but probably don't…
Medical practitioner and health lawyer Dr Maura McGill says every woman needs to get their hormone levels checked before any artificial or natural hormone treatment.
'Surprisingly few women – or their doctors – know what is going on with their hormones, particularly as they approach menopause," she said. 'Men also need to know if their hormones are out of balance as they too approach middle age."
Dr McGill says medical practitioners should be checking hormone levels at regular intervals if they are prescribing any hormone treatment from the contraceptive pill to hormone replacement therapy.
'If doctors aren't ordering the tests, people should demand them, especially when taking medications to minimise any symptoms," said Dr McGill.
The following questions are the questions that doctors need to address when any consultation for hormone treatment is being considered:
How do I know if I am menopausal?
Technically you are menopausal if your FSH goes over 30 but in my experience women gradually increase their FSH until they go over 30 and sometimes that increased stimulation of the ovaries actually works and the ovaries spring into life for a short period. This means that you might be over 30 FSH one month and under the next. Until the FSH is consistently over 50-60 or even 100. I would not rely on being fully menopausal.
How do I find out my hormone levels?
Your doctor will take your history and will give you a pathology form to have your hormones measured. I get all seven hormones measured the first time and then an abbreviated list from then on approximately every 3-6 months. The hormones that should be measured the first time are: DHEA, FSH, LH, Oestradiol, progesterone, testosterone, SHBG. And I also add the ovarian tumour marker CA 125 at that stage as well.
Are blood tests or saliva test better?
It is clear that saliva tests are better but in Australia they are prohibitively costly, being around $250 every time. As the hormones change fairly often during the two to five years of menopause, I like to track them as accurately as possible and women simply cannot afford regular saliva testing. So we manage to extrapolate with blood tests as best we can. With proper supervision of blood results, the optimum hormone levels for women can be achieved.
When can I expect to become menopausal?
Women differ widely as to when they come into menopause, just as they vary a lot as to the time they begin to menstruate. I have patients as young as 33 and others who are not menopausal even though they are 52! But the average age of onset of menopause is around 45 to 50. Then, if the hormones are well controlled, begins the best time of a modern woman's life; freedom from pregnancy, freedom from young children, freedom to become who she really wants to be!
How long will my menopause last?
Again, the average time is around three to five years but some women hardly notice the change and some women are still flushing after 10 years! The latter women really need to be helped as their problem might not only be menopause. If you are taking hormones, whether by drug company products or by natural bio-identical hormones, the recommended maximum time for taking oestrogens is 5 years post-menopause. If you are taking only progesterone, there is no such recommended limit, but be aware that some progesterone will convert to oestrogen by enzyme action in the body so too high progesterone will also be a problem after five years. Careful monitoring is needed throughout these stages.
I am taking what my doctor ordered so why am I still having hot flushes?
If your doctor has not measured your hormones in the last six months, have them tested. If the hormone balance is good and you are still having flushes, even with an oestrogen level of 100 or more, then other causes for flushing should be explored. Some are simple; some are rare, but important. For you to get relief, you need further testing e.g. three hour GTT, and thyroid.
Maura McGill is an internationally known medical practitioner, lecturer and health lawyer, a charismatic speaker and a sought-after advisor on women's health issues, especially in relation to hormones. She has practised medicine on three continents over 40 years, is a qualified lawyer, and was a partner in Clayton Utz, one of Australia's top four legal firms, before returning to medicine to specialise in women's primary care. This is a woman with her feet firmly planted on the ground, with substantial research to support her practices. www.drmauramcgill.com.au