We always hear “get your mammogram,” but what about your thyroid, vitamin D, iron, or even your bones? If you’re over 40, this convo can change how you advocate for yourself at the doctor’s office.

This episode kicks off a special series with Dr. Kudzai Dombo, MD, FACOG, MSCP—a board-certified OB/GYN and menopause expert with 20+ years devoted to women’s health. Dr. Dombo has practiced and advocated for women across the globe and now focuses on supporting women through perimenopause, menopause, and beyond.

Today, we start with the baseline labs and screenings every woman over 40 should know—plus how to read your risk, when to push for more, and what to ask when guidelines don’t tell the whole story.

Get your FREE Grown-Ass Woman Health Cheat Sheet!

What you’ll learn

• Breast & cervical screening basics: When to start, how often, and when you can stop (mammogram, Pap + HPV).
• Colon cancer screening: Why guidelines moved from 50 to 45, and what “earlier” looks like with risk factors.
• Annual exam ≠ Pap only: Why pelvic exams, symptom checks, and imaging still matter—even if your Pap is spaced out.
• Heart health numbers that matter: BP, lipids, A1C, waist-to-hip ratio (and why CVD is the #1 killer of women).
• Thyroid & vitamin D: How low thyroid and low D can mimic menopause symptoms (fatigue, hair loss, temperature issues).
• Ferritin/iron: Why checking iron stores can explain hair loss and exhaustion.
• CMP/CBC: What these panels reveal about liver, kidney, anemia, and overall health.
• Lipoprotein(a): The one-time, genetics-based test that can change how tightly your BP and cholesterol are managed.
• Bone health reality check: Why waiting until 65 for a DEXA scan isn’t cutting it—and options if insurance says no.
• Personalized care: Why population guidelines are a starting point—not the finish line—especially for Black women and others with different risk profiles.

Download the companion resource: Your Health After 40: The Grown-Ass Woman’s Cheat Sheet — a one-pager covering screenings, hormones, supplements, and vaccines.

About our guest:

Dr. Kudzai Dombo, MD, FACOG, MSCP, is a board-certified obstetrician-gynecologist and menopause expert with 20 years of experience dedicated to women’s health. Known for her deep commitment to both individual care and global health advocacy, she brings a unique cross-cultural perspective shaped by her upbringing in the U.S. and Zimbabwe.

Her career has spanned continents, with work for Doctors Without Borders and NGOs in Sri Lanka, Cambodia, El Salvador, South Africa, and Haiti, where she has advocated for women at every stage of life. In recent years, she has focused her practice on supporting women in midlife and the menopausal transition, most recently as a practicing physician and Director of Advocacy and Outreach at Alloy Women’s Health and Akasha Center for Integrative Health.

She is currently a fellow of the American College of Obstetrics and Gynecology, a Diplomate of the American Board of Obstetrics and Gynecology, a Menopause Society Certified Practitioner, and a member of the International Society for the Study of Women’s Sexual Health.

She loves the creative arts, enjoys traveling, and appreciates time with her family. 

They always tell us to get our mammograms, but we don't often hear talk about our thyroid, vitamin D or even our bones.

If you're a woman over 40, this conversation could shift how you advocate for yourself at the doctor's office.

Welcome to the Grown Ass Woman's guide.

I'm Jackie McDougall.

This episode is part of a special series with Dr. Kudzai Dombo, a board certified OBGYN and and menopause expert with 20 years of experience dedicated to women's health.

Dr. Damba's career has spanned continents where she's advocated for women all over the world.

Now she focuses her practice on supporting women in midlife and the menopausal transition as a practicing physician and director of advocacy and outreach at Alloy Women's Health and Akasha center for Integrative Health.

Throughout this series, we're breaking down everything you need to know in midlife, from prevention and screenings to hormone therapy, supplements and vaccines.

Today, we start with the basics, the screenings and labs every woman over 40 should know about.

