The intervals below come from international guidelines. National screening programmes differ from country to country. Please discuss your own screening plan with your doctor.
Bone health: DEXA and risk calculation
Osteoporosis has no clear symptom — which is why it has to be screened for.
Who has a bone density scan (DEXA)?
- Aged 65 and over: a DEXA scan at least once is advised for all postmenopausal women, even with no other risk factor.
- Under 65: going straight to DEXA is not considered appropriate as general screening. Instead the 10-year fracture probability is first calculated with a risk tool such as FRAX; DEXA follows if the risk is high. (The FRAX tool has not been validated in women under 40.)
- Early menopause and ovarian insufficiency: a DEXA scan must be done at the time of diagnosis, to establish a baseline.
How often is it repeated?
- If the baseline scan is normal and adequate systemic oestrogen therapy has been started, there is little clinical value in repeating it within 5 years.
- If osteoporosis or reduced bone mass has been found, it is checked every 1–3 years depending on personal risk factors.
- In women taking medicines that cause bone loss and not on hormone therapy, repeating it every 2 years is advised.
In those at high risk of bone loss, measuring the vitamin D level at the outset, or considering supplementation directly, is advised.
Cardiovascular risk assessment
After the menopause the protective effect of oestrogen is lost, so risks relating to the heart and to metabolism increase.
- In early menopause and ovarian insufficiency the risk is markedly higher. In this group blood pressure, weight and body mass index, cholesterol profile and blood sugar should be checked at the outset and then repeated once a year.
- In natural menopause a baseline risk profile is established during the transition; lifestyle changes (a Mediterranean-style diet, stopping smoking, exercise) are supported, and regular cholesterol and blood pressure monitoring follows according to the level of risk.
Breast screening
- In women at average risk: current advice is to begin screening with mammography every two years from the age of 40.
- In women on hormone therapy follow-up is closer: clinical protocols include breast imaging together with a gynaecological examination once a year to monitor the safety of treatment.
Cervical screening
This continues in line with the national screening programme; if it is overdue it should be arranged without delay. For women on hormone therapy, clinical protocols include a smear test once a year.
See the smear and HPV testing page for screening methods and intervals.
Summary table
| Screening | Who | How often |
|---|---|---|
| DEXA (bone density) | Everyone aged 65 and over | At least once |
| FRAX risk calculation | Under 65 | Risk calculation first; DEXA if high |
| DEXA — normal baseline + oestrogen therapy | — | No need to repeat within 5 years |
| DEXA — osteoporosis found | — | Every 1–3 years |
| Mammography | Average risk | Every 2 years from age 40 |
| Cardiovascular monitoring | Early menopause / ovarian insufficiency | Once a year |
| Cervical screening | Everyone | Per the national programme |
Frequently Asked Questions
At what age should I have a bone scan (DEXA)?
A scan at least once is advised for all postmenopausal women aged 65 and over, even with no other risk factor. Under 65, going straight to DEXA is not considered appropriate as general screening — the 10-year fracture probability is first calculated with a tool such as FRAX, and DEXA follows if the risk is high.
I had an early menopause — when should I be scanned?
In early menopause and ovarian insufficiency a DEXA scan must be done at the time of diagnosis, to establish a baseline. Because cardiovascular risk is markedly higher in this group, blood pressure, weight, cholesterol and blood sugar should also be checked once a year.
Do I need to repeat the DEXA scan every year?
No. If the baseline scan is normal and adequate oestrogen therapy has been started, there is little clinical value in repeating it within 5 years. If osteoporosis or reduced bone mass has been found, it is checked every 1–3 years; in women taking bone-losing medicines who are not on hormone therapy, every 2 years is advised.
At what age should I start mammography?
Current advice for women at average risk of breast cancer is to begin screening with mammography every two years from the age of 40. In women on hormone therapy follow-up is closer; clinical protocols include breast imaging together with a gynaecological examination once a year.
Does my heart risk rise at the menopause?
Yes. After the menopause the protective effect of oestrogen is lost, so risks relating to the heart and metabolism increase. In natural menopause a baseline risk profile is established during the transition, lifestyle changes are supported, and regular cholesterol and blood pressure monitoring follows according to risk. In early menopause this monitoring should be annual.
Should I have my vitamin D measured?
In those at high risk of bone loss, measuring the vitamin D level at the outset, or considering supplementation directly, is advised. The amount of supplement is decided individually, so no dose is given on this page.
Sources
- British Menopause Society (BMS) and International Menopause Society (IMS) recommendations — follow-up and screening protocols around the menopause.
- US Preventive Services Task Force (USPSTF) — breast cancer screening recommendation.
- International guideline on premature ovarian insufficiency (POI), 2024 — bone density measurement at diagnosis, follow-up intervals and cardiovascular risk monitoring.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday