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A doctor visit for menopause is not just a chance to talk about hot flashes. While your gynecological health is certainly in the spotlight, menopause for many women is also a wake-up call to pay attention to cardiovascular disease risks and osteoporosis.
Use this time to check in with the doctor no matter how much or how little you've seen the doctor before. Keep in mind that menopause is a normal part of aging, just like puberty or pregnancy. Bring up your symptoms, but also talk about other health concerns.
Should I talk about hormone therapy?Tell your doctor about any menopausal symptoms that are interfering with your day-to-day function.
If symptoms, such as hot flashes and trouble sleeping, are really bothering you, you may want to talk to your doctor about treatment options. Symptoms occur around menopause when your body gradually stops ovulating and makes less of the hormones estrogen and progesterone. Hormone therapy (HT) does not replace or make up for the hormones your ovaries no longer produce. rather, low levels of hormones are used only to control symptoms. there are risks involved with taking hormones. so the most important guiding principle if HT is suggested is to take the lowest effective dose of medicine for the shortest period of time.
What else should I cover at my doctor appointment?Discuss your medical and family medical history. your doctor will talk about your risks for heart disease, osteoporosis and breast cancer. You'll have a physical exam, including a gynecological exam and clinical breast exam.
You may discuss non-hormone, alternative treatment for any bothersome menopause symptoms. if your doctor thinks that you will benefit from hormone treatment, you'll discuss the risks, options available to you and how hormone treatment may help.
What questions should I ask my doctor?Here are questions to ask your doctor:
How long will my symptoms last?
Every woman's menopause experience is unique. but on average, most symptoms stop within five years. many women, though, have bothersome symptoms longer.
Could my menopause symptoms be related to another medical condition?
Menopause symptoms are normal. but sometimes these same signs may be due to other medical conditions. so your doctor will take a thorough medical history and may check your thyroid gland, urinary tract and other body systems.
What is my risk for heart disease?
Awareness of your own heart disease risks is very important as you approach menopause. The loss of natural estrogen after menopause may raise your risk of heart disease. your doctor will check your cholesterol (high cholesterol is a heart disease risk), suggest that you quit smoking (if you're a smoker) or lose weight if needed.
What is my risk for osteoporosis?
The loss of estrogen can contribute to bone loss. your doctor will want to know if you're getting enough calcium and vitamin D, which are important for building strong bones. also ask about weight-bearing exercise, which also helps strengthen bones.
How can hormone therapy help symptoms?
Your doctor may advise a short course of hormone treatment if you have severe symptoms such as moderate or severe hot flashes and night sweats. For vaginal dryness, your doctor may suggest a vaginal estrogen product.
Do you recommend I take hormone therapy to prevent osteoporosis?
While HT can help prevent osteoporosis, it is not the first choice to prevent the disease. Calcium, vitamin D and possibly medications (such as the bisphosphonates) are usually effective and have fewer risks.
Who should not take hormone therapy?
Using HT depends on several factors. The first is age. you should not take HT if you are too many years past menopause. if you have a history of breast or uterine cancer – or are at risk for these cancers – you should avoid hormone therapy. you should also not take HT if you have a history of blood clots, liver problems, heart disease or risks for heart disease.
How long should I stay on the therapy?
Most doctors advise that you take it only for the shortest period possible and not longer than longer than five years.
What follow-up tests will I need? how often will I need to take each test?
Whether you take HT or not, it's important to keep your appointments. For example, you may need fasting cholesterol test and other bloodwork as part of routine screening. also, get your blood pressure checked as often as your doctor suggests.
What are other alternatives to hormone therapy?
Most women find that their symptoms lessen when they take extra care to live a healthier lifestyle and lower their stress. This includes daily exercise, limiting alcohol and caffeine and eating well.
There is not enough evidence to know whether natural remedies like soy or black cohosh help.
Remember that menopause is normal, and usually doesn't require any treatment at all. if you and your doctor decide on hormone therapy, then you should take the smallest effective dose for the shortest amount of time.
Check in with your doctor on a regular basis to review your health and your risk profile, which may change over time.
SOURCES:
- American Congress of Obstetricians and Gynecologists. Hormone therapy. Accessed: 12/11/2009
- National Women's Health Information Center. Understanding menopause. Treatment and talking to your doctor. Accessed: 12/11/2009
- National Institutes of Health. Women's Health Initiative. Questions and answers about the WHI postmenopausal hormone therapy trials. Accessed: 12/11/2009
- North American Menopause Society. The hormone therapy story. Accessed: 12/11/2009
- American Association of Clinical Endocrinologists Menopause Guidelines Revision Task Force. AACE Medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice. 2006;12(3): 315-337.
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