Dr. Dambo is an incredible OB GYN, but she's also someone who has done the extra work to educate herself and her patients about what really happens to our bodies in perimenopause, menopause and beyond.

There are a lot of things that as an OB gyn I hadn't been educated on and it was a massive self education for myself to be able to identify.

Okay, prevention is so important and we don't talk enough about it or we at least don't explain the why.

Right.

Because I think when we understand why, when an individual knows why, they're more inclined to change their behavior.

If I know why I'm exercising, right?

Yes, it's, it's kind of wild because I think growing up Gen X, it was like, do this, don't ask questions, you know, just, just fall in line.

Yeah.

And now, you know, we're at a certain age and you know, some of us have raised kids and we hear that this, you know, Gen Z, they won't do anything without asking why, you know.

Yep.

And I think we're just like, oh, wait a second, maybe they have something there.

Maybe we don't have to just fall in line.

We can question the experts.

We can understand our own bodies and advocate for ourselves in a way that's very different from how we were raised.

And that's 100% because I see some of my patients who are in their 60s, right.

Like over 60 and 70s, and they feel like there's been A disservice for them after the WHI study where they were denied hormones.

And now they are actually starting to ask those questions because they're empowered by seeing that, wait, a lot of people aren't taking this laying down.

I don't want to just assume that I am, you know, I'm no longer, you know, a candidate or this may not necessarily apply.

So it just involves a more deeper and nuanced conversation based on where they are, you know, and what risk factors they have.

So I think that is what I'm seeing overall, is that, yes, our patients who are, you know, who were denied hormones at a particular time when they were probably suffering the most, they're now starting to say, I want this.

When we talk about screenings in labs, those are the baseline, the tests every woman needs.

Anything beyond that should be discussed with a health professional.

It is important to recognize that medicine is not one size fits all.

Menopause can look very different depending on who you are and also how you're treated.

Studies have shown that specifically black women go through menopause earlier, have perimenopausal symptoms longer, and, you know, they have a higher risk of some of the long term, chronic conditions than, you know, other groups.

So it really became very important to me as a mission to be able to bring that conversation to all women.

A lot of doctors who may be dismissing these symptoms aren't aware of the profound difference when it comes to long term and chronic health benefits that black women may experience by starting hormone therapy or at least being educated about the option during the earlier stage right before they've gotten down to like full blown menopause.

And I'll tell you this one other thing, Jackie, because I think it's really important when it comes to black women specifically, because again, there is a lot of mistrust with the medical system.

Right?

So I had another patient who I started her on the patch and progesterone testosterone, and she ended up going to her primary care physician who basically told her, I am not talking to you.

Her primary care physician was.

Was also African American.

I am not talking to you about this because our ancestors didn't use this stuff.

So I am not counseling you on it.

Thankfully, that patient came back to me and said, okay, my doctor started me on a blood pressure med.

Is it okay for me to continue on my hormone therapy with this blood pressure med?

Because my doctor wouldn't tell me that is a level of trust.

Because that's another reason right there where she could have been like, no, yeah, you're a computer doctor.

I don't know you yet.

My primary doctor.

I see her in person.

So, you know, it's really.

You feel like you're making a big difference.

Speaking of computer doctors, virtual care is on the rise.

Telehealth companies focused on midlife women's health are growing fast because the demand for personalized, accessible menopause care is bigger than ever.

And the best part is you can get it all from the comfort of your home.

But is this kind of care only for the wealthy, or is it truly accessible to all?

I've had women across the board, right?

The women who come and they're like, you know what?

Give me everything, and, you know, money is not an issue.

And then I have other women who come who are like, hey, I really want to, you know, use my insurance.

I want to be able to figure it out.

But I think one thing that is so great about the Alloy platform, and I hear this from a lot of patients, is that you're getting a response from your clinician about any issue that you're having within a short period of time, right?

It's not this situation where you put a message into your doctor who's taking care of multiple other issues, right?

