Preventive medicine has a gender problem. Many check-up formats and risk models were developed around a typical patient profile — male, middle-aged — and that reflects both who has traditionally been studied and who tends to show up. The result is that women are often underserved by standard preventive care. The irony is that women in midlife often have as much or more to gain from a thorough assessment than the men for whom these formats were designed.

Why women's preventive health is different

Women's health screening has several distinct dimensions that standard check-ups often handle poorly — or not at all:

  • Perimenopause (typically 40–55): The hormonal transition affects cardiovascular risk, bone density, mood, sleep and metabolic health. Most women navigate it with minimal medical guidance. In women over 45, perimenopause is usually diagnosed from symptoms and cycle changes; NICE advises against hormone tests such as AMH or oestradiol for this purpose. Blood tests are mainly useful in younger women or when the picture is unclear — what matters most is a doctor who takes the symptoms seriously.
  • Breast cancer screening: Mammography is less sensitive in dense breast tissue and is more likely to miss cancers there, especially in extremely dense breasts. For these women, radiology societies support considering supplemental imaging such as MRI or ultrasound, although the USPSTF judged the evidence on its overall benefit insufficient in 2024. Together with cervical screening, this covers the core of breast and cervical cancer screening.
  • Osteoporosis: Bone density loss accelerates dramatically after menopause. A DEXA scan of spine and hip detects osteoporosis before a fracture occurs; US guidelines recommend screening from 65, and earlier after menopause for women at increased risk.
  • Cardiovascular risk: Cardiovascular disease kills more women than all cancers combined, yet women's risk is often underestimated — by patients and physicians alike. Heart attack symptoms can present differently in women. Markers such as ApoB and Lp(a) apply to women just as much as to men.
  • Thyroid: Women are 5–8 times more likely to develop thyroid dysfunction than men. A TSH test (with fT4 if abnormal) is simple and worth doing when symptoms suggest a thyroid problem; routine screening of women without symptoms is not universally recommended because its benefit is unproven.

Health is often shared

Many of the risk factors that matter in prevention — lifestyle, diet, sleep patterns, stress levels — are shared by people who live together. And many of the most effective interventions — dietary changes, exercise habits, sleep hygiene — are far more likely to succeed when a whole household is on board. If you live with a partner, it can make sense for both of you to review your risk factors and plan changes together.

Questions to ask your doctor

  • Given my age and stage of menopause, which screening tests are due — and which are not?
  • Has my cardiovascular risk been assessed, and does the calculator used account for female-specific factors?
  • With dense breast tissue, is supplemental imaging appropriate for me?
  • When should my bone density be measured?

A careful three-generation family history is particularly valuable for families with children — it identifies hereditary risks that affect the next generation and allows timely screening recommendations for them as well.

References

  1. Mehta LS, et al. Acute myocardial infarction in women: a scientific statement from the AHA. Circulation. 2016;133(9):916-947.
  2. Panay N, et al. International Menopause Society (IMS) recommendations and key messages on women's midlife health and menopause. Climacteric. 2025;28(6):634-656. doi:10.1080/13697137.2025.2585487
  3. Monticciolo DL, et al. Breast cancer screening for women at higher-than-average risk: updated recommendations from the ACR. J Am Coll Radiol. 2023;20(9):902-914. doi:10.1016/j.jacr.2023.04.002
  4. NICE. Menopause: identification and management. NICE guideline NG23.
  5. US Preventive Services Task Force. Screening for osteoporosis to prevent fractures: recommendation statement. January 2025.
Prof. Dr. med. Markus Guba

Head of Liver Surgery and Transplantation at LMU University Hospital Munich. Edits this independent journal in a private capacity; views are his own. About →

This article is general information and not individual medical advice. Decisions about tests and treatment belong in a conversation with your own physician.