MENOPAUSE SCREENING

Age:                       BP                           Height:                 Height at 18:                      Weight:               Weight at 18:    

BMI:                      Date of last menses/HRT?

 Family history:  CAD / DM / Cancer- colon, breast, ovarian, uterine, cervical / OP

PMH:

Past surgical history:

Presence of symptoms:

Hot flashes

Vaginal dryness

Irritability

Anxiety

Forgetful / distracted

Weight gain

Changes in skin

Dietary review  include.  Number of dairy products serving/day:              Calcium/ Vitamin D Supplement:                    

Exercise review

Vertebral frac ture:  yes or no

Any fracture since age 45?

Current smoking:  how many packs/day               

Past history of smoking:

Alcohol/caffeine consumption  servings

Current medications include:  Steroids?  Thyroid?  Anti seizure?

 Heart disease:

Angina / Stroke review –

BP monitoring

Cholesterol screening

 Diabetes

 Mental status

Depression /anxiety      screening                           

 Yearly Mammogram                     Pap smear

Vaginal bleeding

Colon cancer - Hemocult / Sigmoidoscopy / Colonoscopy  

Caregiver issues