When Should Women Get a Colonoscopy?
I remember the exact moment I finally decided to schedule my first colonoscopy.
I was sitting in my office, scrolling through labs and clinical notes, and I paused on a line in my own chart: “No colonoscopy to date.”
I stared at that for a long time.
Here I am, a triple‑board‑certified OB‑GYN and functional medicine physician, someone who has spent decades teaching women how to optimize their hormones, gut health, and longevity — and yet I had never walked through the door for my own colonoscopy, because I, like so many women, kept putting my own health in the “later” pile while I took care of my family, my patients, and my business.
Eventually, as I approached 60, the reality sank in: my Second Spring deserves to be vibrant, strong, and fully protected — and that means doing the hard things, not just the convenient ones.
That gap in my own care hit me hard.
So, yes, I finally did it — at almost 60, after 20 years of functional stool testing, microbiome panels, and Cologuard‑style screenings. In this article, I’m going to pull back the curtain on what I discovered, why colon cancer screening is so important for women, and exactly when you should strongly consider scheduling your own colonoscopy.
If you’ve ever wondered, whispered, or Googled, “When should women get a colonoscopy?” — this is your invitation to lean in, listen with your body’s wisdom, and then act.
Why I Finally Chose a Colonoscopy After 20 Years of Gut Testing
As a functional medicine doctor, I’ve been immersed in gut health for decades. I’ve personally run and interpreted advanced stool tests like GI‑MAP, microbiome arrays, and microbiome‑ and immune‑focused panels. I’ve tracked inflammation markers, pathogen burdens, and microbial balance in thousands of patients.
For many years, I told myself:
“I’m already monitoring my gut. I’m tracking inflammation, digestion, and microbiome balance. I’m not ignoring my health.”
And that was true.
But what I wasn’t doing was directly visualizing the structure of my colon.
Functional stool testing is incredible for understanding gut function: digestion, microbial balance, immune activity, inflammation, and toxin load. But it doesn’t show you polyps. It doesn’t reveal the subtle changes in the colon lining that can turn into cancer years down the road.
Functional stool testing answers questions like:
What is my microbiome doing?
Are there pathogens, parasites, or overgrowths?
Are there signs of inflammation or immune activation?
Are my digestive enzymes and short‑chain fatty acids balanced?
In other words, it tells us a lot about how your gut is functioning — but it does not show polyps, tumors, or structural changes in the colon lining.
A colonoscopy, on the other hand, allows a gastroenterologist to:
Directly visualize the colon lining
Identify polyps, diverticula, tumors, and bleeding
Remove precancerous polyps before they become cancer
That act of polyp removal is where colonoscopy becomes true prevention, not just detection.
When Should Women Get a Colonoscopy? The Latest Guidelines
One of the most common questions I’m asked — both as a clinician and as The Girlfriend Doctor — is:
👉 “What age should women get a colonoscopy?”
The U.S. Preventive Services Task Force (USPSTF), the American Cancer Society, and the CDC now recommend that average‑risk adults begin colorectal cancer screening at age 45 — not 50, as many people still assume.
This change came because of the rising number of colorectal cancer diagnoses in younger adults.
For most people with normal results:
Colonoscopy every 10 years
Stool‑based testing (like Cologuard, FIT or stool‑DNA tests) annually or every 1–3 years, depending on the test
Screening generally continues through age 75
Ages 76–85 require individualized decisions based on health status and history
Women may need earlier or more frequent screening if they have:
Family history of colon cancer
Personal history of polyps
Inflammatory bowel disease (Crohn’s or ulcerative colitis)
Chronic gastrointestinal symptoms
Rectal bleeding
Genetic syndromes like Lynch syndrome
Iron‑deficiency anemia
Persistent changes in bowel habits
If any of these apply to you or your family, do not wait until age 45. Have that conversation with your primary care provider or gastroenterologist and map out a personalized timeline.
Colon Cancer Is Rising — Especially in Younger Adults
I’ve said it before, and I’ll say it again: colon cancer is no longer just an “older person’s disease.”
