingly.
This is particularly important as you go through menopause, because some conditions related to these risk factors become more common after this time. The check may also flag up conditions which could make HRT more risky or unsuitable for you.
You will automatically be called for an NHS health check every 5 years. If you think yours might be overdue, you should be able to book it in yourself by contacting your GP surgery.
Other tests depending on your own medical history
Depending on your own medical history, your doctor may advise other screening tests. Examples include:
- Regular eye and foot checks if you have diabetes
- Routine screening tests in pregnancy
- Early cholesterol tests if you have a strong family history of heart disease, or familial hypercholesterolaemia
Your doctor will be able to advise you about which tests you need.
Final word
Screening is a valuable part of your healthcare and it’s important to stay up-to-date. However, if you have any new or unexplained symptoms, it’s equally important to get them checked out properly by your doctor as screening tests only look for a handful of specific illnesses.
If you would like any further information, speak to your own doctor.
Find out more about menopause on our blog or in our symptoms library.
Cancer Research UK information on cervical screening: https://www.cancerresearchuk.org/health-professional/screening/cervical-screening
NHS information on cervical screening: https://www.nhs.uk/conditions/cervical-screening/
Jo’s Trust information on cervical screening after menopause: https://www.jostrust.org.uk/about-us/news-and-blog/smear-tests-after-menopause
Jo’s Trust information on cervical screening for transmen and non-binary people: https://www.jostrust.org.uk/information/cervical-screening/trans-non-binary
NHS information on breast screening: https://www.nhs.uk/conditions/breast-screening-mammogram/
Cancer Research UK information on breast screening: https://www.cancerresearchuk.org/about-cancer/breast-cancer/getting-diagnosed/screening/breast-screening
NHS information on checking your breasts: https://www.nhs.uk/common-health-questions/womens-health/how-should-i-check-my-breasts/
NHS information on bowel cancer screening: https://www.nhs.uk/conditions/bowel-cancer-screening/
Bowel cancer UK information on screening: https://www.bowelcanceruk.org.uk/about-bowel-cancer/screening/
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