A lot of us are primarily focused on this stage in life, and so, you know, we're able to respond within a reasonably short amount of time.

Sometimes it can be a few hours, sometimes it can be a little longer, but we're responding in real time to the concerns.

And I find that a lot of patients find so much value because I've had patients on the Alloy platform who said, I want to go take this prescription to my doctor and prescribe it.

And we have just a policy where we say, if you're going to do that, you can definitely do that.

However, we want to make sure that you have access to this 247 doctor messaging, as well as being able to if there are any issues with shortages.

We have been really successful in being able to make sure that there is no interruption, you know, for patients, you know, when shortages in certain forms, like the estradiol patch, we have been very fortunate in being able to assure patients that they will have continuity.

The only thing is, we may not necessarily be able to say that you'll get the same manufacturer, but we really make sure of that.

And then I think of other platforms that do take insurance.

I think it's just I've had so many patients say the fact that I can be on my lunch break or in my office when I take a break and I can just kind of do all this stuff, fill it out.

I get an answer.

When I'm on my way home, I notice the doctors messaged me.

By the time I get home, I can message back, answer any questions, and then, boom, it's delivered to my door.

I think we have transitioned from a very simple system barrier, right?

Like the system of medicine that has a lot of barriers when it comes to getting what we need, to a system where access.

Being able to talk to your doctor directly, being able to get an answer from your doctor, being able to know that I can get my prescriptions shipped to me.

If there's a mistake, I can talk to the support team.

It's really a big team that works together, and everybody's taken care of a specific aspect to make it so that the experience for the customer or the patient, we call the patient.

But obviously on the other side, it's the customer experience for my patients is taken care of.

Like, if there's any error, any issue, boom, I can reach out to support.

They can get that message quickly.

They go to the pharmacy, and it's taken care of.

And I think that's what I love about being in a system like this versus being in a structure where we're dealing with an insurance company and, you know, preauthorization, this is not covered.

We bypass all of that.

And you can't get in for six months if you make an appointment.

And I've had patients who come and say that I couldn't get in for six months.

I am dying.

Please at least get me in until I can see my doctor.

Yeah.

So it's providing a real service.

And there's some people who are in remote areas.

Like, I have patients who are in remote areas, and they don't have access to menopause trained physicians in some of those remote areas.

So, you know, I have licenses, you know, in 20 different states.

So I get to see patients in 20 different states.

And so I have a patient in Maine.

You know, I have a patient in Arizona, and I know them, and I appreciate that.

Even with this platform, that ability to connect and know my patients, I mean, they'll send me selfies and like, Dr. Do, this is how I look today.

I just wanted to, you know, because there's that desire to connect, and they figure out how to connect with us in some way.

Yeah, that's amazing.

All right, let's get into the basics.

These are the screenings and labs every woman over 40 should know about.

Don't worry.

I know it's a lot to keep track of.

So I've put together a simple guide, kind of a cheat sheet with everything we cover in this episode.

You'll find the link wherever you're listening or watching.

So let's talk about just some of the general screenings that we recommend for all women over 40.

So one of the things, I mean, the main thing we recommend, at least the American College of Obstetrics and Gynecology, is a screening mammogram.

Right.

And this just gives you your baseline risk for breast cancer or any type of breast conditions.

And this is recommended starting at age 40, and we recommend it every one to two years.

If you have no risk factors.

If you have risk factors, it may look a little different.

And when I talk about risk factors, it could involve, like, family history.

It could be of, you know, breast cancer diagnosed at a young age.

It could mean that you've had, you know, the BRCA gene or some other gene, because there's, you know, the check 22 mutation.

There are all these different mutations that are there.

So, you know, it may mean that you get your mammogram earlier.

It may mean that you get additional testing, like you get an mri or you end up getting a mammogram, you know, with ultrasound, or you just maybe get more frequent testing.

Right.

So it really depends on what your risk factors are.

If you have absolutely no risk factors, you're really looking at getting a mammogram every one to two years, at the very least, starting at age 40.

