A comprehensive mid-life checkup is essential to preventing long-term problems and enhancing the body’s functions. A mid-life checkup provides you and your healthcare practitioner with an opportunity to discuss your family medical history, evaluate your current health condition, and screen for potential future problems. It also establishes a baseline for monitoring the many “normal” physical and hormonal changes you go through with age—which is especially important for women approaching menopause, but also useful for detecting conditions that are not related to menopause as well.
Many conditions are more likely to develop—or begin developing—during mid-life, such as:
- Thyroid disorders
For these reasons, both the North American Menopause Society (NAMS) and the American College of Obstetrics and Gynecology (ACOG) have published guidelines regarding comprehensive health evaluations for women at mid-life. Such a checkup should include:
- A detailed medical history, including psychological and social concerns
- A complete physical exam, including height, weight, and blood pressure, as well as breast, pelvic, and thyroid exams
- Laboratory tests, including blood tests to check hormones and other biomarkers for thyroid, ovarian, cardiovascular, and metabolic functions
Providing a Medical History
A thorough medical history is essential to accurately evaluate an individual’s risk for potential health problems. Many conditions, such as thyroid dysfunction, tend to run in families. Include any psychological concerns in addition to physical health concerns.
Habits that commonly affect your quality of health include:
- Stress management
- Tobacco use
- Alcohol consumption
An honest discussion about your lifestyle will help assess their impact on your long-term health and allow your healthcare practitioner to recommend changes to promote well-being.
Tell your healthcare practitioner about all surgeries or procedures, including a complete list of past and current medications. Include all prescription and non-prescription treatments, as well as alternative or natural remedies and supplements. Mixing treatments may cause one or more of them to be less effective or may prove harmful.
The Physical Exam
An annual physical exam typically includes breast and pelvic exams to screen for cancer, as well as a thyroid exam. A physical exam also measures height, weight, and blood pressure that will help provide a context for changes with age. With these three simple measures, your healthcare practitioner can begin to assess your risk for osteoporosis, cardiovascular disease, and obesity-related concerns such as diabetes and gall bladder disease.
Measuring your healthy, adult height is useful for catching signs of osteoporosis. Height should be measured at approximately the same time of day each visit, if possible, as it varies slightly throughout the day. An overall height loss of more than 1.5 inches from your maximum adult height may indicate osteoporosis. If you experience height loss or are at risk for osteoporosis, your healthcare practitioner may suggest a bone density test for a more accurate assessment. (For more information on bone health, see our related Connections articles No Bones About It! and Osteoporosis.)
Weight is an important indicator of potential health problems, especially if you are overweight. Obesity is strongly associated with many conditions, including:
- Gall stones
- Certain types of cancers
Your healthcare practitioner is not only interested in your current weight, but any trends over time. Unexplained weight gain or loss, in combination with other symptoms, may contribute to a diagnosis of other health problems. Other weight-related indicators your healthcare practitioner might discuss are body mass index (BMI) and body shape.
BMI is a measure of body fat based on height and weight. While it is not a perfect indicator, a woman with a BMI rating of 30 or greater is considered obese. This means that, if she does not lose the extra weight, she is more likely to face additional health problems than a woman who is at a normal weight.
Because using BMI may be an imprecise measure of weight health, body shape, or waist circumference may be a better indicator of health risks. Waist-to-hip ratio provides an estimate of intra-abdominal fat, often described in terms of “apple” or “pear” shaped body types. Excess fat in the waist or stomach area (the apple shape) is more closely associated with conditions such as diabetes, hypertension, and heart disease than excess in the hip area (the pear shape).
A woman with a waist circumference greater than 35 inches (40 inches for men) is considered to be at greater risk for heart disease and Type 2 diabetes. If you are overweight at mid-life, attaining and maintaining a normal weight for your height and body type is one of the most important measures you can take to improve your long-term health. (For more information, see our Connections article “Weighing In” on Hormone Balance.)
High blood pressure (hypertension) is a fairly reliable indicator of cardiovascular disease, especially in women. Women who have used oral contraceptives are more likely to have high blood pressure, and women who are post-menopausal and/or of African descent are at the greatest risk for cardiovascular disease. Hypertension does not exhibit symptoms, so it is important to check your blood pressure regularly—especially at mid-life, as its occurrence increases with age.
For a more accurate reading, blood pressure should be checked two ways:
- While you are seated, after sitting quietly for approximately 5 minutes
- Using a method called the Ragland postural test, in which you lie quietly on your back for 5 minutes, take a blood pressure reading, stand up, and immediately take another reading.
