Your Menopause Cheat Sheet

At Menopalooza, I was on a panel about personalized menopause care when a woman in the audience asked a question I hear constantly: "What do I do if I can't see someone like you?"

She actually lived here in Chicago. But many menopause specialists, including me, practice in direct care models. Some people aren't ready to make that kind of investment in their health, and others simply can't.

Her primary care doctor told her everything was "normal," even though she didn't feel normal at all.

I hear this every week from women who find my profile online. They're searching for answers because midlife care often falls through the cracks of our healthcare system. Primary care doctors have 15-minute appointments and dozens of concerns to address. Most endocrinologists focus their practices on diabetes and thyroid disease. The kind of comprehensive metabolic care midlife women need is hard to find. They need someone who can look at hormones, insulin resistance, cardiovascular risk, bone density, and body composition as one connected picture, with menopause and perimenopause understood as part of that whole. They're looking for the kind of care I provide, but it isn't always accessible.

If you can't, this is what I recommend.

This is the same framework I use in my own practice, the foundation for comprehensive midlife care. It's what happens when endocrinology meets menopause expertise, something most women never get access to. Walk into your next appointment prepared. Know what to ask for. Get the care that matches the standard I set for my patients.

Why midlife care matters

Most women will spend nearly 40 percent of their lives post-menopausal, decades in a low-estrogen state that affects bones, brain, metabolism, heart, sexual function, and mood.

These changes start subtly, then compound. Osteoporosis. Heart disease. Insulin resistance progressing to Type 2 diabetes. Cognitive decline.

Many women think menopause is mostly about managing hot flashes, but for me, it's about shaping your health for the next 30 to 40 years. The interventions you make now or don't make will define your trajectory.

Start here: the labs I actually order

When a woman comes to me in her 40s or 50s with midlife concerns, this is my starting point:

- Complete blood count (CBC)

- Comprehensive metabolic panel

- A1C and fasting glucose

- Lipid panel (total cholesterol, LDL, HDL, triglycerides)

- Optional: ApoB and lipoprotein(a) if there's personal or family history of heart disease

- Vitamin D

- Vitamin B12 and folate

- Iron studies (ferritin, iron, TIBC)

- Omega-3 index or fatty acid profile

- Thyroid panel (TSH, T3, free T4 ± antibodies)

- Inflammatory markers (hs-CRP, homocysteine)

- Testosterone (total and free) and sex hormone–binding globulin

Notice what's missing? Estrogen, progesterone, LH, and FSH. I check them in perimenopause but with the caveat that hormone levels fluctuate daily and don't guide treatment decisions. Symptoms and history matter far more.

This foundation gives you real data. Your history may call for more, but this is where I begin.

At Well Endocrinology, we can complete this full panel for under $250, which is especially meaningful for women with high-deductible plans or limited insurance coverage. It ensures that high-quality, comprehensive testing remains accessible; without compromising precision or care.

The heart disease conversation no one's having with you

Here's what frustrates me: cardiovascular disease is the leading cause of death in women, yet the standard screening timeline often means we're not looking closely until later in life.

There's an opportunity we're missing.

Hormonal shifts unmask insulin resistance, high cholesterol, and hypertension. By menopause, your metabolic risk profile has often changed dramatically. If your screening approach hasn't evolved with you, there's more we could be learning.

I recommend coronary artery calcium (CAC) scoring between ages 40 and 45 for women with family history of early heart disease, high cholesterol, borderline labs, or metabolic concerns. It's a quick CT scan that shows what's actually happening in your arteries, not just what a calculator predicts.

If you don't qualify for CAC, that's okay. But this is still the moment to have detailed conversations about your cardiovascular health, not at 65, but now, when early intervention makes the biggest difference.

Bone loss starts earlier than you think

Standard guidelines say to wait until 65 for a bone density scan. I almost never wait.

We lose up to 20 percent of bone mass in the five to seven years after menopause. By 65, much of that loss has already occurred. At that point, we're managing damage instead of preventing it.

I order a DXA scan within the first five years of menopause, especially if there's early menopause, family history of osteoporosis or fracture, history of restrictive eating or low body weight, autoimmune disease, chronic steroid use, or thyroid dysfunction.

Bone loss is silent until you fracture. It's better to know early, when we can still act.

Hormones, symptoms, and the quality of life conversation

Too many women are told their symptoms are just "part of getting older" or that hormone therapy is too risky to consider.

Every woman deserves an informed discussion about menopausal hormone therapy (MHT). The data is clear: for most women under 60 and within 10 years of menopause, it's safe and effective. It addresses hot flashes, night sweats, sleep disruption, brain fog, mood instability, vaginal dryness, painful sex, and bone protection. It may also support metabolic health.

It's not for everyone, there are excellent non-hormonal options, but dismissing the conversation entirely is outdated medicine.

And yet, for many women, the hardest part isn't getting access to therapy. It's getting anyone to take their symptoms seriously.

You're waking at 3 a.m. every night. You're gaining weight despite eating the same way you always have. Sex is uncomfortable or impossible because of dryness. Your brain feels foggy. You're overstimulated, exhausted, and disconnected.

These aren't minor inconveniences. They're real issues that deserve thoughtful, evidence-based solutions, not vague advice to "relax" or "get more sleep."

Push your doctor to address:

- Vaginal estrogen or other local therapies for dryness and bladder symptoms

- Pelvic floor therapy if sex is painful or muscles feel weak

- Proven approaches for sleep and anxiety

- How stress and insulin resistance may be shaping your weight and mood

Your quality of life is not a luxury. It's the foundation of everything else.

This is the standard

You're not overreacting. You're not too young. And you shouldn't settle for dismissive care.

Perimenopause and menopause are hormonal transitions that are windows into long-term health. They require someone who sees the full metabolic picture: reproductive hormones, thyroid function, insulin resistance, lipid metabolism, body composition, and bone density. My training in internal medicine, endocrinology, and obesity medicine allows me to address all of it not in isolation, but as the interconnected system it is. The care you receive now shapes how you age.

Even if you can't access a menopause specialist, you can advocate for yourself. Use this framework. Ask better questions. Expect thoughtful answers.

If you're ready for care that listens and leads with science, I'd be honored to work with you. Book your consultation today.