A women’s health assessment, and what it covers at each stage of life

What a women’s health assessment is

A women’s health assessment is an unhurried appointment with a doctor about your health as a whole, at whatever stage of life you are in. It covers your history, your periods, contraception or plans for pregnancy, your family history, your blood pressure and weight, and the screening you are due, with tests chosen for the questions that come up.

Many questions are answered without a blood test. NICE advises that perimenopause and menopause in women aged 45 or over with typical symptoms are recognised from the symptoms alone, without laboratory tests [1]. The time is best spent on what will change your care.

Why it is done and who it is for

It suits a woman who feels well and wants a clear view of her health, and a woman with a particular concern such as changing periods, tiredness, hot flushes, a family history of breast or ovarian cancer, or plans for a pregnancy. It also suits a woman who has lived in several countries and is unsure which screening she has had, because the doctor can bring the record up to date.

What it covers at each stage of life

In your twenties and thirties the focus is usually contraception, sexual health, planning a pregnancy and cervical screening. In England, cervical screening is offered to women aged 25 to 64, with an invitation every 5 years [2]. If you are planning a pregnancy, NICE advises taking folic acid ideally for 3 months before trying and for at least the first 12 weeks of pregnancy [3].

In your forties, perimenopause often begins, and heart and metabolic health start to matter more. NICE advises reviewing the risk of heart disease and stroke on an ongoing basis from 40 [4], and encourages a type 2 diabetes risk assessment for adults aged 40 and above [5]. A history of gestational diabetes or polycystic ovary syndrome raises the risk of type 2 diabetes, so mention either to the doctor [5].

From 50, breast and bowel screening begin. Breast screening in England is offered to women aged 50 up to their 71st birthday [6], and bowel screening with a stool test called FIT every 2 years from 50 to 74 [7]. Bone health joins the conversation after menopause. NICE advises a fracture risk assessment for all women aged 65 and over, and earlier for women after menopause with risk factors such as a previous fragility fracture or long-term steroid tablets [8].

When family history changes the plan

Family history can move screening earlier or bring in a specialist. NICE recommends that a woman be offered referral if, for example, her mother or sister was diagnosed with breast cancer before 40, her father or brother had breast cancer at any age, two first-degree relatives had breast cancer at any age, or one relative had breast cancer and another ovarian cancer [9]. Write down who had which illness and at what age before you come, because the detail decides the route.

Who it is not for

A general assessment is the wrong place for a new symptom that needs looking at in its own right. A new breast lump, or bleeding after the menopause, has a fast referral route of its own, and NICE sets out when it applies [10]. Tell us about it when you request the appointment so the doctor can focus on it.

If you have heavy bleeding with dizziness or fainting, severe pain in your abdomen, chest pain or sudden breathlessness, call 999 in the UK or the local emergency number elsewhere [11].

Benefits and limitations

The benefit is a clear plan made with a doctor who has the whole picture, with screening on time, menopause symptoms treated, heart and bone risks found while they are easy to change, and your questions answered. Screening has its own evidence. An independent UK review estimated that breast screening prevents around 1,300 deaths from breast cancer each year [12].

Every test also carries limits. The same review found that for every death prevented, around 3 women are treated for a cancer that would not have harmed them [12]. A normal result can reassure too much, and an unexpected one can lead to more tests. The doctor explains what each result would change before you decide to have it.

How you prepare and what to expect

Bring the dates of your last screening tests, any results from other countries, a list of your medicines and supplements, and your family history. The appointment lasts 30 minutes. The doctor takes your history and examines you where it helps, measuring your blood pressure, weight, height and waist. If blood tests are needed, they can be taken the same day or arranged for a morning that suits you.

• Which screening am I due, and has anything been missed?
• Do my symptoms need a test, or can they be recognised without one?
• What is my risk of heart disease, stroke, diabetes and fracture, and what would lower it?
• Does my family history change when or how I should be screened?
• When should we review this again?

How The Wellness can help

A GP appointment gives you time to talk through every stage above with a GMC registered doctor, who can examine you, prescribe, arrange tests and refer you to a named specialist [13]. If menopause is the main question, our page on menopause explains how it is recognised and treated. The Advanced Health blood test adds a hormone profile, full thyroid, iron studies, vitamin B12 and folate, with a consultation included, and samples go to accredited laboratories.

Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, open 7am to 9pm every day, and a doctor can come to your home or hotel in London.