Okay.

Okay.

And that's one screening test.

Is there a time where you stop getting mammograms?

So the number that has been quoted is 75.

If you have any form of risk factors, like if you are on hormone therapy, like, I personally will continue with my patients.

But it's obviously a conversation between the two of us because there are some patients who are just like, absolutely not.

My role, my responsibility is to arm you with the guidelines, give you the information, and I can give a recommendation.

At the end of the day, it's really like the patient autonomy.

And then the next thing we know of is the Pap smear.

And, you know, before the age of 21, we typically don't recommend a Pap smear being done.

But once you get to the age of 21, that's when we start 21 to 29, we look at doing a Pap smear with an HPV every three years.

Okay.

Versus what we used to do before, which was every year.

And I think it's important to identify that the combination of the Pap.

And the HPV has increased the sensitivity of the test.

And that's why we've kind of spaced out the time frame.

Because not only that, but also when you're in that early age group, 21 to 29, you're more inclined, if you do have HP, to shut it, like your immune system.

And your body is very strong.

And hpv, even if it does lead to some lesions, your body tends to really shut it.

So that's why age 30 to 65.

Now we start recommending you could do the HPV along with a Pap smear.

And that's done every five years.

So it's important to realize that.

And this is where I think it becomes a little tricky because patients start to think, oh, I don't need to go to the doctor for five years, which is not the case.

You know, it's not the case at all.

It's really important that you are going because, you know, when you go for your annual exam, we're screening you as well for like, are you having any irregular bleeding?

What are your periods like?

And are you having bleeding after intercourse?

And sometimes some of the answers to those questions may mean that we need to do, you know, additional, you know, additional screening or additional testing.

We also, it's important for us to do a pelvic exam so we can feel your ovaries, feel your uterus, does it feel enlarged?

You know, and that helps also guide us and determine whether or not we need to do additional imaging, like an ultrasound, endometrial biopsy.

There's just a lot of different things that we're looking for.

And it's not just confined to, you know, your Pap smear.

Right.

And then is there an end where you stop getting a Pap?

You know, I mean, I guess if you don't have a cervix.

Right.

Like, that's.

Yeah.

So if you've had it.

If you.

Absolutely.

If you've had a hysterectomy and you have had no risk factors.

Right.

So your Paps have been fine.

Like, you've had no risk factors.

You do not need a Pap smear anymore.

If you are 65 and over and you've had no risk factors, you definitely can stop getting your Pap at that age.

Okay, good to know.

And that those are just some of the, you know, the guidelines that we go by.

And I think it's important too to remember that these are population based guidelines.

Right.

And, and I think it's really important, especially for women to identify, like, if I'M feeling like something's not right, you know, and, you know, in my body, I still tell my patients to bring it up and ask, you know, if that is something, because you know your body better than we do.

And we're going based on population numbers and not, you know, individual, you know, people.

And then there's the dreaded colonoscopy.

Everybody talks about that prep, but I promise you, it's not that bad.

I've had a few.

But when should we expect to get our first?

So if you have no.

No risk factors, no family history, we say age 45.

Okay.

And I think it's important to recognize because for a long time it was age 50, and I think with a lot more younger people being diagnosed with corporations, colon cancer and later stage colon cancer, and they looked at the statistics and they changed the guidelines and basically said 45 is when it's recommended to start having a colonoscopy.

I waited until 50 because I just, I. I did because I just, you know, it's the mind.

It's like thinking about the prep, thinking about the whole procedure.

It just took me a little bit.

But I do tell my patients 45 as know what the guidelines are.

And I think the beautiful thing about that is if it's normal, it's every 10 years.

So, you know, unless they find a polyp, unless they find something that may be concerning, it's at least every 10 years.

And it's reassuring when you can get a negative one because you're like, okay, I've done that.

Like, if there changes in my bowel habits, which can occur during the perimenopausal transition and into menopause, your bowel habits can change.

