On Estrogen and Progesterone After Menopause? Here’s What to Check Every Year

Your Annual Exam Should Include Cardiovascular Risk

Heart disease is still the number one killer of women. And menopause changes the risk conversation. The American Heart Association has noted that cardiovascular risk rises after menopause and that hot flashes, night sweats, depression, blood pressure changes, and metabolic shifts may all matter in the bigger risk picture. At your annual exam, ask: “Can we review my cardiovascular risk, not just my cholesterol?” You want:

• Blood pressure
• Weight and waist circumference
• Full lipid panel
• ApoB
• Lipoprotein(a), at least once
• hs-CRP, when appropriate
• Fasting insulin, especially if belly weight or blood sugar issues are present
• Discussion of family history
• Discussion of coronary artery calcium scan if your risk is unclear

A standard lipid panel includes total cholesterol, LDL, HDL, and triglycerides. Helpful? Yes. Complete? Not always. ApoB gives a better sense of the number of atherogenic particles that can drive plaque formation. Lipoprotein(a) is largely genetic. The American Heart Association describes elevated Lp(a) as an independent risk factor for heart disease and stroke. Levels of 125 nmol/L, or 50 mg/dL, and higher may increase risk. Triglyceride/HDL ratio. You want it less than 2. This is one of those “why did nobody test this before?” labs. If your cholesterol looks “fine” but you have a strong family history of heart disease, please ask about ApoB and Lp(a). And if your risk is intermediate or unclear, a coronary artery calcium scan may help refine risk and guide decisions about statins or other prevention strategies. ACC/AHA guidance supports CAC scoring when treatment decisions are uncertain in borderline or intermediate-risk adults.

Blood Sugar Regulation: The Midlife Sneak Attack

Blood sugar problems often start quietly. You may see:

• Belly weight that won’t budge
• Afternoon crashes
• Cravings
• Brain fog
• Waking at 3 a.m.
• Higher triglycerides
• Fatty liver markers
• Higher blood pressure

Ask for:

• Fasting glucose
• Hemoglobin A1c
• Fasting insulin; this will uncover evolving blood sugar problems long before glucose and hemoglobin A1C
• Comprehensive metabolic panel
• Liver enzymes
• Triglycerides
• Waist circumference

The American Diabetes Association states that fasting plasma glucose, A1c, and a 2-hour oral glucose tolerance test can be used for screening and diagnosis of diabetes and prediabetes. Here’s where I get bossy: fasting glucose and A1c alone do not always tell the whole story. Insulin can be elevated for years before glucose rises. That means your body may be working overtime to keep blood sugar “normal.” Meanwhile, you’re tired, inflamed, gaining weight, and being told everything looks fine. Fine is a four-letter word when it comes to midlife labs.

Bone Health: Do Not Wait Until You Break Something

Bone loss accelerates after menopause because estrogen helps regulate bone remodeling. Hormone therapy can help prevent bone loss, but that does not mean you get to ignore your bones. Ask: “Do I need a bone density scan, and when should it be repeated?” The USPSTF recommends osteoporosis screening for all women 65 and older, and for postmenopausal women younger than 65 who are at increased fracture risk. Listen up, 65 is WAY too late to begin looking at this. Osteoporosis can be well entrenched by then. Get a DEXA scan at around age 50. If you already have osteopenia, osteoporosis, fracture history, steroid use, early menopause, low body weight, smoking history, high alcohol intake, or strong family history, you may need screening earlier. Useful bone health tools include:

• DEXA scan
• Vitamin D
• Calcium intake assessment
• PTH if calcium is abnormal or bone loss is unexplained
• Bone turnover markers in select cases
• Fall risk assessment
• Strength and balance assessment

AACE guidance recommends baseline DXA and repeat DXA every 1 to 2 years until findings are stable, then less often depending on clinical circumstances. And please hear this: bone health is not just calcium chews and hope. You need strength training, protein, vitamin D adequacy, mineral sufficiency, hormone assessment, fall prevention, and a plan.

What Else Should Be Checked Yearly?

Here is a practical annual lab and screening list to discuss with your physician.

