Why Health Screenings Matter More After 35

For many women, turning 35 doesn’t feel dramatic—but internally, important changes are already underway. Hormones begin to fluctuate, stress compounds, metabolism shifts, and risks for conditions like heart disease, diabetes, thyroid disorders, bone loss, and mood disorders quietly increase.

This is also the age range when perimenopause can begin, often years before menopause and long before many women—or providers—name it. Because symptoms can be subtle or inconsistent, they’re frequently dismissed as stress, burnout, or “normal aging.”

The reality is this:

Your mid-30's and 40's are critical prevention window:

Annual and perimenopause-focused health screenings help you:

• Establish baselines before major hormonal shifts
• Catch health issues early—when they’re easiest to manage
• Understand what’s hormonal versus something else
• Advocate for care instead of being dismissed

In this guide we’ll cover the most important annual health screenings for women over 35, with special attention to perimenopause-related health risks—so you know what to prioritize and why.

What Health Screenings Should Women Over 35 Get?

Women over 35 should receive annual health screenings that include blood pressure, cholesterol, blood sugar, thyroid testing, cervical cancer screening, breast health exams, mental health screening, and bone health assessment.

These screenings are especially important because perimenopause may begin during this stage, increasing the risk of heart disease, metabolic changes, bone loss, and mood disorders—often before symptoms appear.

Here's what every woman over 35 should prioritize:

• Annual well-woman exam
• Blood pressure screening
• Cholesterol and lipid panel
• Blood sugar and A1C testing
• Thyroid function testing
• Pap smear and HPV testing
• Breast exams and mammograms
• Bone health and vitamin D assessment
• Mental health screening
• STI screening

1. Annual Well-Woman Exam (With a Perimenopause Lens)

How often: Every year

Your annual well-woman exam is the foundation of preventive care. After 35, it should go beyond basic checklists and focus on patterns and changes over time.

This visit should include discussion of:

• Changes in cycle length, flow, or regularity
• Worsening PMS, anxiety, irritability, or sleep disruption
• Libido changes or vaginal dryness
• Fertility goals or pregnancy history
• Family history of heart disease, osteoporosis, or thyroid conditions

Many early perimenopause symptoms don’t show up clearly on lab work. Context matters, and this appointment is where that context should be taken seriously.

2. Blood Pressure & Cardiovascular Screening

How often: At least once per year

Heart disease is the leading cause of death in women, and risk begins rising well before menopause.

Estrogen helps protect blood vessels. As hormone levels fluctuate in the late 30s and 40s, blood pressure and vascular inflammation can increase—even in women with no prior history.

Women with a history of:

• Preeclampsia
• Gestational hypertension
• Gestational diabetes

Have a significantly higher lifetime risk of cardiovascular disease and should be monitored closely.

3. Cholesterol & Heart Health Labs

How often: Every 4–6 years (or more often if elevated)

A standard lipid panel measures:

• Total cholesterol
• LDL (“bad” cholesterol)
• HDL (“good” cholesterol)
• Triglycerides

Many women see cholesterol rise during perimenopause without any lifestyle changes. This is hormonally influenced and often misunderstood.

Tracking trends over time—rather than relying on a single “normal” result—helps identify cardiovascular risk early, when prevention is most effective.

4. Blood Sugar, Insulin Resistance & Metabolic Health

How often: Every 3 years, or more often if risk factors exist

Perimenopause is a common time for insulin resistance to emerge. Declining estrogen affects how the body processes glucose and stores fat, especially around the abdomen.

Screening typically includes:

• Fasting blood glucose
• Hemoglobin A1C

Signs this screening matters:

• Weight gain despite unchanged habits
• Increased belly fat
• Energy crashes or brain fog
• Strong sugar cravings

Women with a history of gestational diabetes or PCOS should be screened more frequently, as risk persists long after pregnancy.

How Health Screening Needs Change After 35

5. Thyroid Screening

How often: Every 5 years, or sooner if symptomatic

Thyroid disorders disproportionately affect women and often appear during hormonal transitions like postpartum and perimenopause.

Symptoms frequently overlap with perimenopause and are often dismissed:

• Fatigue
• Hair thinning
• Anxiety or depression
• Brain fog
• Irregular cycles

Autoimmune thyroid conditions commonly emerge in the 30s and 40s, making screening especially important during this stage.

