Q&A: blood test for menopause; multivitamins; osteoporosis meds; & the Mediterranean diet

ICYMI 👉

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• Mental Health is Health

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The first question (about a blood test for menopause) is free for all subscribers. Questions 2-4 (on taking a multivitamin; osteoporosis medications; & the Mediterranean diet) are for paid subscribers only. If you would like a paid subscription but it’s not in your budget, please message me directly.

Click here to submit your questions (about anything) for future Q&A posts!

Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

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The following subscriber questions have been lightly edited for clarity & length.

QUESTION #1: A BLOOD TEST FOR MENOPAUSE

Is there a blood test for menopause? I read this in a NYT article in the fall. What are your thoughts about it?

-Katie

Dear Katie,

While it’s true that we can measure hormone levels in the blood, menopause is actually a clinical diagnosis. In other words, lab testing isn’t usually necessary to determine whether or not a woman is in menopause. In addition, lab tests aren’t usually needed to help decide on hormone replacement therapy, nor are lab tests needed to guide treatment.

That said, medical providers often advocate for checking hormone levels (e.g., FSH, estradiol, progesterone, sex hormone binding globulin, testosterone). Patients commonly assume it is necessary. And indeed, sometimes checking hormone levels can help with the diagnosis and treatment of various hormonal imbalances.

However, when it comes to assessing a woman’s reproductive hormone status and their eligibility for menopause hormonal therapy, we treat the patient, not the lab tests. For example, if a woman is experiencing significant symptoms of perimenopause (such as hot flashes, night sweats, and vaginal dryness, among others), it may make sense to initiate hormone therapy even if the woman’s hormone levels were to show she was not fully in menopause (which is defined as having gone a full twelve months without a menstrual period.)

The upshot: when and if to start HRT is about understanding the patient’s symptoms, using clinical judgement, and making an evidence-based, shared decision with the patient; it is not always dependent on checking hormone levels.

For more about menopause and HRT, check out my podcast with GYN and menopause expert, Dr. Mary Claire Haver here!

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QUESTION #2: DAILY MULTIVITAMINS

I've been working on optimizing my health, and I’m considering adding a daily multivitamin to my routine. Is this something you recommend to your patients?”

-Susan

Dear Susan,