Menopause Expert

Diagnostic and Screening Tests For Menopausal Women

Before beginning hormone therapy (HT) your health care provider should recommend some basic diagnostic and screening tests.

LABORATORY TESTS
Blood tests should include a fasting lipid profile which includes measurement of total cholesterol, LDL, HDL and triglycerides and fasting blood sugar / glucose for diabetes. These help determine your cardiovascular risk.

Thyroid function should also be evaluated with a blood test called a TSH, thyroid stimulating hormone. Women with irregular periods and/or vasomotor symptoms such as hot flashes should have their thyroid checked at their initial visit.

A woman’s medical and menstrual history and symptoms are usually all that is needed to diagnosis menopause. There is no need to test estrogen, progesterone or testosterone levels. They will be low during menopause and fluctuating during perimenopause. Dosage of hormones should be adjusted according to symptom relief with the least side effects.

I do not recommend any blood work for hormone levels. There is no single test available that will predict or confirm menopause. This is primarily because hormone levels are fluctuating throughout perimenopause. The only time hormone tests may be helpful is if you cannot get relief of symptoms with hormone treatment.

Some providers will draw a follicular stimulating hormone (FSH) level to diagnosis menopause. However, this level varies over days, weeks or months depending on your ovarian function. A woman who has not had a period for three months will have a high FSH. If she begins to menstruate again, which is common, her FSH level may return to normal. A single FSH level is unreliable.

PAP SMEAR AND PELVIC EXAM
Women should continue to have pap smears up to age seventy-five. Frequency varies according to pap history and types of tests you have done. Most providers are using the liquid based pap smear versus the conventional slide. The liquid based pap should be performed every two years or every three years if you combine it with a HPV test. History of an abnormal pap or positive HPV test will change the frequency recommendation.

Women who have had a hysterectomy for noncancerous reasons may discontinue pap smears. Pap smears are a screening test for cervical cancer. After a hysterectomy you no longer have a cervix therefore the pap is no longer necessary. If you had a hysterectomy for cervical cancer you should continue with pap smears for a few more years before discontinuing them.

A pelvic exam should be done every year. This consists of inspection of the vulva, outside of the vagina, and insertion of the speculum to check the inside of the vagina. This is followed with a manual exam by inserting a gloved finger into the vagina and with the other hand on top of the lower abdomen the pelvis is checked for any pain or masses.

COLORECTAL EXAM
For women over age fifty and average risks for colorectal cancer a rectal exam should also be done following the pelvic exam. The American Cancer Society recommends selecting one of the following additional options:
” Annual Fecal Occult Blood Test (FOCBT). This is a take home test where you collect stool samples to be returned by mail for testing by your provider for blood.
” Flexible sigmoidoscopy every 5 years
” Annual FOBT plus flexible sigmoidoscopy every 5 years
” Colonscopy every 10 years.

BREAST HEALTH
All women should have a clinical breast exam and mammogram before beginning hormone therapy. A clinical breast exam is done annually by your provider and you may supplement it with monthly self breast exams. Women should begin yearly breast mammogram, xray of your breast, at age forty. Any palpable breast lump should be evaluated immediately.

BONE DENSITY / OSTEOPOROSIS SCREENING
All postmenopausal women should be evaluated for osteoporosis by history questionnaire and diagnostic tests. The history helps determine risk and prevention for fractures. It can also help determine diagnosis and treatment.

Bone mineral density (BMD) testing is used to actually diagnosis osteoporosis. The two most commonly utilized methods are dual-energy x-ray absorptiometry (DXA) and quantitative ultrasound (QUS).

The DXA measures bone density at the hip and spine where most of the debilitating fractures occur. X-ray measurements are reported as a T-score. The lower your T-score is the more severe the osteoporosis and your risk for a fracture.

QUS uses ultrasound to measure BMD of the forearm, tibia, fingers or heel. The heel measurement is a very good predictor of risk of hip fracture and much less expensive. It is very easy to transport since it does not involve x-ray and often offered at health fairs and pharmacy.

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Diagnostic and Screening Tests For Menopausal Women

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