• Goodbye, Aunt Flow.

  • You good?
  • Hormones or…?
  • When it is menopause.
  • Your symptoms, your plan.
  • Expanding your care team.
  • You good?

    One of the most important things we’ll cover at your wellness visit is what you’re doing for YOU. That starts with the wellbeing assessment you’ll complete in MyHealth before your visit. Of course, you don’t have to answer questions you’re uncomfortable with—but the more candid you can be with us, the more we can do to help. Eating healthy and being active play a big role in health and wellness, even more so as we age—but ultimately you’ll define what wellness means to you. We are here to help you achieve whatever that is. If you’re having problems reaching your health goals, ask your provider if a visit with one of our behavioral health specialists might be right for you.

  • Hormones or…?

    Entering the late 40s, many people begin wondering if changes they’re experiencing are related to perimenopause. The short answer is: maybe. Mood changes, sleep disturbances, weight gain, vaginal dryness and declining interest in sex are all common concerns during this time and can be linked to hormonal changes. People in this age range can also have many outside stressors—raising teenagers, caring for aging parents, job and relationship stress—that can cause or contribute to at least some of these symptoms. Your provider will want to explore these issues and work with you on the best plan for managing your symptoms—now and into the future. If there isn’t enough time at your wellness exam, your provider may recommend a follow-up office visit to do a more detailed evaluation.

  • When it is menopause.

    Menopause is defined as 12 months without a spontaneous period. In the United States, the average age of menopause is 51. To determine where you’re at in the transition, your provider will want to talk to you about whether or not you’re having regular menstrual cycles and other symptoms, such as discomfort with sex, hot flashes or trouble sleeping. If you’re post-menopausal, your provider will want to find out how you’re doing; are your symptoms manageable? Are you sleeping? Do you feel depressed?

  • Your symptoms, your plan.

    About 20% of people will go through menopause essentially symptom-free. Another 60% will have mild symptoms and 20% will have more severe symptoms that seriously impact their quality of life. The good news is: if you have symptoms, we can help. Many people have heard for years that hormone replacement therapy (HRT) poses too many health risks. But there are more recent, respected studies that show the benefits of HRT in people under 60 can outweigh the risks.

    HRT is not a one-size fits all remedy; if we recommend something that you find doesn’t work, we will work together to find the right solution for you. And, we’re not going to pressure you into HRT—there are non-hormonal options we can discuss to improve your sleep and quality of life.

  • Expanding your care team.

    While we would love to see you for everything, now is an important time to establish a relationship with a primary care provider if you haven’t already. We can recommend the most important health screenings and even take care of many of them for you in our office—but if an issue arises with blood sugar, cholesterol or something else outside our realm of expertise, we may need to refer you to a primary care provider or other specialist to help.

A Simple Guide to Screenings and Prevention

Pregnancy prevention
Breast cancer screening
Cervical cancer screening
Sexually transmitted diseases
Early osteoporosis screening
Colon cancer screening
General health screenings
Don’t forget your vaccines

Pregnancy prevention

Although fertility declines as we age, you can still get pregnant until menopause. Talk to your provider about your current health and risk of breast cancer to decide what type of contraception might be right for you.

Breast cancer screening

If you’ve chosen to wait to begin having mammograms to screen for breast cancer or have been–or have been on the every-other-year plan—your provider will recommend annual screening by age 50.

Cervical cancer screening

Pap smears with combined HPV testing continue until age 65. If your results are normal, your provider will likely recommend screening every three to five years, depending on what type of testing you’ve had in the past and your past results.

Sexually transmitted diseases

Talk to your provider if you’ve had a new partner since your last screening. You should also be tested for HIV at least once. There is no agreement among medical professionals about how often re-testing should occur; your provider may assess your risk and recommend re-testing.

Early osteoporosis screening

Screening for osteoporosis is recommended for people of average risk beginning at age 65, but talk to your provider about starting earlier if you have had broken bones as an adult; you have a biological parent who has had a hip fracture; or if you smoke, drink excessively or are underweight. Also discuss screening frequency, which can vary from person to person.

Colon cancer screening

The U.S. Preventative Services Task Force recommends screening for colorectal cancer beginning at age 50, but talk to your WHA or primary care provider about starting screening earlier if you:

Have had a close relative with colorectal polyps or colorectal cancer

You have an inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis.

You have certain genetic conditions.

