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Exams women need in their 40s

“The most important thing that I want women in their 40s to consider is their general health habits,” says Charlotte Grayson, M.D., a primary care physician at Piedmont. “I want women to go into their 40s at a healthy weight, and I want them to develop habits of exercise and a good diet."

Pelvic exams and Pap smears

Just like other age groups, women in their 40s need to see a primary care physician for an annual physical exam. They should have a Pap smear and pelvic exam from either their primary care physician or their gynecologist.  

If a woman still has her uterus and ovaries, she needs to have a Pap smear every two years. Women who have had a hysterectomy may not need Pap smears, depending on the reason for the hysterectomy.

Breast health

Dr. Grayson says mammograms and breast exams are two of the most important things women in their 40s can do for their health. Unfortunately, there is a lot of confusion over screening recommendations.

“My general recommendation is that any woman coming in for an annual exam should get a clinical breast exam, which is an exam done by me to familiarize a woman with what her breasts feel like and teach her how to [feel for] lumps or masses,” she says.

Dr. Grayson does not agree with new guidelines that have suggested women in their 40s and 50s do not need annual mammogram screenings.

“I always recommend a mammogram for women over 40,” she says. “I agree with cancer guidelines which start annual screenings at age 40, because breast cancer, if caught early, is curable and treatable.”

Weight gain

“Most of my patients who come in and have gained weight are concerned that it’s because of their thyroid,” says Dr. Grayson.

The guidelines for thyroid testing recommend that screening begin in a woman’s 50s. However, because so many women are concerned about thyroid issues, Dr. Grayson starts annual screenings in her 40-year-old patients.

“But the thyroid is generally not the reason women are gaining weight in their 40s,” she explains.

More likely, weight gain can be attributed to a slowing metabolism, hectic schedule, lack of exercise or poor diet. Getting back on a healthy diet and exercise plan is the way to go to lose weight, she says.

Heart disease

Heart disease risk usually increases after menopause, but the 40s are a great time to start mitigating factors that increase a woman’s risk of heart problems, including cholesterol, hypertension and obesity.


Hypertension, or high blood pressure, is one of the most common conditions that Dr. Grayson treats. It often starts in the 30s or 40s. She recommends that her patients keep their blood pressure around 120/60. When it climbs above 140/90, she begins treating patients with medication, diet and exercise.


Dr. Grayson screens her female patients with a general blood panel that includes blood sugar testing.

“Diabetes risk is starting to increase in younger women,” she says. “Even when their blood sugars aren’t in the diabetic range, I will often counsel them, put them on diets and help them lose weight so they don’t develop diabetes later on.”


Current guidelines recommend that cholesterol testing occur every three to five years in women and men over the age of 20. When her patients are in their 40s, Dr. Grayson typically tests their cholesterol on a yearly basis. She says the breakdown of total cholesterol is more important than the total cholesterol number itself. This includes:

  • Triglycerides, a blood fat often related to obesity or diabetes. Ideal triglycerides levels are below 250 for those without diabetes or below 150 for those with diabetes.

  • HDL (“good”) cholesterol. With this type of cholesterol, the higher the number, the better. If a patient’s HDL level is below 50, Dr. Grayson says they should watch their diet and increase the amount of fish that they eat to raise this number.

  • LDL (“bad”) cholesterol. This number is the most important to look at because a high level is closely related to heart disease, stroke, kidney disease and overall cardiovascular death. LDL levels should be below 160 in a healthy, pre-menopausal woman. Those with obesity, hypertension or diabetes need that number to be even lower, such as 130. In some women, Dr. Grayson wants a level as low as 100 or even 70. In these high-risk cases, medication is often needed to achieve low numbers.

Overall health

When a woman reaches age 40, she often needs to make some lifestyle adjustments.

“What worked in our 20s and 30s will not work for us in our 40s and 50s,” says Dr. Grayson.

Women should find ways to incorporate fitness and a healthy diet into their busy lives, while balancing careers and family.

“It’s never too late to get healthy,” she says. “I’ve seen women go from being very unhealthy to healthy within a year or two by developing a lifestyle they can stick with through their 50s.”

Dr. Grayson practices at Piedmont Physicians Yorktown, located at 101 Yorktown Drive, Suite 100, Fayetteville, GA 30214. Schedule an appointment with Dr. Grayson or one of our other primary care providers. Save time, book online.

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