Recent data from the American Cancer Society shows that:
Colorectal cancer diagnoses in adults under 55 have nearly doubled since the mid‑1990s
About 1 in 5 new colorectal cancer cases now occur in people under 55
Younger adults are often diagnosed at later stages, because symptoms are chalked up to “stress,” “hormones,” or “just aging.”
Researchers are still studying why this is happening, but suspected contributors include:
Ultra‑processed foods
Low‑fiber diets
Sedentary lifestyles
Insulin resistance and obesity
Chronic inflammation
Microbiome disruption
Environmental toxin exposure
Alcohol excess
Smoking
Chronic stress
This matters tremendously for women in perimenopause and menopause, when bloating, constipation, fatigue, abdominal discomfort, and bowel changes are often normalized as “hormones” or “just aging.”
Yes, hormones play a role. But persistent symptoms are not normal — and they deserve attention.
The Early Warning Signs of Colon Cancer Women Should Never Ignore
Another question that keeps coming up in my inbox and DMs is:
👉 “What are the first signs of colon cancer?”
Here’s the hard truth: early colon cancer can be silent. That’s why preventive screening is so powerful — it catches problems before any symptoms appear.
That said, there are symptoms that should never be ignored, including:
Blood in the stool
Rectal bleeding
Persistent constipation or diarrhea
Narrow, pencil‑thin stools
Ongoing bloating or abdominal distension
Abdominal pain or cramping
Feeling like you can’t fully empty your bowels
Unexplained fatigue
Iron‑deficiency anemia
Unexplained weight loss
Persistent changes in bowel habits
As a menopause‑focused physician, I’m especially attuned to how these symptoms mirror hormonal changes. Many women are told, “You’re just peri‑ or post‑menopausal,” and then their symptoms are dismissed.
Hormonal changes can absolutely contribute to bloating, constipation, and abdominal discomfort — but new, persistent, or worsening symptoms should never be brushed off. If something feels different, track it, write it down, and bring it to your clinician’s attention.
Functional Stool Testing vs Colonoscopy: What’s the Difference?
This is one of the most important distinctions I want women to understand.
Functional stool testing answers:
What is my microbiome doing?
Are there pathogens, parasites, or overgrowths?
Are there signs of inflammation or immune activation?
Are my digestive enzymes and short‑chain fatty acids balanced?
In other words, it tells us a lot about how your gut is functioning — but it doesn’t show polyps, tumors, or structural changes in the colon lining.
A colonoscopy, on the other hand, allows a gastroenterologist to:
Directly visualize the colon lining
Identify polyps, diverticula, tumors, and bleeding
Remove precancerous polyps before they become cancer
That act of polyp removal is where colonoscopy becomes true prevention.
Stool‑based tests (like FIT or stool DNA tests) are helpful, non‑invasive tools that can be done at home and are usually repeated every 1–3 years. But they are less sensitive than colonoscopy for detecting small polyps and early‑stage lesions.
For many women, the best strategy is to integrate both tools:
Use functional stool testing to understand gut function and microbiome health
Use a colonoscopy (or another structural screening) to see the structure of the colon and remove precancerous lesions
Why Gut Health Matters So Much In Perimenopause and Menopause
If you’ve followed my work for any length of time, you know I’m obsessed with the gut‑hormone‑brain connection.
Your colon is not just a “waste tube.” It’s an intelligent interface between:
Your microbiome
Your immune system
Your hormones
Your neurotransmitters
Your detoxification pathways
Your metabolism
Your brain health
During perimenopause and menopause, hormonal shifts can profoundly affect:
Bowel motility
Microbiome diversity
Digestive enzyme production
Stress‑response signaling
Inflammatory markers
Food sensitivities
Many women notice increasing bloating, constipation, reflux, and digestive discomfort in midlife — and often normalize it as “just aging.”
In reality, chronic constipation isn’t just uncomfortable — it can contribute to:
Estrogen recirculation and hormonal imbalance
Increased inflammation
Toxin reabsorption
Microbiome disruption
Abdominal discomfort and metabolic dysfunction
Supporting healthy elimination — through hydration, fiber, movement, and gut‑supportive foods — is one of the most powerful ways to support your Second Spring. But it does not replace proper colon cancer screening.
