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Dr. Sarrel describes the best way to evaluate menopause symptoms.
Dr. Sarrel:
At EmpowHer, we are often asked by women, “What is a proper evaluation for menopause symptoms and whether or not to use any kind of hormonal therapy.” Well, there are three categories to think about that are sort of data categories. At a visit to a healthcare provider, there are at least three things that should be done, three major areas. One is historical.
So you bring your information about your symptoms, what you are experiencing, and I would strongly urge you, the consumer, to do that in a systematic way. What we have done at Yale for many, many years, decades now, is when a woman has made an appointment to our menopause clinic, we send her a very simple list.
There’s 18 symptoms on that list, and there are symptoms like hot flushes, and sleep disturbance, and changes in short-term memory, and touch sensitivity, numbness, problems with small joint pain, chest pain, vaginal dryness, pain with intercourse, loss of desire. A very simple list--anxiety, depression--these are all symptoms that we found develop at menopause, respond to hormone replacement, and don’t respond to placebo.
All of the women are sent that with their appointment, and we ask them to keep that diary for a month so that when they come to visit us for the first time, our nurse or our resident or myself say to the woman, “May I see your list of symptoms?” “I am Dr. Sarrel; may I see what you have recorded that’s happening in you?”
And for each of those symptoms we are going to ask whether you experience it or not and if it’s a problem to you or not. For example, you might be aware of a loss of desire, but you are not in any kind of sexual relationship, and you might say, “Well, yeah, it’s loss of desire, but it’s not a problem.”
I am going to focus on what you have identified as your problem. So you can help the healthcare provider tremendously if you come prepared. Bring the information with you, not as you remember it, but write it down; bring it with you. That’s the data about history.
Then a proper examination should be done. Your blood pressure should be taken. Your whole body should be looked at and evaluated for any changes, and there are many that could be related to menopausal changes. You should have a proper breast examination. You should have a pelvic examination. During the pelvic examination, the doctor or the nurse should actually take a sample, a Pap smear of your cells that they are going to send to the laboratory for evaluation of hormone effects in your body.
See, it will be one thing to order a blood test for hormones, which may or may not be done, but much more important is to get a simple measure of cells, not a biopsy, just a Pap smear, but that little Pap smear for 20 bucks will tell them if you have adequate hormone effects in your body or not because there are women who can have very little hormone but in fact have perfectly adequate cellular function, and you don’t want to be treated for something you don’t need to be treated for.
So a proper physical examination should be done, and then there are probably some baseline laboratory studies that are worth doing, depending on the problem that you present. Some doctors measure blood-estrogen levels; some measure pituitary hormone levels. I think the simplest and most helpful is that 20 dollar Pap smear looking for hormone effects on the cells of your body.
If there’s one simple test that probably should be done for everybody, it should be a fasting blood sample to look at your lipids, your cholesterol, and in fact as you know, there’s a good cholesterol and a bad cholesterol. So we call it a lipid profile–the total cholesterol, the HDL, the good guy--the LDL, the bad actor in the scene--and another part of that lipid family called triglycerides. All of that costs another 20 bucks in a laboratory that’s not overcharging.
So in fact, it’s not expensive to do the simple screening before starting anything. Why do I say that? Because it will turn out that there’s a change in your body that you can’t possibly know about, and that’s a change in how cholesterol is being metabolized that’s affected by your blood hormone levels, especially the estrogen.
And we know that 20-40 percent of women start to change their lipids in the wrong direction as they approach the menopause or immediately thereafter. About 40 percent of women also start losing bone. So for your physician or nurse to suggest that you have a bone density done, that’s not inappropriate. This would be especially true if you smoke.
For women who smoke, there are several other measures, but probably the most important are going to be bone density and also the lipids. So depending on the individual’s story, you certainly want to have good historical information. Your diary will beat anything else the doctor could ask about.
Then you want to have a proper physical examination, and then you want to have some fairly minimal laboratory testing, and you should have a follow-up, something like two to four weeks later to go over the results. I usually don’t start any hormonal treatment at the first visit because I don’t know enough data in order to make a conclusion.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.