Basic yearly labs

• CBC
• Comprehensive metabolic panel
• Fasting lipid panel
• ApoB
• A1c
• Fasting glucose
• Fasting insulin
• TSH, Free T4, Free T3 when appropriate
• Vitamin D
• B12, especially if vegetarian, on metformin, on acid blockers, or dealing with neuropathy or fatigue
• Ferritin if fatigue, hair loss, restless legs, or history of low iron
• hs-CRP if inflammation or cardiovascular risk is a concern

Hormone-related monitoring

• Estradiol when clinically useful
• Progesterone when clinically useful
• Testosterone panel if using testosterone
• SHBG
• DHEA-S
• Follow-up for any bleeding
• Review dose, route, side effects, and goals

Preventive screenings

• Mammogram based on age, risk, and guidelines
• Cervical cancer screening if still indicated
• Colon cancer screening
• Skin exam
• Dental exam
• Eye exam
• Bone density scan based on age and risk
• Blood pressure
• Vaccines as appropriate

The Women’s Preventive Services Initiative well-woman chart is designed to help clinicians incorporate preventive services across a woman’s lifespan.

What Should You Ask Your Physician at Your Annual Exam?

Bring a written list. Not because you’re difficult. Because you’re prepared. Try these:

1. “Can we review my hormone therapy based on my current symptoms, risk factors, and goals?”
2. “Am I on the safest and most effective route of estrogen for me?”
3. “If I still have a uterus, is my progesterone dose appropriate for uterine protection?”
4. “Should we check estradiol, progesterone, testosterone, SHBG, or DHEA-S based on what I’m using?”
5. “Can we review my cardiovascular risk beyond a basic cholesterol panel?”
6. “Can we check ApoB and lipoprotein(a)?”
7. “Do I need a coronary artery calcium scan?”
8. “How is my blood sugar regulation? Can we check fasting insulin, not just A1c?”
9. “When should I have my next DEXA scan?”
10. “What are the top three things I should work on this year to lower my long-term risk?”

That last question is gold. It turns the visit from a box-checking exercise into an actual health strategy.

The Bottom Line

If you’re post-menopausal and on estrogen and progesterone, you need more than refills and reassurance. You need a yearly review that asks:

• Are my hormones working for me?
• Are my bones protected?
• Is my cardiovascular risk being fully evaluated?
• Is my blood sugar trending in the wrong direction?
• Are my labs “normal,” or are they optimal for where I want to go?
• Do I have a plan?

Because midlife health is not about surviving the annual exam. It’s about using the annual exam as a checkpoint. You deserve to know what’s happening in your body. You deserve clear answers. And you deserve a plan that helps you feel strong, steady, sharp, and at home in your body for years to come. If you want help connecting the dots between hormones, metabolism, bones, heart health, and how you actually feel, book a Clarity Call. We’ll talk through where you are, what feels stuck, and what the next best step may be.

References

American Diabetes Association. (2025). Standards of care in diabetes, 2026: Diagnosis and classification of diabetes. Diabetes Care. https://diabetesjournals.org/care/article/49/Supplement_1/S27/163926/2-Diagnosis-and-Classification-of-Diabetes American Heart Association. (2023). The connection between menopause and cardiovascular disease risks. https://www.heart.org/en/news/2023/02/20/the-connection-between-menopause-and-cardiovascular-disease-risks American Heart Association. (2026). What is lipoprotein(a) and how does it impact my risk? https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a-risks Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C., Virani, S. S., Williams, K. A., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation, 140(11), e596-e646. https://doi.org/10.1161/CIR.0000000000000678 Camacho, P. M., Petak, S. M., Binkley, N., Diab, D. L., Eldeiry, L. S., Farooki, A., Harris, S. T., Hurley, D. L., Kelly, J., Lewiecki, E. M., Pessah-Pollack, R., McClung, M., Wimalawansa, S. J., Watts, N. B. (2020). American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis. Endocrine Practice, 26(Suppl 1), 1-46. El Khoudary, S. R., Aggarwal, B., Beckie, T. M., Hodis, H. N., Johnson, A. E., Langer, R. D., Limacher, M. C., Manson, J. E., Stefanick, M. L., Allison, M. A., & American Heart Association. (2020). Menopause transition and cardiovascular disease risk: Implications for timing of early prevention. Circulation, 142(25), e506-e532. https://doi.org/10.1161/CIR.0000000000000912 The Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767-794. https://doi.org/10.1097/GME.0000000000002028 U.S. Preventive Services Task Force. (2025). Osteoporosis to prevent fractures: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening Women’s Preventive Services Initiative. (2025). Recommendations for well-woman care: A well-woman chart. https://www.womenspreventivehealth.org/wellwomanchart/