Menopause PREMIUM package

Women entering menopause go through significant physiological changes that can affect the cardiovascular, endocrine, reproductive and bone systems, and even mental health. Therefore, a comprehensive systematic review for (peri)menopause that will cover key aspects of women's health is extremely important.

LABORATORY DIAGNOSTICS

Laboratory tests are crucial for assessing hormonal status, metabolic parameters and general health. Recommended searches include:

• AMH (anti-Müllerian hormone): refers to ovarian reserve, which is important in early menopause for women who want to get pregnant, for example.
• Thyroid hormones (TSH, fT3 and fT4): rule out thyroid disorders that may have similar symptoms to (peri)menopause.
• Fasting glucose and insulin and postprandial glucose and insulin (after 120 min), HbA1c: to assess the risk of type 2 diabetes, which can increase during (peri)menopause due to hormonal changes.
• Lipidogram (cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides): due to increased risk of cardiovascular diseases.
• Vitamin D: important for bone health because a decrease in estrogen increases the risk of osteoporosis.

• Serum magnesium (Mg) and calcium (Ca): important for assessing bone health.
• KKS, iron (Fe), AST, ALT, GGT, bilirubin, urea, creatinine: tests important for health in general.
• HsCRP (so-called High Sensitivity C-reactive protein): a marker of inflammation, but helps to assess the risk of cardiovascular diseases.

• Vitamins B6 and B12 and folic acid: important for the functioning of the nervous system and metabolism in general.
• Tumor markers: CA 125, HE-4, ROMA index (pre and/or postmenopause), CEA, CA 19-9 and CA 15-3.

COMPLETE GYNECOLOGICAL CHECK-UP

A gynecological examination includes a series of tests and evaluations to assess the reproductive health of a woman in (peri)menopause:

• Clinical examination by a gynecologist (including evaluation of vaginal dryness and atrophy): a common symptom in (peri)menopause that may require therapy.

*If necessary, treatment with PRP and radiofrequency is possible for an additional charge.

• PAP smear: cervical cancer screening should be performed regularly.
• Pelvic ultrasound: assessment of the thickness of the endometrium, changes in the ovaries and exclusion of pathologies.
• Personalized consultation on menopause symptoms: Counseling on possible therapies, including hormone replacement therapy (HRT) if necessary, and recommendations for further targeted diagnostic and specialist examinations, depending on each woman individually (e.g. urologist for frequent urinary incontinence, neurologist, physiatrist, physical therapy, dermatologist or psychologist).

ENDOCRINOLOGIST EXAMINATION

(Peri)menopause directly affects the endocrine system, therefore an endocrinologist's examination is crucial, and includes:

• Assessment of hormonal balance: a more detailed examination of the thyroid, adrenal glands and the risk of developing insulin resistance and stress.

CARDIOLOGIST EXAMINATION

Decreased estrogen levels can increase the risk of cardiovascular disease. Complete cardiologist includes:

• ECG: to assess heart function.
• Blood pressure measuring: regular measurement is necessary due to the increased risk of hypertension.
• Ultrasound of the heart: a more detailed assessment of heart health and cardiac function.

RADIOLOGY DIAGNOSTICS

Performing radiological diagnostic examinations for the purpose of early detection of various diseases or conditions that often occur during (peri)menopause:

• Breast ultrasound or mammography: screening for breast cancer is necessary, especially due to the increased risk in (peri)menopause.
• Whole body densitometry: to assess bone density and detect osteoporosis, due to the increased risk in (peri)menopause for bone changes.
• Abdominal ultrasound: useful if the patient has abdominal pain or digestive problems.
• Color Doppler Flow Imaging (CDFI) of the carotid and vertebral arteries: can help assess the risk of atherosclerosis and stroke.

NUTRITION EXAMINATION

Nutritional advice helps maintain a healthy body weight and prevent diseases associated with (peri)menopause:

• Diet rich in calcium and vitamin D: for the prevention of osteoporosis.
• Heart health: a diet rich in fiber, protein, omega-3 fatty acids and with a reduced intake of saturated fat.
• Weight control: during (peri)menopause, there are changes in metabolism that often lead to weight gain, so it is important to adjust your diet.
• Measurement of body weight and height: for the purpose of calculating the body mass index (BMI) which is closely related to the amount of excessive fat tissue in the human body.

