6 Tests To Maximize Your Well Woman Exam In Menopause

By: Dr. Mary Claire Haver
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6 Tests To Maximize Your Well Woman Exam In Menopause

During your well woman exam, your doctor asks how you’ve been feeling, does a brief exam, and usually orders blood work. She might rattle off the names of a couple of lab tests she’s ordering, like a CBC (complete blood count) or CMP (comprehensive metabolic panel)—but rarely has the time to explain what exactly these tests are looking for. So you get your blood drawn, get a call a few days later that things came back “normal,” and you don’t really think much about it until next year. Sound familiar? 

If you are seriously proactive about optimizing your health in menopause and perimenopause, what are the key tests to consider requesting that any doctor can order and will most likely be covered by your insurance? 

It’s important to note that everyone’s health insurance coverage is different, but you can increase your chances of getting the tests you need (and getting them paid for) if you take the following steps before/during your next appointment: 

  1. Write down your family history of diseases and illnesses, which relative had them, and at what age. This information could qualify you for certain medical tests you may not otherwise be qualified for. For example, if you have fatigue and a family history of hypothyroidism, your physician can utilize that diagnostic code and increase your chances of insurance covering the test.  
  2. Keep a symptom journal, noting any changes to your health since your last visit, including new aches and pains, increased fatigue, hair loss, weight gain or loss, constipation, forgetfulness, depression, etc. 
  3. If there is ever a question, call your specific insurance company to confirm coverage for tests.  
  4. Try to obtain the first appointment of the morning – and show up fasting (no food/drink other than water after midnight). This timing will ensure a fresh physician and may avoid any delay in testing due to needing a fasted state. 
  5. Write down the specific tests you would like and what symptoms you have that would make testing these levels a good idea.  

1. The “Standard Tests” Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) and Lipid Panel

These three are basic tests that are often included as part of an annual checkup—but do not forget to ask for them. They are basic screening tests and do not require symptoms for insurance to cover them during an annual exam.  

The CBC measures different features of your blood, including red blood cells, white blood cells, platelets, hemoglobin, and hematocrit. It is important for the diagnosis of anemia, and it is also a screening test for immune system issues and different types of cancer.  

The CMP reveals information about your overall metabolism, including kidney and liver function and type 2 diabetes risk. It also looks at electrolytes like sodium, calcium, and potassium, which can indicate whether you’re dehydrated, and it’s a screening test for your liver and kidney function. This panel measures the blood levels of albumin, blood urea nitrogen, calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium, total bilirubin and protein, and liver enzymes.

The lipid panel, usually drawn while fasting, is a broad picture of heart health, which is a measure of your HDL (“good”) cholesterol, LDL (“bad”) cholesterol, and triglycerides. One of the strongest predictors for preventing heart disease is having a good HDL-to-triglycerides ratio. Your HDL should be higher than or equal to triglycerides.

2. The Diabetes Screen: Hemoglobin A1C (HbA1C)

This test is a more powerful indicator of blood sugar dysregulation than a single fasting glucose level. The HbA1c test measures the percentage of red blood cells saturated with glucose.1 The higher your A1C, the higher the estimated average blood glucose over the past 6 weeks. A high HbA1C marker may also increase your risk of Alzheimer’s disease and cancer—potentially making the test a good predictor of overall longevity.
 

3. The Thyroid Panel 

Thyroid disorders are incredibly common, affecting one in 10 women, and about 60% of people with a thyroid problem are unaware of their condition—and thus, unable to manage it appropriately. The TSH is a great screening test, but a more comprehensive thyroid panel is needed for women experiencing unexplainable weight gain or loss, chronic fatigue, cold intolerance, hair loss, forgetfulness, constipation, and feeling generally depressed. Ask for a TSH, free T4, free T3, reverse T3, and two types of thyroid antibody levels called anti-TPO and anti-thyroglobulin. A more comprehensive panel can spot issues early while they can still be addressed with lifestyle changes.

4. Nutritional Deficiencies: Vitamin D, Zinc, and Magnesium

Vitamin D: 42% of patients on average have low Vitamin D, and this number gets worse with age and menopause.2 This deficiency can be due to geography limiting sun exposure, darker skin limiting absorption, a genetic issue, absorption issue, or kidney disease. Vitamin D has MULTIPLE roles in the body: it is a hormone-precursor that plays a key role in immune function and mood. Deficiencies in vitamin D can also be a factor in autoimmune disease and certain cancers.3 Be sure to ask for it if you have mood disorders or fatigue.  

Zinc: Zinc is used by your body in cell production and immune functions. When you’re zinc deficient, your body can’t produce healthy, new cells. This deficiency leads to symptoms such as unexplained weight loss, wounds that won’t heal, lack of alertness, and decreased sense of smell and taste.4

Magnesium: Deficiency is linked to poor sleep, nerve problems, mood disorders, fatigue, muscle cramping, headaches, and brittle hair and nails. It is also important in heart health, blood pressure, and to keep your thyroid in balance.5  

5. Anemia Panel (iron, ferritin, folate, and vitamin B12)

Anemia is a major cause of chronic fatigue. Low vitamin B12 is common among vegetarians and vegans but can also exist among omnivores due to nutrient malabsorption issues caused by antibiotic overuse or celiac or Crohn’s disease. Folate plays a crucial role in healthy pregnancy and preventing birth defects but often is not screened. Low iron can present as anemia or even hypothyroidism. Even if you’re not anemic (which can be tested for with a CBC), you can still be iron deficient—which is why testing for iron and ferritin separately is important.6
 

6. Chronic Inflammation Testing: high sensitivity C-Reactive Protein (hsCRP), Erythrocyte Sedimentation Rate, Plasma Viscocity

These tests are great ways to see if you are inflamed, then use them as a marker after nutrition/lifestyle changes to track progress. However, these markers are nonspecific, meaning that abnormal levels can show that something is wrong, but not what is wrong. Since nutrition and lifestyle changes fight so many of the causes of chronic inflammation – it is worth testing.

hsC-reactive protein (CRP): CRP is naturally produced in the liver in response to inflammation. A high level of CRP in your blood can occur due to several inflammatory conditions.7

Erythrocyte sedimentation rate (ESR)

The ESR test is rarely performed alone, as it doesn’t help pinpoint specific causes of inflammation. Instead, it can help your doctor identify that inflammation is occurring. It can also help them monitor your condition.8

Plasma viscosity

This test measures the thickness of blood. Inflammation or infection can thicken plasma.9


Now that you have read through the different tests available. Do you feel more confident, more empowered? We hope you advocate for your best health! These tests can help you get the most out of your health care and your annual well woman exam. There is nothing more important than understanding what is going on in your body to make the best nutritional choices for your future. 

 

References

1 https://care.diabetesjournals.org/content/42/4/576

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4571146/

4 https://www.ncbi.nlm.nih.gov/books/NBK493231/

5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637834/

6 https://www.ncbi.nlm.nih.gov/books/NBK499905/

7 https://www.sciencedirect.com/science/article/abs/pii/S0002914903007744

8 https://www.aafp.org/afp/1999/1001/p1443.html

9 https://www.bmj.com/content/344/bmj.e454

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With an anti-inflammatory approach to nutrition, Dr. Haver has cracked the code and found an innovative solution that actually works at this time in our lives. The Galveston Diet can help women in menopause lose weight, burn fat, and feel more confident in their skin.

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