Sustained elevated readings may indicate the need for lifestyle changes, such as changing your diet and getting more exercise; your healthcare practitioner may also suggest medical treatment.
Low blood pressure (hypotension) may also occur in mid-life. Symptoms include cold hands or feet, weakness or light-headedness, and heart palpitations. Mention these symptoms to your healthcare practitioner, as they are also associated with low adrenal function. (For more information, see our Connections article on High Blood Pressure.)
As of 2020, a woman’s lifetime risk of developing breast cancer is considered to be approximately 1 in 8. As a result, most women have already had a clinical breast exam by the time they reach mid-life. While the risk of breast cancer declines with age, the risk never totally disappears, so continue annual breast exams with your healthcare practitioner. (For more information, see our Connections article on Breast Health Awareness.)
An annual pelvic exam, including a Pap test and a rectal exam, is just as important during mid-life as it is during the childbearing years. At mid-life, a pelvic exam provides an opportunity to screen for uterine, ovarian, and endometrial cancer. The rectal exam screens for colorectal cancer, the third most common cancer among both men and women in the United States.
Most healthcare practitioners recommend annual pelvic exams, even if the uterus and both ovaries have been removed. The primary purpose of a Pap test is to screen for cancerous or pre-cancerous conditions in the cervix and vagina. It may also be used to evaluate hormonal changes or their effects.
Thyroid dysfunction is particularly prevalent among women and the elderly. During a mid-life checkup, your healthcare practitioner will probably examine the area near your thyroid (on your neck) to see if it is enlarged. If you exhibit any symptoms that could be thyroid related, he or she may also request lab tests to assess thyroid function. (For more information, see our Connections article on Hypothyroidism.)
A comprehensive mid-life checkup will most likely include laboratory tests to assess your thyroid, ovarian and cardiac functions, especially if you have known risk factors. Depending on your family history and other risk factors or symptoms, your healthcare practitioner may also want to evaluate your glucose tolerance to screen for diabetes and related conditions.
Laboratory tests that measure hormone levels can provide detailed information about thyroid function. The thyroid-related hormones most often measured include triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH). These hormones primarily regulate metabolism, but also affect protein synthesis, carbohydrate and lipid metabolism, and vitamin absorption.
The thyroid hormones most often measured include triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) to get the full picture of a patient’s thyroid function. These hormones primarily regulate metabolism, but also affect protein synthesis, carbohydrate and lipid metabolism, and vitamin absorption. TSH is a pituitary secretion that triggers the thyroid gland to release T3 and T4 into the bloodstream.
Another indicator of thyroid imbalance is measuring reverse T3, which blocks normal T3 activity at the receptor sites and T4 transport into the cell. Testing for thyroid antibodies will alert you to the possibility of autoimmune thyroiditis. However, some practitioners believe that the typical thyroid test results may not be an accurate indicator of thyroid function because they do not account for the intracellular effects of the hormone.
The Barnes basal temperature test is another way to check thyroid function:
- Before going to sleep, put an ordinary thermometer next to your bed
- In the morning, upon awakening and with as little movement as possible, place the thermometer under your armpit and lie quietly for ten minutes
If your temperature is between 97.8º and 98.2º, your thyroid is probably functioning normally; if not, talk to your healthcare practitioner about requesting more detailed thyroid testing.
Most women associate menopause with a decline in ovarian function, primarily resulting from decreasing estrogen levels. But the shift from pre- to post-menopause is complex and may be a lengthy transition. Many healthcare practitioners agree that reproductive aging precedes menopause by at least 10 years.
Despite the decline in fertility that accompanies aging, women can still become pregnant until menopause is confirmed (usually 12 consecutive months without menses). Knowing if or when you are menopausal is not as important as accurately assessing your ovarian function, because that will play a far greater role in your overall health and well-being.
A mid-life checkup can help you evaluate your reproductive and hormonal health. It also helps prepare you for the changes ahead. Many of these changes disrupt ovarian function, such as:
- Estrogen levels fluctuate and decline with age while other hormones fluctuate and rise
- The number of follicles rapidly declines
- The ovaries begin to decrease in size
- Menstrual cycles become more erratic
Healthcare practitioners sometimes measure follicle-stimulating hormone (FSH) to gauge if you are near menopause. However, oral contraceptives and other medications may interfere with FSH and other hormone levels. Confer with your healthcare practitioner about stopping them for several weeks before the lab tests to achieve a good reading.
