Life with HRT: Monitoring your health

Assuming we're all in this for the long haul, there are some regular maintenance things we've got to take care of now that maybe we were sloughing off on before.

Although it hardly seems fair, we do still need to have regular pap smears. They may not need to be annual (discuss this with your doctor and set up a schedule), but they should be regular. Even if you no longer have a cervix, remnant cervical cells could conceivably still turn malignant. A pap also screens for vaginal cancer, a lower but still present risk. So it's still a good idea.

Mammograms are a necessary adjunct of HRT. While the risks of dying of breast cancer are way lower than those of heart disease or osteoporosis, the fact remains that your risk of breast cancer is related to your lifetime hormone exposure. Regular self-exams are a must, but with the denser breast tissue estrogen promotes, mammography is necessary for a thorough exam. Nobody likes getting their tits smashed, but the alternative is way more wretched. Take heart—as the demographic bulge gets into the menopause years, better and gentler screening methods are being developed.

Bone density measurement is something to think about having done at surgical menopause and every few years thereafter, just to make sure you are holding your own on (or off, as the case may be) your HRT. Since the worst rate of bone loss is in that first year post menopause and that is the time when you are least likely to be well-balanced on HRT, you may need to keep a closer eye on things for the first few years till you stabilize.

Although many insurance plans will cover bone density testing, if you don't have insurance or are otherwise burdened by the cost of the scan (it runs a couple hundred dollars, on average), a less precise but nonetheless useful method is also available. This uses ultrasound or xray (there are several varieties of specialty measuring devices) to measure the density of one single bone, and is performed using a small machine that is often located in doctors' offices. While its results are limited to that one bone (and density loss can vary from bone to bone), it at least is valid as a monitor of change over time and costs well under $100 in most offices. If your doctor doesn't have one, call around to the larger area OB-GYN practices or private radiology practices and you may locate one. They are usually willing to do the test for a non-patient if you have a referral from your doctor.

Another recent arrival on the scene is the mobile "health fair" that comes into a community once or twice a year to provide educational booths and low-cost testing to walk-ins. These are increasingly offering single-bone screenings in addition to a broad range of basic blood tests, and provide excellent value for those who are uninsured or juggling insurance deductibles.

We've already talked about the usefulness (or not) of getting ovarian hormone levels done. So long as you feel good, there is probably no particular reason to check them on any regular basis.

Some lab work you might find worthwhile is a check for diabetes. The changes in insulin and metabolism that come with menopause can push those who were marginally under control over the line into "adult-onset" or "Type II" diabetes. This should certainly be part of your workup if you are having long-standing difficulty finding hormonal balance, since many of the symptoms can overlap with hormonal ones.

Thyroid problems are so common after a hyst that checking thyroid hormone levels should almost be considered a routine measure. It is very difficult to distinguish one imbalance from the other, and in fact there is often overlap. When checking, it is appropriate to ask for free T3 and T4 levels in addition to TSH, since it is very common for menopausal women to show a normal TSH but low circulating T3 or T4 levels. If you are at the bottom range of normal, some practitioners feel it may be worthwhile supplementing with just a little thyroid—it may bring your whole system into better balance, even though you were not hypothyroid in the strictest sense.

And then there's good nutrition (remember those essential nutrients we talked about?), a diet that doesn't aggravate that middle-age tendency to pork up around the middle, and plenty of weight-bearing exercise. May we repeat that about exercise? One of the most important adjuncts to HRT is regular (several times a week) weight-bearing exercise. It doesn't even have to be that strenuous or prolonged: results from a large study released not long ago indicated that as little as an hour a week could halve some cardiac risk measurements. Exercise strengthens your bones, maintains your flexibility and counters depression. All you have to do is get off your butt and do it. And don't bother with the excuses—we've already thought of them all for ourselves.

You've taken a big step to reach for better health when you had your hyst and began working on hormone balance. Now you are entitled to enjoy your new, healthier life…by keeping that body healthy. Go for it.