Menopause Masterclass: How to Read Your Labs

**Mary Claire Haver** (0:02)
On today's Master Class, I want to walk you through something practical, something you can take directly into your next doctor's appointment. Over the years, I've had countless conversations with women who felt like their labs were all coming back normal, but they still didn't feel well. Fatigue they could not explain, weight changes that did not respond to the things that used to work, brain fog, poor sleep. And when they asked their doctors what was going on, they were told their numbers looked fine. The problem, more often than not, was not the numbers. It was the numbers that were actually being checked. Standard annual labs are designed for a general population. They do a good job of screening for a lot of things, but they're not designed to capture what happened specifically to a woman's body during the menopausal transition. There are seven categories of testing that can give you and your clinician a much more complete picture of your cardiovascular health, your metabolic health, your bone health, your hormonal status, and your inflammatory baseline.
And most women have never heard of them.
So that's what this episode is about. I am going to walk you through each test, what to ask for, why it matters, and how to have a productive conversation with your doctor. These are not specialty tests. They are not out of reach. They are reasonable, evidence-based labs that any clinician can order.
Knowing what to ask for is the first step.
So let's start there. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to unPAUSED, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.
The views and opinions expressed on unPAUSED are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis or treatment.
So let's talk about blood work and why the standard annual labs often miss the full menopausal picture. And don't panic, we are going to have links to the checklist in the show notes and also on our website at the pause life.com. So your doctor probably runs a CBC and a CMP every year. That's a complete metabolic panel and a complete blood count. These labs are important. They check your liver, your kidneys, your red and white blood cells and your basic electrolytes. I am not telling you to skip them at all. These are important. But what I'm telling you is they're not really designed to catch what a woman's body is doing during the menopause transition. They're designed for the general population, and that general population for most of the history of clinical medicine was assumed to be male and was not assumed to have any hormonal changes. We know from research that it takes 17 years for a clinical study to come out to then make it through the guidelines and then be regularly practiced in clinical practice. That means that what your doctor learned in medical school about cardiovascular risk, about bone loss, about women's insulin metabolism was likely already a decade behind the science when they learned it, and it has continued to fall behind ever since. So here's what the standard annual panel typically misses for women in perimenopause, menopause and postmenopause. For women specifically, there are lipid particles that drive cardiovascular risk and estrogen depleted women. We don't find these in premenopause. We really only find them in postmenopause for most women. It misses insulin resistance in the early stages. It misses bone loss before it fractures. It misses thyroid dysfunction that mimics almost every menopause symptom. It misses iron depletion from years of chronic, heavy vaginal bleeding. And it misses the hormonal picture entirely. Seven categories. That's what we're going to cover today. I'm going to tell you what to ask for, what the science says, and what to say to your doctor if you meet resistance. Okay, lab number one. This is an advanced lipid panel. So most of you are probably getting a total cholesterol, an LDL, which is considered the bad cholesterol, and an HDL, which is considered the good cholesterol.
We want to continue to have those checked, but we want to add in a couple of more very, very, very important tests. We want to add in an Lp little a, we want to add in an ApoB, and if you are in perimenopause, you may want to consider adding in small dense LDL particles, and we'll go over each one and why. So it turns out not all LDL particles are created equal. Lp little a and ApoB are very, very specific particles that are directly linked to heart disease. So just having an LDL does raise a flag of concern, but more specifically related to your risk of atherosclerosis and cardiac disease is going to be the Lp little a and the ApoB, and most of you have probably not had these two labs checked.