But I always say that it is so reassuring to be able to know that, okay, I've had a colonoscopy, and I know that there is nothing pathological going on.

Every individual is different.

Okay, you smoke, you may have another history.

Like, it may be worth having a colonoscopy done before age 45.

But I think you would really have to tease out your individual risk factors.

But definitely, if you already have chronic disease within your GI tract, you are already a candidate or somebody who.

It is recommended to have a colonoscopy sooner.

That makes sense.

As a side note, it's important to be honest.

They ask if you smoke, they ask if you drink, they ask, you know, about sexual partners or whatever.

I can only imagine from your side, people don't want to be judged or perceived as something.

What would you say to those people who are just.

They don't want to necessarily give all the information.

This is something that comes up for me all the time, because as an OB GYN, right.

STDs are one.

You know what your history is.

And sometimes it may be important that if there's somebody else in the room, I just have them step out.

And I think it's important.

The other area where I find that people have a tendency to lie is when it comes to just substance abuse.

And here's how I frame it.

When I ask the question, and I just said, you know, this is a question I ask everybody, and I'm asking so that I can actually be able to help you.

And I want you to be able to feel comfortable, to be able to be honest with me.

So I think when you preface it like that, because that it's a space of no judgment.

It's really like clinical information that will help me be able to help.

Come up with the best treatment plan for you.

They tend to be a lot more willing to tell the truth, but it takes years of doing this and, you know, knowing that there are a lot of people who don't want to admit to any substance abuse, and if they do, they want to err on the side of, like, even less than, you know, what they may be taking at the time.

If the patient feels that there will be no judgment, I think it's easier for them to be able to open up.

Absolutely.

It's like when they ask about your weight on your license.

Why.

Absolutely.

We all.

That's another area that is definitely another area that it can become.

Because usually, like, when I was in the hospital, they get weighed, or we have it in their clinic chart.

Right.

But it's definitely, you know, because we get records.

Right.

So they're weight at their offices.

So it's.

It's not anything that I've ever had to navigate until I was doing telehealth.

And I have to ask.

And some patients refuse to put their weight on their intake forms.

But I think when people understand the why, it makes it a little bit more helpful for them to be a little bit more open.

What are some of the reasons that you would want to know somebody's weight?

So, I mean, this is a segment into heart health, which is beautiful because one thing that it's not stressed to us women is the number one killer for women is cardiovascular disease.

And what I tell patients and I tell myself this is.

It's so important to know your numbers.

Right.

Because there are specific risk factors for cardiovascular disease.

And when you know what yours are, we can look at mitigating them.

And so either your bmi, which, that's another metric that's probably going to be going away soon because we're going to be looking at body composition.

But right now, what we have to go with overall is just a bmi, which is really takes into account your height and your weight.

If you know that number, you know where you kind of fall into, if it's normal, if you're underweight, if you're overweight, or if you're obese.

And that is a known risk factor for cardiovascular disease.

But not just that in isolation.

Right?

So I tell patients it's not just your bmi, but I'm also interested in your hip waist circumference.

And what that is, is you take a tape measure, you measure the thinnest part where your belly button is around, you know, your waist, and then you go to the widest area around your hips, and we look at that ratio and that gives us a sense if it's above 0.8, it tells us whether or not you have a lot of visceral adipose fat around your organs.

So if we know that you have a lot of visceral fat around your organs, especially your heart, that is another risk factor for cardiovascular disease.

Right?

So knowing what that number is, knowing what your blood pressure is, you know, I like, okay, it was taken at the doctor's office.

I don't know, they told me it was normal.

But knowing where you are in the spectrum is important.

Even if you are normal and if you are borderline, knowing that you're borderline, and even if you go to the doctor's office and they tell you your number, asking, hey, where does that stand?

You know, where am I?

Am I in the good range?

Am I in a borderline range where that's something to be concerned about?

And obviously if you're in a high range, I'm thinking they would tell you.