6. Cervical Cancer Screening (Pap Smear & HPV Test)

How often:

• Ages 30–65: Pap + HPV testing every 5 years (or Pap alone every 3 years)

HPV exposure is common, but persistent infection is what increases cervical cancer risk. Regular screening detects abnormal cellular changes long before cancer develops.

7. Breast Health Screening

How often:

• Breast self-awareness: monthly
• Clinical breast exam: annually
• Mammograms: typically begin between 40–50, depending on risk

Hormonal changes, pregnancy, breastfeeding, and aging all alter breast tissue. Knowing your baseline helps you recognize changes early.

Women with dense breast tissue or a family history of breast cancer may need earlier or additional imaging like an ultrasound instead of a mammogram. 

8. Bone Health & Vitamin D

How often: Vitamin D as needed; bone density baseline if high risk

Bone loss doesn’t begin at menopause—it can start during perimenopause, years earlier than most women realize.

Estrogen plays a key role in maintaining bone density. As levels fluctuate, bone breakdown can quietly outpace rebuilding.

Risk factors include:

• Family history of osteoporosis
• Low body weight
• Thyroid disorders
• Eating disorders
• Chronic stress or under-nutrition

Early screening provides a baseline and helps guide preventive strategies.

9. Mental Health Screening

How often: At least annually

Mood changes during perimenopause are biological, not a personal failure. Anxiety, depression, irritability, rage, and emotional volatility are common—and frequently underdiagnosed.

Mental health screenings help distinguish between:

• Hormonal shifts
• Situational stress
• Clinical mood disorders

Support is part of medical care, not an optional extra.

10. STI Screening

How often: Annually or with new partners

STI risk does not disappear with age or long-term relationships. Screening remains an important part of preventive care at every life stage.

What Health Screenings Are Important During Perimenopause?

During perimenopause, women should prioritize screenings for heart health, blood sugar, thyroid function, bone density risk, mental health, and hormone-related symptom changes.

Hormonal fluctuations during perimenopause affect multiple systems in the body, making early detection and trend tracking critical for long-term health.

At What Age Should Women Start Perimenopause Screenings?

Women should begin perimenopause-focused health screenings in their mid-30s, especially if they experience cycle changes, sleep disruption, anxiety, or unexplained weight changes.

Perimenopause can begin years before menopause, and early screening helps establish baselines and identify silent health risks.

Frequently Asked Questions About Health Screenings After 35

Can perimenopause start before 40?

Yes. Perimenopause can begin in the mid-to-late 30s. Symptoms may include shorter or longer cycles, sleep issues, anxiety, mood changes, or heavier periods—even when labs appear “normal.”

Do women over 35 need hormone testing?

Routine hormone testing is not always required, but symptom tracking combined with metabolic, thyroid, and cardiovascular screening often provides more useful insight during perimenopause.

Why is heart disease risk higher after 35?

As estrogen fluctuates, its protective effect on blood vessels decreases. Pregnancy complications, stress, and metabolic changes further increase risk during this stage.

Are mental health symptoms during perimenopause normal?

Mood changes are common during perimenopause due to hormonal shifts, but they should never be dismissed. Screening helps identify appropriate support options.

What Every Woman Over 35 Should Know

• Perimenopause can begin years before menopause
• Hormonal changes affect heart, bone, brain, and metabolism
• Many health conditions develop silently without symptoms
• Annual screenings help detect issues early
• “Normal labs” don’t always mean optimal health
• Prevention after 35 shapes long-term health

Screenings now shape your health for decades to come.

How to Advocate for Yourself After 35

• Ask for baseline labs—even if you feel fine
• Track trends year over year, not just single results
• Speak up about subtle changes in sleep, mood, or cycles
• Request explanations, not reassurance alone

Your body isn’t failing—it’s transitioning.

Final Thoughts

Health after 35 isn’t about waiting for something to go wrong. It’s about awareness, prevention, and informed care during a powerful hormonal transition. Perimenopause deserves attention—not dismissal and preventive screenings are one of the strongest tools women have to protect their future health.

Source: 

American College of Obstetricians and Gynecologists (ACOG)

National Women’s Health Fact Sheet (womenshealth.gov)

U.S. Preventive Services Task Force & HRSA Women’s Preventive Services Guidelines