In your 30s, your “Annual Physical” was a quick chat, a blood pressure cuff, and a Pap smear. In your 50s and beyond, that is negligence. Your body has lost its primary protector (estrogen). The warranty has expired, and you are now in the “Active Maintenance” phase. You cannot rely on your General Practitioner to remember everything. You must be the CEO of your own health. This is your Annual Audit. Print it out. Take it to your appointment.
1. The Cardiovascular Panel (The Big One)
Heart disease is your #1 threat. A basic “Total Cholesterol” number is useless. Demand these labs:
- ApoB: The most accurate count of atherogenic particles (better than LDL).
- Lp(a): A genetic risk marker. (Test once in a lifetime; if high, you need aggressive management).
- Hs-CRP: A marker of systemic inflammation.
- Fasting Insulin: Not just Glucose. Insulin rises years before blood sugar does. If this is > 6, you are becoming resistant.
2. The Bone Audit
Do not wait until you break something.
- DEXA Scan: Every 2 years (insurance usually covers every 2 years post-menopause).
- Check: Ask for the “TBS” (Trabecular Bone Score) if available—it measures bone quality, not just density.
- Height Check: Have them actually measure you. Losing more than 1.5 inches helps diagnose silent vertebral fractures.
3. The Cancer Screenings
The schedule changes now.
- Mammogram: Annual. (Ask for 3D/Tomosynthesis).
- Note: If you have dense breasts, add the Ultrasound.
- Colonoscopy: Every 10 years (or every 5 if they found polyps). Remember, start at 45 now.
- Pelvic Exam: You still need this!
- Even if you don’t need a Pap (over 65 or hysterectomy), you need a Vulvar/Vaginal Check.
- The doctor should check for GSM (atrophy), Lichen Sclerosus (a common skin condition), and vulvar cancer.
- Skin Check: Full body check by a dermatologist annually. Estrogen loss thins the skin, making it more susceptible to UV damage.
4. The Thyroid Check
Thyroid symptoms (fatigue, weight gain, hair loss) look exactly like menopause symptoms. Do not let them just run “TSH.” Demand the full panel:
- TSH
- Free T3 & Free T4
- TPO Antibodies (to rule out Hashimoto’s, which flares in midlife).
5. The Sensory Audit
These are often ignored until they fail.
- Eye Exam: Every year. You are checking for Glaucoma and Macular Degeneration. Estrogen loss causes dry eye, which can damage the cornea if untreated.
- Hearing Test: Baseline at 50, then every few years. As discussed, hearing loss is the #1 modifiable risk factor for dementia. Catch it early.
6. The Vaccine Update
Your immune system is aging (immunosenescence).
- Shingles Vaccine (Shingrix): Get it at 50. Shingles is a nightmare you want to avoid.
- Pneumonia Vaccine: Usually at 65, but ask if you have asthma/risk factors.
- Tetanus/Whooping Cough booster: Every 10 years.
7. The “Vitals” That Matter
- Blood Pressure: Don’t trust the one reading in the office (White Coat Syndrome). Buy a cuff. Measure it at home for a week. If it averages > 120/80, treat it. Hypertension ruins kidneys and brains.
- Waist Circumference: The scale lies. The tape measure tells the truth about visceral fat. Keep it under 35 inches (for women).
This feels like a lot of work. It is. But high-performance machines require high-level maintenance. You are building a body that needs to last you another 40 years. Do the maintenance, and the machine will run.