But I think it's important for us to know our numbers, right?

So it's think of your high blood pressure, you think of your lipid panel.

What is your cholesterol value?

Right.

I think as a doctor, you know, I kind of would be like, oh, I have a vague idea.

But, you know, I never really took this on as being in charge of my cardiovascular health.

So it was just like, okay, you know, what is my test result for prediabetes?

Am I far away from that?

Am I close to it?

Am I pre diabetic or am I full blown diabetes?

Right?

So we have a test called.

It's a diabetes screen.

It's a hemoglobin A1C.

So it tells you what your blood sugars have been doing over the last three months.

That is another key, important metric when we're looking at heart health, because we know that when you go through midlife and you have this shift in hormones, you develop a level of insulin resistance that's important to screen for because it's profoundly impacted by when your hormone levels shift.

And then being able to know, like, your lifestyle, what is the quality of your sleep, how are you managing stress, what is your nutrition like?

So when you ask those questions, it really gives you a clearer picture of what your particular risk factors for cardiovascular disease are.

And that should be like, something that we all know, because.

Right.

If that's the number one killer of women, why wouldn't we.

Right.

And does that require going to a cardiologist?

Or we can get that as just a general well visit.

General well visit.

You can get that either at your primary care doctor when you go in for your gynecologist for your annual exam.

We've covered the big screenings and heart health.

Now let's move into the rest of the blood work that's important to look at, starting with your thyroid.

A thyroid function panel.

Like, it's really important to get that done, because I think if your thyroid levels are low, that can mask many different conditions.

And if we don't know that your thyroid has been assessed and we can get you back to feeling more like yourself, that is a huge part that could potentially be missed.

So, you know, your thyroid is responsible if you're fatigued, if you feel like having difficulty with temperature regulation, hair loss.

These are all common symptoms that can occur during midlife.

But again, thyroid can be one aspect that's contributing, you know, or it could be just your ovarian hormones.

But it's really important that we can eliminate that as a potential cause for symptoms, by the way.

And it also may cause weight gain.

And these are really profound, bothersome symptoms that occur during perimenopause and menopause.

Right.

Vitamin D level is another one that's really important.

And I always say, like, a baseline blood count, which is what we.

A cbc, which is just your general blood count that tells us whether or not you're anemic.

Because, again, if you're having symptoms of fatigue, it's important for us to know or even to get a baseline and then, you know, a complete metabolic panel which tests for your kidney function, your liver function, Just to get a sense of what chemically is going on in your body.

Are these organs functioning normally?

Are they sluggish?

Are we seeing things that we may not have known, you know, like your liver function?

They're elevated.

Then we can kind of investigate and look at why.

Why is your liver function suboptimal at this point?

Have you been exposed to hepatitis B or hepatitis A or any condition that could impact your liver function?

Ferritin is another good test to do in midlife, and it tests our ability to store iron.

And that's important because hair loss, like, if you're iron stores are low, it can contribute to hair loss.

And I think when we go through that transition, we're trying to figure out what is causing my hair loss.

And also, like, is it my hormones?

Is it this?

Is it my thyroid?

Because thyroid can also cause that.

It's important to kind of screen for ferritin levels.

Your iron stores, do you have adequate iron stores?

Because that'll also help eliminate some symptoms that you're having or how we can come up with a treatment plan that applies to you.

Right.

I could see how easy it could be to, like, brush off a lot of these symptoms as just perimenopause or menopausal symptoms, because it's like, here you have your category of menopause, and then here you have your thyroid iron.

All of these over here, and they mirror, they resemble each other.

And so I'm assuming it's really important to just not disregard symptoms and just go and get it checked out.

Yes.

And this is why I tell all patients, just get your screening labs and make sure that we've looked at all of these things and know that we're not looking at any other deficiencies that could be contributing to symptoms.

Because this is foundational when it comes to being able to really make a diagnosis.

Right, right.

Because we know perimenopause is a clinical diagnosis.

