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Tests
Usually there are very few tests (if any) necessary around the time of the menopause. However your doctor may wish to examine you (abdominal and pelvic examination) before commencing any treatment. Sometimes a blood test or DEXA bone density scan may be needed. The doctor or nurse will decide what is appropriate for you
Blood pressure:
This is usually carried out as part of a health check. If your blood pressure is raised, your doctor will want to bring it back to normal before starting certain treatments including HRT.
Blood tests:
Some of these tests can be helpful in selected women:
- Haemoglobin - a measure of the amount of red blood cells in circulation. If the levels are insufficient, this is 'anaemia'.
- Full blood count - this measures the haemoglobin, white blood cells and platelets (clotting), as well as looking at the size and shape of the cells. It can be useful in looking for causes of anaemia.
- Liver function tests- a group of tests performed if the doctor is concerned about liver damage.
- U and E's (urea and electrolytes) - tests of kidney function, checked if the doctor is concerned that the kidneys may not be functioning perfectly.
- FSH - follicle stimulating hormone. The level of this hormone is raised as women approach the menopause (last period).
- Oestradiol - the female hormone. Levels vary greatly during a normal menstrual cycle and leading up to the menopause. Levels tend to be low once your periods have completely finished.
- Progesterone - the female hormone produced in the second half of a normal menstrual cycle. If present in sufficient amounts, it can indicate if a woman has produced an egg that cycle (ovulation).
- Testosterone - the male hormone, but present in smaller amounts in women. A lack of this hormone can sometimes be associated with a loss of energy and libido in a woman after the menopause, particularly if she has had her ovaries surgically removed.
- SHBG (sex hormone binding globulin) - a protein in the blood which carries various hormones around the body.
- Free androgen index - a measure of how much of the testosterone (male hormone) is available to be used by the body.
- Thyroid function tests - these tests check whether the thyroid is under or overactive. Some of the problems caused by abnormal thyroid function can be similar to 'menopausal' symptoms.
If osteoporosis is suspected, a set of blood tests will be taken, to check to see what may be causing the 'brittle bones'. Tests include a blood count to check for anaemia, checks of thyroid, liver and kidney function, test for proteins and a test to rule out coeliac disease (a gluten allergy leading to malabsorption from the bowel).
Cervical smear:
Cervical smears check for pre-cancerous changes on the cervix (neck of the womb). You will be offered regular smears as part of the national Cervical Screeinig Programme from your 20's onwards. There is no need to have a smear performed before starting any treatment for the menopause, unless it is overdue.
DEXA scan:
Picture: Having a DEXA bone density scan (Dual X Ray)
DEXA (Dual X-ray Absorptiometry) bone density scanning is the test used to measure whether a person has osteoporosis of the spine, hip or wrist. These are the areas of the body most likely to fracture (break) due to osteoporosis. The test takes about 10 minutes to complete. It is completely painless and uses only a small amount of radiation. The report will be sent on to your clinic doctor or GP, whoever ordered the scan. The result will be discussed at your next clinic visit.
Endometrial biopsy:
If you have been experiencing abnormal vaginal bleeding, your doctor may wish to check a sample of the lining of the womb before starting any treatment. This can be done in the clinic. It is done by passing a very thin tube into the womb through the vagina. No anaesthetic is necessary as it usually only causes mild discomfort. However in some circumstances it is necessary to give you a local anaesthetic (freeze the neck of the womb) or general anaesthetic (put to sleep).
Mammography
This is an X-ray of your breasts to see if there are any abnormal areas. This can be helpful to diagnose breast cancer in the early stages. You will be offered mammography routinely from the age of 50 onwards as part of the National Breast Screening Programme. There is no need to have any extra mammography before starting HRT if you are up to date with your mammograms. If you are under 50, ask your doctor whether you need mammography.
Ultrasound Scan.
If your doctor suspects any problem with your womb (uterus) or ovaries, you may need an ultrasound scan of your pelvis. This is a painless examination using sound waves rather than X-rays. In order to see your pelvis clearly, the radiographer will scan you on your lower abdomen. You are likely to need to be scanned internally also (transvaginal scan).
X-rays
X-rays are unlikely to be necessary unless your doctor suspects a fracture (broken bone).