GENETIC COUNSELING

By carrying out genetic testing, it is possible to find out the risk of developing hereditary forms of cancer, obesity, endocrinological, cardiovascular and other diseases:

• Genome4All – comprehensive genetic test: very useful if the patient has a family history of diseases such as breast cancer, ovarian cancer, colon cancer or cardiometabolic disorders, because genetic testing can help in the prevention and early detection of these..

*If necessary, it is possible to perform pharmacogenetic testing for an additional fee: very useful for women who, for example, take a lot of medication or are not satisfied with the prescribed hormone replacement treatment, in order to find the best possible therapy and drug dose and reduce the risk of side effects.

NUTRIGENETIC

Nutrigenetics enables the creation of a personalized diet plan adapted to the patient's genetic profile, which achieves the prevention of certain diseases, delaying the onset of the disease or alleviating symptoms if the disease has already occurred:

• Nutri4All nutrigenetic test: very useful in a personalized approach to nutrition in (peri)menopausal women, because hormonal changes affect metabolism, bone health and the cardiovascular system:
  • Bone health and osteoporosis: genetic variations such as the VDR and COL1A1 genes can affect vitamin D absorption and the risk of osteoporosis. Personalized recommendations may include increased vitamin D or calcium supplementation.
• Cardiovascular health: Cardiovascular diseases, including coronary artery disease, hypertension and atherosclerosis, are the leading causes of heart attacks and strokes. Gene variants in genes such as PPARG, APOA5 and FABP2 significantly affect lipid metabolism and body weight regulation. On the other hand, the FABP2 gene also affects fat absorption and fatty acid metabolism, which can result in dyslipidemia and disturbances in cholesterol and triglyceride levels. In addition to the above, genes such as PLIN, which regulates fat mobilization from fat cells, and FADS1 and FADS2, which participate in the biosynthesis of omega-3 and omega-6 fatty acids, also play a significant role in lipid metabolism. The analysis of these genes enables personalized recommendations for the prevention of cardiovascular diseases.
• Type 2 diabetes and glucose metabolism: Type 2 diabetes is a metabolic disease characterized by insulin resistance and elevated blood glucose levels. The Nutri4All test analyzes genes such as SLC2A2, TCF7L2 and UCP1. SLC2A2 is responsible for transporting glucose into cells, while TCF7L2 regulates insulin secretion and insulin sensitivity, which directly affects the risk of developing type 2 diabetes. UCP1 is involved in the regulation of energy expenditure and thermogenesis, which can affect the balance between calorie intake and expenditure and, consequently, on insulin sensitivity. Variants in these genes enable personalized dietary recommendations to optimize carbohydrate intake and control the glycemic index, reducing the risk of developing type 2 diabetes.
•  Weight regulation and metabolism: genetic variations in genes such as FTO and ADIPOQ can increase the risk of weight gain and insulin resistance. A diet low in carbohydrates and high in fiber is recommended.
• Genes related to B vitamin metabolism: genes such as MTHFR play an important role in converting folate into its active form and in methylation processes, which are important for detoxification and weight regulation. Disturbances in the function of these genes can affect the metabolism of fats and carbohydrates, as well as energy levels, which is especially important for obese people.
• Estrogen detoxification: variants in the COMT, CYP1B1, and NQO1 genes play a key role in the body's ability to detoxify estrogen metabolites and neutralize free radicals. For example, variations in the COMT gene can affect the breakdown of estrogen, which can increase the risk of accumulating toxic metabolites. Also, genes like CYP1B1 affect the metabolism of estrogen, turning it into potentially carcinogenic derivatives, while NQO1 helps fight oxidative stress by neutralizing reactive compounds.
• Oxidative stress: genetic variations in the GPX1, SOD2 and CAT genes are also important for maintaining the balance between oxidants and antioxidants in the body, thus reducing the risk of oxidative stress and related diseases.