Menopause is defined as the last menstrual period followed by no menstruation for the next 12 months, when there are no pathological causes for the condition. Menopause is one of the most important events in the female reproductive life cycle, a transition from the reproductive to the nonreproductive stage.

An annual “well-woman” appointment provides an excellent opportunity to counsel patients on maintaining a healthy lifestyle and minimizing health risks. The periodic well-woman medical appointment should include screening, evaluation, and counseling.

Screening recommendations

Breast cancer. There is consistency across multiple organizational guidelines that women benefit from a screening mammography at least every other year from the age of 50 to 74 years. Evidence that screening reduces mortality due to breast cancer is strongest for women age 50 to 69 years.

On the other hand, the American Cancer Society (ACS) recommends performing an annual mammography for women age 45 to 54 years, and biennially for women age 55 years and older.

Cervical cancer. In the elderly population, cancer is one of the predominant causes of mortality and morbidity, and its incidence increases with age. Sixty percent of all cancers and 70% of cancer-related deaths occur in patients aged 65 years and over.

In patients aged 65 and over, cervical cancer has a mortality rate ranging between 40 and 50%. However, there is evidence that regular screening reduces by 80% the risk of cervical cancer due to early detection through a routine papanicolaou (pap) smear test, and treatment of precursor cervical intraepithelial neoplasia can lower the mortality rate from cervical cancer.

According to ACS, screening tests for cervical cancer should be initiated within the first 3 years from the first sexual intercourse or at the latest, at the age of 21. Postmenopausal women should undergo the human papillomavirus and cytology co-testing every five years, or cytology alone every three years, until the age of 65 years. If the last 2 tests yield negative results, screening should be stopped when the patient reaches 65 years of age. Once screening has stopped, it should not be resumed in women older than 65 years, even if they have a new sexual partner.

Screening should be discontinued in women who undergo total hysterectomy for benign disease.

Endometrial cancer and intrauterine

Pathologiesendometrial cancer is the most common gynecologic cancer in developed countries and accounts for nearly 5% of cases and more than 2% of deaths due to cancer in women, worldwide.

Between 4 and 11% of postmenopausal women will experience postmenopausal bleeding, accounting for approximately two-thirds of all gynecologic visits among perimenopausal and postmenopausal women.

The most common causes of uterine bleeding in postmenopausal women are benign and include vaginal or endometrial atrophy, cervical polyps, and submucosal fibroids.

In many European countries, guidelines recommend transvaginal ultrasound as a first-line approach to evaluate postmenopausal bleeding, with histologic assessment.

Gynecologists can have a significant impact on the health of the female patient. Nowadays, women live one-third of their lives after menopause. Therefore, there is plenty of opportunity to cater to the needs of postmenopausal women.

Dr Cátia Paixão Martins. Gynaecology and Obstetrics at HPA – Alvor