Once you are past menopause, the levels of estradiol (the primary estrogen produced) and estrone (the second most abundant estrogen) are significantly reduced, and the ratio of the two is reversed, with estrone becoming more abundant than estradiol. During the years preceding menopause, however, these measures are of little value because hormone levels can fluctuate widely. Hormone testing, in conjunction with keeping track of symptoms such as irregular bleeding and hot flashes, will help you and your healthcare practitioner monitor your ovarian and hormonal health at mid-life.
Because cardiovascular disease is the leading cause of death among both men and women, a mid-life checkup should include a thorough assessment of cardiac function. Blood pressure is one component of that assessment, while cholesterol levels and other biomarkers are used to complete the picture.
Cholesterol tests typically measure the total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Cholesterol levels may fluctuate with stress and the time of year. Therefore, calculating an average from multiple screenings may yield a more accurate assessment.
In the past, it was thought that reducing overall cholesterol should be the goal to prevent cardiovascular disease. However, additional evidence then indicated that the ratio of total cholesterol to HDL was a better indicator of heart disease than the levels of LDL or total cholesterol. Now, taking into account data from nearly 20 years of long-term studies, high cholesterol is not regarded as predictive of heart disease as originally thought for people under 60 years of age, and smoking and high blood pressure are considered more reliable predictors of heart attack or stroke for people at mid-life.
Oxidized LDL is emerging as a more important cardiovascular marker than the usual cholesterol measurements. Oxidation in the body is analogous to rusting. This test can help measure the level of oxidative stress in the body, which some practitioners believe is more predictive of heart disease, heart attacks, and other health problems.
Other biomarkers considered to be indicators of cardiac risk include:
- High-sensitive C reactive protein (hsCRP), which measures inflammation, is considered to be an indicator of the risk of heart attack or stroke.
- Homocysteine, which is associated with stress, is an extremely irritating molecule and results in cardiovascular tissue damage and clogged arteries. Deficiencies of folic acid and vitamins B6 and B12 can increase homocysteine levels.
- Elevated levels of fibrinogen, a blood coagulant, may also indicate a higher risk for cardiovascular disease.
Each of these biomarkers may be improved with lifestyle changes, including increased exercise. (For more information, see our Connections article Matters of the Heart.)
Glucose and Insulin Tolerance
Impaired glucose function (diabetes mellitus) is associated with or a known contributor to many other health problems, including:
- Excess weight
- Hormone imbalances
- Accelerated aging
Prediabetes and Type 2 diabetes (formerly called adult-onset diabetes, but now found in younger age groups as well) have become so common that they are considered to be nearly epidemic, with potentially deadly consequences.
The onset of diabetes may precede its diagnosis by a decade or more, and many people develop the disease without realizing it. For anyone who is obese or has a family history of diabetes, a mid-life checkup should include glucose/insulin testing. People in ethnic groups that have a higher incidence of diabetes (such as patients of African, Hispanic, or Native American descent) should also have their glucose/insulin function tested regularly.
Predicting the risk of diabetes as early as possible allows for more time to make the necessary lifestyle changes to possibly prevent its occurrence. Routine preventive measures include fasting glucose tests to predict metabolic syndrome and diabetes. However, testing for fasting insulin also provides an earlier warning sign because abnormalities in insulin function tend to show up sooner than in glucose.
A biomarker commonly measured for evaluating long-term blood glucose control is glycated hemoglobin (A1C). The blood test for A1C measures the level of glucose attached to hemoglobin, the oxygen-carrying protein in red blood cells. Glycation, the process by which glucose attaches to a cell, is associated with cell aging. High hemoglobin A1C is not only associated with diabetes but also metabolic syndrome, heart disease, dementia, and some cancers. (For more information, see our Connections articles on Insulin Resistance and Diabetes.)
Another important biomarker to keep tabs on at mid-life and beyond is vitamin D, a hormone, which plays a crucial role in maintaining the health of bones, brain, and blood vessels. Vitamin D has also emerged as having a strong anti-cancer effect. Because our primary source of vitamin D is sunshine, it is nearly impossible for people in the northern climes, and those who consistently use sunscreen, to maintain adequate levels of vitamin D without supplementation. (For more information, see our Connections article Vitamin D: The Sunshine Hormone.)
For some people, a comprehensive mid-life checkup may be a lifesaver. Advancements in our understanding of the various biomarkers mentioned can alert you to potential underlying health issues. Perhaps more importantly, a mid-life checkup may steer you toward lifestyle changes that might prevent future health problems and improve your long-term well-being.