From puberty to menopause, a life-course approach helps anticipate risk and support prevention at every stage

Medical diagnostics brings together many specialties that help support health, detect disease and monitor clinical conditions. These include imaging techniques, from pregnancy ultrasound to DEXA for the diagnosis of osteoporosis; laboratory testing in endocrinology or for the assessment of ovarian reserve; pathology for HPV-related lesions of the cervix; and molecular genetics for the investigation of more complex clinical pictures.

Traditionally, women’s health has been described according to distinct stages, such as reproductive age and menopause. While this classification remains useful, it does not always reflect current clinical practice.

Women are living longer, may not have children or may have them later in life, and often develop health risks that evolve gradually over time. Considering these stages in isolation can lead to missed opportunities for prevention. A life-course approach encourages clinicians to focus on transitions, their timing and the progressive accumulation of risk.

Puberty: when timing matters

Puberty is a period of profound hormonal and metabolic change. Clinical challenges arise particularly when pubertal development is not aligned with chronological age or progresses irregularly.

Decisions made at this stage may influence metabolic health, bone development and reproductive function in later years.

Reproductive age: beyond fertility

Reproductive age includes health priorities that go beyond motherhood.

Some women choose to have children — with the average age at first childbirth in Switzerland being 31.3 years — while others decide not to have children or face unexplained infertility.

When fertility assessment is requested, markers such as anti-Müllerian hormone, known as AMH, and thyroid function can help guide counselling.

This stage also marks the beginning of breast cancer risk stratification. Family history is central, and in carriers of pathogenic variants in the BRCA1, BRCA2 or PALB2 genes, intensified screening is indicated from the age of 30, with breast MRI being more sensitive than mammography alone.

Menopause: from symptom management to prevention

Menopause is an often underestimated transition. The decline in oestrogen levels is associated with an increased cardiovascular risk and accelerated loss of bone mass, amounting to 2–3% per year in the first postmenopausal years.

Considering that female life expectancy in Switzerland is 85.9 years, this phase represents a key window for prevention.

Recommendations include cardiovascular risk assessment after menopause and bone density screening from the age of 65, or earlier in the presence of risk factors.

Screening strategies across the life course

In Switzerland, mammography is recommended between the ages of 50 and 69, or up to 74 depending on the canton.

European guidelines extend organised screening to women aged 45 to 74, recognising that breast cancer risk is distributed across a broader age range.

From stages to prediction

A life-course approach does not mean increasing the number of investigations, but rather improving the ability to anticipate risk.

Gestational diabetes increases the risk of type 2 diabetes; polycystic ovary syndrome is associated with long-term metabolic issues; and early menopause requires earlier attention to cardiovascular and bone health.

For general practitioners and specialists, this perspective promotes continuity of care and places women’s long-term health at the centre of medical practice.

Author: Dr. sc. nat. Julia Falschlunger