General health screenings

We may be able to help with some of these when we see you. Otherwise, see your primary care provider for screening related to:

High blood pressure. Get your blood pressure every year. Optimal blood pressure in healthy people assigned female at birth is less than 120/80.

Diabetes. Screening for diabetes is recommended if you are overweight or obese, have high blood pressure, high cholesterol or have had diabetes during pregnancy.

Thyroid disease. Periodic screening is recommended beginning at age 45.

Cholesterol/lipids. Screening tests for high cholesterol are recommended periodically for all women, but may be done more frequently if you are overweight, obese or have other risk factors.

Don’t forget your vaccines

We can help with seasonal flu and Tdap if you’re in to see us.

Seasonal flu vaccine is especially important for people with chronic health conditions, pregnant people, and older adults.

Tdap vaccine (if you’ve never had one) or a Td (tetanus, diphtheria) booster shot every 10 years.

Shingles vaccine. Healthy adults aged 50 years and older should get a zoster vaccine to prevent shingles and complications from the disease.

COVID vaccine. Stay up to date with current guidelines here >

Is This Normal?

Answers you want, questions you may not want to ask

Let's Talk About It

Here are some topics your provider may bring up

  • 1 Menopause


    Menopause is defined as the absence of spontaneous periods for 12 months. The average age of menopause in the U.S. is 52. Symptoms of the menopause transition (called perimenopause) can begin as early as 10 years before menopause and continue for several years after. Learn more >

  • 2 Emotional wellbeing

    Emotional wellbeing

    Emotional health and wellbeing refers to our ability to cope with the stresses of everyday life in a positive way and recognize and manage negative emotions, like stress, anger and sadness. Emotional health is very important to physical health because when you’re not able to process negative emotions or manage stress, it can impact sleep or lead to unhealthy coping strategies—such as substance abuse, emotional eating, etc. If you’re having a hard time sleeping, your relationships are suffering or you’d like help finding healthier coping strategies, talk to your provider about a referral to one of our behavioral health specialists.

  • 3 Sex drive (libido)

    Sex drive (libido)

    The desire for sex can naturally fluctuate over the years and can be affected by many things, including puberty, pregnancy, menopause, illness, medications, relationships and life circumstances, among other things. If you have questions or concerns about your sex drive, talk to your provider.

  • 4 Breast health

    Breast health

    Breast health is about more than just getting mammograms! You should also be familiar with how your breasts look and feel normally and know your family history of breast cancer. It’s also important to understand the daily steps you can take to reduce your risk of breast cancer, including getting regular exercise, maintaining a healthy body weight–especially after menopause–and limiting alcohol consumption.

  • 5 Disease prevention

    Disease prevention

    Sometimes your risk of developing a disease–such as cancer, heart disease, or diabetes–is linked to family history or genetics. But there are often steps you can take to reduce your risk. (The fancy term for this is “modifiable risk factors.”) Examples of modifiable risk factors include not smoking, not drinking alcohol excessively, exercising regularly, eating a healthy diet, and controlling high blood pressure and cholesterol. Talk to your clinician about your health and family history and what you can do to minimize your risk.

  • 6 Abnormal bleeding

More Resources for You

What to Expect During a Physical Exam

This resource from the Oregon Medical Board provides more information on what to expect from various types of physical exams at the doctor's office, including how to advocate for your rights and what to know about medical chaperones.


A website to compare the cost of prescription medications.

Up to Date

A searchable database of current medical information for both patients and providers.


The website of the Centers for Disease Control and Prevention – this is a great resource for vaccination and disease screening and prevention recommendations.

MiddlesexMD Blog

A good resource for articles on sex after 40. Also includes various products, but this is not a specific endorsement of those.

Voices for PFD

A great resource from the American Urogynecologic Society for women experiencing pelvic floor disorders, including bladder and bowel control issues and pelvic organ prolapse.


On online resource and forum for women having bleeding issues, fibroids, pelvic pain, etc.

Office on Women’s Health

Articles, fact sheets, resources and infographics on staying healthy throughout your life from the U.S. Department of Health and Human Services. Excellent breastfeeding information!

Check Accepted

If you’re pregnant and want to begin care at WHA–or need to schedule an appointment during your pregnancy, call us! Find a provider and location here.

Please have your insurance information handy before you begin scheduling.

This will allow our teams to check whether your plan may require a referral for the care you need or to prepare benefits information to share with you at your visit. If you do not enter insurance information when scheduling, you may be asked to pay a $200-$500 deposit before receiving service.