A friend with morning muscle pain ran from orthopedist to rheumatologist, got diagnoses like rheumatism and osteoarthritis, went to an MRI to finally hear from a gynecologist that the cause of her pain is probably her now low estrogen level, because the less estrogen we produce, the greater the risk of inflammation and bone loss. This doctor also criticized the fact that even gynecologists don’t know enough about menopause because it hardly plays a role in residency training. Someone who is a gynecologist doesn’t have to know about hormone levels and hormone replacement therapy.

A good doctor first tries to find out why the patient is feeling so bad. But a hormone dance that is out of control doesn’t always have to be the solution. Or the sole one. A good doctor will try to find out if you feel listless because maybe the kids have moved out or you’re going through a breakup, if you don’t have a good social network, or if you’ve had bouts of depression in the past, for example.

Some gynecologists now have a self-developed questionnaire to classify whether the symptoms could be menopausal symptoms. Useful questions to ask include:

Do you suffer from concentration problems? Are you irritable, tense and restless or nervous for no apparent reason? Do you suffer from previously unknown depressive moods such as despondency, sadness, dejection, lack of drive or mood swings? Do you notice changes in your monthly cycle such as irregular, unusually heavy or light periods? Has your period stopped completely for a long time? Have you recently had trouble falling asleep or staying asleep? Are you gaining weight without having changed your eating habits? Has your skin become drier without any apparent external cause? Do you suffer from heart problems such as sudden palpitations? Do you have frequent urination, pain when urinating? Is your day overshadowed by diffuse anxiety? Do you have panic attacks with no apparent cause? Is your vagina very dry more often? Do you have pain during sexual intercourse?

A next step could be a hormone test, which many doctors do not expect to be very informative, because during menopause estrogen peaks alternate with estrogen valleys. If ovulation becomes rare, there is also rarely an increase in the corpus luteum hormone progesterone. The other problem: If the cycle is already irregular, when is the best time to take the test? Therefore, a test is often only considered if the symptoms are very severe.

Whether it’s a test or just a questionnaire or both, a good doctor will definitely take enough time to talk to you about everything and discuss whether to try phytotherapy or homeopathic remedies first, or whether hormone replacement therapy might be the right thing to help you now. And that brings us to the next newsletter: hormones yes or no? Perhaps it is the most hotly debated topic surrounding menopause.

The next article will be about hormone replacement therapy, conflicting studies, two glasses of red wine a day, and hormone fans and hormone opponents.