Getting The Right Care
As a woman enters mid-life, she may find herself unable to optimally manage the emotional and physical symptoms of menopause on her own. During menopause, the focus of primary care changes, with an emphasis on addressing symptoms, preventing disease and optimizing health over the long-term.
This change in focus presents women with an opportunity to seek out individualized care from a clinician who can help make sense of the options available and explain the benefits and risks of menopause-related treatment. The key to determining where to get the best care is to ask plenty of questions.
Take an active role in ensuring that you are being offered recommended health screenings and treatment appropriate for your age. Before you decide on care, talk with your prospective doctor about the tests and procedures you may need, given your age, current health status, and family history.
When it comes to choosing a provider, you have options. Many women choose to see their primary care physician for menopause-related care. Others may opt to see an ob-gyn. Integrative medicine specialists are available to provide naturopathic or alternative treatments. Endocrinologists can help assess and treat hormonal imbalances. And if you’re seeking a certified menopause clinician – a licensed health professional who specializes in care for women in perimenopause and beyond – visit the North American Menopause Society (NAMS) at www.menopause.org for a list of providers.
The Menopause Map
The Endocrine Society has developed a Menopause Map to help women navigate their treatment options. This online tool helps women and their doctors discuss which hormonal and non-hormonal treatment options would be most effective and safe to relieve the sometimes-debilitating symptoms of menopause.
Physical Exam Checklist
The following test and screening checklist outlines what you should expect from a physical exam when you’re in menopause.
Record body habitus (build, constitution), height, weight, blood pressure. Perform thyroid, breast, cardiac and abdominal examinations.
Based on the physical, a questionnaire and health history, the following tests may be indicated:
- FSH (follicle stimulating hormone) Saliva or Serum (blood) estradiol (a type of estrogen)
- Saliva or serum progesterone
- Saliva or serum testosterone
- Complete blood count
- Lipid profile
- Blood chemistry
- Thyroid function
Perform bimanual pelvic examination, including Pap smear (vaginal, cervical and endocervical samples). Undiagnosed bleeding may require an endometrial (lining of the uterus) biopsy. Ovarian cancer screening: For high-risk women, serum CA 125 levels testing and vaginal ultrasound may be indicated.
Perform digital rectal examination, fecal hemoccult test (for blood in the stool) and endoscopy. For women at risk for colon cancer: a contrast barium enema and colonoscopy recomended.For women over 50: baseline sigmoidoscopy (colon exam) recommended.
Baseline mammogram between ages 35-40. Mammogram every year for women over 40. Monthly breast self-exam.
A bone density test using either dual-energy x-ray absorptiometry (DEXA) or a urine (NTx) test to measure bone loss may be advisable for women at risk of osteoporosis. Risk factors include, among others, being female, a thin or small frame, advanced age, a family history of osteoporosis, and early menopause. A diet low in calcium, an in active lifestyle, cigarette smoking and excessive use of alcohol also increase the risk of developing osteoporosis. Talk with your healthcare provider about your risks of osteoporosis, and whether bone density testing is appropriate for you.
Serum cholesterol and lipid profile (HDL, LDL, and triglycerides), serum glucose, blood pressure, and smoking status.
Source: Ambulatory screening for postmenopausal patients: What is needed, and when?, Julian L. Peskin, M.D. and Wulf H. Utian, M.D., Ph.D., Menopause Management, March 1993, pp. 19-31.
In addition to our popular womenshealth.com Women Helping Women forum, you’ll find all kinds of support groups on the topic of menopause. To get you started, the following organizations offer quality, moderated support groups where caring and compassionate members actively post on a daily basis. Here, women share their stories, learn from others, relieve stress and empower each other to find solutions to the problems women face during their mid-life transition.