Colon Hydrotherapy (Colonics): What You Need to Know
Another topic I often see women searching for is:
👉 “Are colonics healthy?”
Colon hydrotherapy, also known as colonics, involves gently flushing the colon with warm, filtered water to support bowel cleansing and elimination.
As a functional medicine physician, I’ve recommended colon hydrotherapy for select patients as part of a broader wellness strategy — but I always emphasize:
Colon hydrotherapy is NOT a replacement for colon cancer screening.
These are completely different tools with completely different goals. A colonoscopy screens for cancer and removes precancerous lesions. Colonics support elimination and bowel cleansing.
Some people report feeling lighter, less bloated, and more regular after a colonic — but this is a temporary symptomatic shift, not a cancer‑prevention strategy.
If you’re considering colonics, make sure it’s overseen by a trained, licensed professional and never use it to avoid or delay appropriate screening.
Is a Colonoscopy Painful? My Honest Experience
Let’s talk about the elephant in the room: the prep and the procedure.
I’ll admit it — my biggest fear was not the prep but the procedure. I had heard so many horror stories over the years. I wanted to ensure I completed a meticulous bowel preparation, drinking only bone broth and my Keto-Green shake for the 2 days prior. There was no way I was going to be risked being told that the prep was inadequate and I need to do it again.
Then the day came.
I followed the instructions exactly. I hydrated, drank the prep as directed, and yes — it was not glamorous. But it was temporary.
Most colonoscopies in the United States are performed under sedation, and many patients remember very little of the procedure itself. I also preferred not being put to sleep if I didn’t have to, so we worked out a light sedation plan that felt right for me.
Next thing I knew, I was waking up cozy and comfortable.
The gastroenterologist came in with the report:
No polyps.
No diverticula.
No inflammation.
And — because I had to ask — no chia seeds stuck anywhere in my colon.
Then of course I asked the really important question:
“Okay… healthy for a 60-year-old or healthy for a 30-year-old?”
She smiled and said:
“Healthy for a 30-year-old.”
I’m not going to lie… I rode that compliment all day.
But this experience also reminded me how many women delay preventive screening because of fear, embarrassment, misinformation, or simply because we are busy taking care of everyone else first.
And with colorectal cancer rates continuing to rise, understanding colon cancer symptoms, screening guidelines, and the difference between functional testing and colonoscopy has never been more important.
Honestly, the anticipation was worse than the procedure. The prep is temporary; the reassurance is long‑lasting.
My Girlfriend Doctor Takeaway: Don’t Wait
If you’re over 45 — especially if you’re a woman who spends every day caring for kids, partners, parents, or clients — this is your loving nudge.
Don’t ignore symptoms.
Don’t assume bloating, constipation, fatigue, or abdominal discomfort are “just part of aging.”
Don’t put everyone else’s health ahead of your own.
Prevention is an act of self‑respect.
Some of the habits that will support your long‑term colon and gut health:
Hydrate
Move your body daily
Eat fiber‑rich whole foods
Support your microbiome with fermented foods and probiotics
Manage stress
Protect your metabolic health
Prioritize healthy elimination
Get screened appropriately — with the right tool at the right time
If you’re over 45 and have never had a colonoscopy, this is your permission to pick up the phone and schedule one.
If you’re younger but have a family history or persistent symptoms, bring up the question with your doctor now.
References
U.S. Preventive Services Task Force. Colorectal Cancer Screening Recommendations. https://www.uspreventiveservicestaskforce.org
American Cancer Society. Colorectal Cancer Facts & Figures. https://www.cancer.org
Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/cancer/colorectal
National Colorectal Cancer Screening Guidelines. https://www.cdc.gov/cancer/colorectal
National Cancer Institute. Colorectal Cancer Statistics. https://www.cancer.gov
Mayo Clinic. Colon Cancer Symptoms and causes. https://www.mayoclinic.org
American Gastroenterological Association of Colonoscopy and Colon Cancer Prevention. https://gastro.org
World Journal of Gastroenterology. Rising Incidence of Early-Onset Colorectal Cancer. https://www.wjgnet.com
Harvard T.H. Chan School of Public Health. Diet, Fiber, and Colon Cancer Risk. https://hsph.harvard.edu
