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Women's health checks and screening by age: what to ask your GP and when

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Screening is one of the few parts of healthcare that comes to you: you get a letter and a test catches changes before they cause symptoms. The invitations only work if you are registered with a GP and your address is up to date, and they do not cover everything worth discussing. This guide walks through the main checks by age, using the NHS in England as the example, and suggests questions to take to your GP. The ages and intervals below are the current NHS England arrangements. They are reviewed from time to time and differ slightly in Scotland, Wales and Northern Ireland and in other countries, so check the NHS website or ask your surgery for what applies to you.

Your twenties

Cervical screening starts at 25. It is often called a smear test, but in England the sample is now tested first for high-risk types of HPV, the virus that causes almost all cervical cancers. Only samples that contain HPV are checked for cell changes.
  • Who is invited: everyone with a cervix aged 25 to 64 who is registered with a GP.
  • How often: NHS England now invites people with a negative HPV result every 5 years across the whole age range. If HPV is found, you will be asked back sooner.
  • Worth knowing: you can ask for a female nurse, a smaller speculum, or a longer appointment if you find the test difficult. Tell the person doing it if you are anxious or have had a bad experience before.
Other things to raise at this age: contraception that suits you, sexual health checks (free at sexual health clinics), and any period problems such as very heavy or painful bleeding.

Your thirties and forties

  • Keep up with cervical screening and do not ignore a letter just because you feel well.
  • Know your family history. If close relatives had breast, ovarian or bowel cancer, especially at a young age, tell your GP. You may be referred for earlier or extra checks.
  • Perimenopause can start in the forties, sometimes earlier. Irregular periods, hot flushes, poor sleep, low mood and brain fog are all worth discussing rather than putting up with.
  • The NHS Health Check is offered in England to adults aged 40 to 74 without certain existing conditions, usually every 5 years. It looks at blood pressure, cholesterol and your risk of heart disease, stroke, kidney disease and type 2 diabetes.

Fifty and over

  • Breast screening in England is offered from 50 up to your 71st birthday, every 3 years. Your first invitation usually arrives between 50 and 53. After 71 you are not invited automatically, but you can still ask your local breast screening service for an appointment every 3 years.
  • Bowel screening uses a home test kit that checks a small poo sample for hidden blood. In England it is sent every 2 years to people aged 50 to 74. Over 75s can request a kit through the bowel screening helpline.
  • Cervical screening continues until 64, after which most people are no longer invited if their recent results were normal.
  • Bone health matters more after menopause. Ask your GP whether you have risk factors for osteoporosis, such as early menopause, long-term steroid use or a previous fracture from a minor fall.

Screening is not a symptom check

This is the most important point. Screening is for people with no symptoms. If you notice something, do not wait for your next invitation. See a GP about:
  • A lump, thickening or change in the shape or skin of a breast, or nipple changes
  • Bleeding between periods, after sex or after the menopause
  • A change in bowel habit, blood in your poo or unexplained weight loss
  • Persistent bloating, pelvic pain or feeling full quickly

Questions to take to your GP

  1. Am I up to date with all the screening I am eligible for?
  2. Does my family history change when or how I should be checked?
  3. Are my blood pressure and weight in a healthy range, and when were they last measured?
  4. Is this symptom something to investigate, and what happens if it does not settle?
  5. What should I do if I miss or need to rearrange a screening appointment?
Writing your questions down before the appointment helps, as does mentioning the most important one first. Trans and non-binary people may not be invited automatically depending on how they are registered, so it is worth asking the surgery directly. Have you found a good way to make sure you never miss a screening letter? Share your tips in the comments.

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