And so we look at symptoms, we look at patterns.

So it's not like there's a test for us to do that'll be like, oh, and this is why it's so hard, I think, for women sometimes to be able to understand, wait, well, aren't you going to check my hormones?

Because, like, if it.

If.

If like diabetes, this number means this, this number means this, this number means that.

And unfortunately, it's not that simple.

So it requires just a little bit more explanation so that patients understand how we look at everything together to be able to determine what we do.

So there's another test which I Recommend to patients, if you can get the ones that I talked about foundationally, that's great.

But there's another test called lipoprotein A, so it's lp.

And the reason why I include this, it's a one time test.

It's not something that you get done like every couple of years.

It's just done once in your life.

And what that is, it's a genetic, it tells us your genetic risk for cardiovascular disease.

Do you have any intrinsic genetic risk for developing cardiovascular disease?

And so why that's of benefit is because you get to work very closely with a cardiologist.

Right.

Or you get to work with maybe even a PCP to make sure that your numbers are dialed in, your blood pressure, your cholesterol.

Like, we're not just being like, you're a little close here, you're a little close there.

No, that really helps your doctor identify whether or not your numbers need to be dialed in a little bit more.

Like if your blood pressure is out there.

No, we need to have you come back next week.

And if lifestyle changes, don't change it, we will need to put you on something to help manage that because we cannot afford for you with this elevated lipoprotein A to have your numbers kind of, you know, because you're just a higher risk.

Yeah.

And so is that a test that a lot of doctors are aware of, giving and also is it covered by insurance typically?

So that is a wonderful question because I was not aware of it until a couple years ago.

And so I think this is the thing.

As we really look at the overlap from cardiologists, from knowing the joint, like the musculoskeletal syndrome of menopause, as we learn how to really improve and impact women's health, my colleagues who are OBGYNs and who aren't specializing in midlife, they don't know because we're not taught.

We're not taught.

Unless you are in rooms with primary doctors, like right now, the space for taking care of women.

Like, they're orthopedic surgeons who've carved out a niche, they're PCPs, they're family doctors.

So when we come together with a confluence of all this information, they're cardiologists, we elevate and we educate each other and elevate so that people like me who want to do best for patients are able to know that, ah, that's something that I need to look at, educate my patients and, you know, move it forward.

My OBGYNs at the hospital who are doing Deliveries.

I'm not going to say all of them, but very few of the ones that I worked with are aware of it.

Wow.

Yeah, that's wild.

And this is just according to the American College of Obstetrics and Gynecologists, if you've never had these two tests ever done before, it really is important to have them done at least once in your lifetime.

An HIV and a hepatitis D. So if you've never had these done in your lifetime, it's considered at least once in your lifetime to be screened for that.

These are some things, you know, if you are getting screening labs from your pcp, your OB GYN can order these labs.

And they're very basic, like, this is the low hanging fruit.

This isn't anything complicated, anything beyond this, because there's so many other tests.

Right.

But I'm just talking at like, what is it that is the foundational, the easy things to look at, because I think sometimes it's very easy to be overwhelmed with a lot of information that's out there.

And then we start to wonder, okay, well, do I need this?

Do I need this?

Do I need this?

I'm just trying to keep it simple.

Screenings, heart health, blood work, check.

But there is another area that often gets overlooked.

Our bones.

Let's talk about the bones.

Because I have had countless conversations with women, just in my experience, the most ignored, like most of the women that I talk to.

And I've said, have you ever had a scan?

They're like, no, never.

Is it just because I've postmenopausal for so long?

Or should we all be getting these bone scans?

So here's what the guidelines say, and I'm going to put that caveat there because we're in an era where the guidelines no longer reflect all the information that has been gathered, all that we know so far for women who are in perimenopause and menopause.

So the guidelines essentially indicate that a DEXA scan is indicated at age 65.

Okay.

And if you think about it, by age 65, I think we can make a lot of change occur before then.

If we knew, right?

If we knew our bones were thinning, if we knew that we had osteopenia by age 65.

I think we're now looking at either pharmaceuticals or some women may not want to start estrogen therapy that late, you know, considering it's outside the window.

But so I think we are in a space where the guidelines have not caught up with what we know about what the changes that occur in women's bodies.

Right.

The only way that you can get an insurance to cover a bone scan before age 65.

Two reasons.

If you personally have had menopause before age 45.

Right.

If you have had surgical menopause or premature ovarian failure or something, or early menopause Prior to age 45, you are definitely a candidate for a DEXA scan.

Or if you had a family history of osteoporosis.

And I know the temptation would be, okay, well, I'm just going to say that I have a family history of osteoporosis so that I can get it approved.

And yet, you know what?

We shouldn't have to do that.

I mean, I think what I tell my patients these days, it's either.

There are usually great out of pocket contracted rates for people to get a bone density scan that may not necessarily be covered by insurance.

But I recommend at least getting a baseline or even one where once you are at that point of menopause, like you've gone through the 12 months, I mean, even in perimenopause, getting at least a baseline so you know where you are.

Right.

Because I think when we're informed, when we know what's going on in our bodies, we're more inclined to make the changes necessary than.

And like with the resistance training.

Right.

Okay.

I know my why.

My why is because of my bones.

I want to be able to reduce my risk of a fracture.

I find that women tend to be more powerful when they are very clear on their why.

So I think there is no cost that I would put when it comes to my health and being able to understand what's going in my body.

However, I think one of the things that we are advocating and fighting for is for that guideline to be changed.

Absolutely.

And if you can't get it covered by insurance, really being able to look at what programs are available to be able to get a DEXA either at the least cost possible, or talk to your insurance rep to see if there's a way that your insurance would be willing to do it.

But I think again, I don't Recommend waiting until 65 for my patients.

I tell them to get it done sooner.

Yeah, yeah.

So I'm not a doctor, so I'm not held to the same standard you are.

Um, so I just lie if I feel like I need to have something checked.

And I like, I trust my gut, my spidey sense.

I recently got a Covid booster and I don't have any of those, you know, under 65.

Listen, if there were a shortage.

Yeah, I would not do that because I don't want to take medicine away from somebody.

Like, that's.

That's not what I'm looking to do.

But that's not the case.

We just have some people in charge who think that they know best.

I also have, you know, family members who have very delicate situations and they live in my house.

And so, yeah, if I can prevent giving them something.

So anyway, so listen, that.

That's why I do.

I go, wink, wink, wink.

Family history.

Osteoporosis is a reason to get it covered.

Yeah.

And I don't think they're sending out a detective to determine whether or not that is something that's true.

Wink, wink.

We'll just go with that.

When it comes to protecting our bones, there's a simple daily step that can make a big difference.

And it might not be what you think it is.

So I think I want to mention one specifically relating to just our conversation about bone health.

It's really like getting a vitamin D level because I think it's really important.

We all think about calcium.

Calcium.

Calcium in our bones.

Right.

But I think it's important to remember that vitamin D, it's responsible for helping that calcium interchange with your bones.

And so I always make sure that I identify what your vitamin D level is because it's very important to know, hey, are you deficient?

And if you are, it is important to supplement because we want to maximize on your bone health.

Right.

So it's going to be the resistance, exercise, training, having protein in your diet, but also vitamin D. So that's just to complete that bone health.

I walked away from this conversation with a checklist and a whole new level of clarity, but it's a lot of information.

So to make it easier for you to take charge of your healthcare, I've created a simple health cheat sheet with all the screenings and labs we covered today, as well as info on hormones, supplements, and vaccines that we'll cover later on in the series.

I'll provide the link wherever you're watching or listening.

And remember, this is just the first in the series with Dr. Dambo.

You don't want to miss what's coming next.

So hit subscribe and turn on notifications.

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Until next time.

You are a grown ass woman.

Act accordingly.