Perimenopause - Part 3: Empower Yourself with Data!
Tl;dr: Your sex and metabolic hormones will change (probably wildly) throughout perimenopause. Every woman is different. Your unique “hormone signature” influences 1. the symptoms you experience, and 2. how you can support yourself.
Why test hormones? When you know your “hormonal baselines,” you can see which hormones have changed over time. That helps you and your doctor make more informed - and likely more successful - decisions around how to support you through nutrition, supplements, lifestyle and hormone replacement, if that’s of interest. The more guesswork you can remove from the equation, the less you’ll struggle.
Here we look at what tests to ask for and how to best prepare for them.
Welcome back! <3
In the previous 2 posts in this series on perimenopause, I outlined what you can probably expect when you talk to your doctor about perimenopause / HRT (= sad face).
So you’re now aware that part of the difficulty you and your doctor will face when looking to correct your hormone balance is this:
There is no formula for balanced hormones:
Every woman is different!
We need to be prepared for that.
…Sooooo, how can we prepare ourselves, you ask?
Well, you can take one very important action in order to help you and your doctor understand how to tend to your shifting hormones (and possibly replace them when the time comes, if that’s of interest to you):
Get your hormones tested, ASAP.
(Like, ideally in your early to mid-30s, but you’re probably past that now, and that’s TOTALLY ok.)
Testing allows you to see your unique hormone levels and their relative ratios.
This is important because there are at least 4 major hormones to consider - though I would actually include 7 in the essentials list.
Most will shift dramatically through perimenopause and post-menopause.
What tests should I ask for?
You want to ask your provider to test these 4 sex hormones:
Progesterone
Estrogen
Testosterone
DHEA
And these 3 metabolic hormones:
Insulin
Thyroid
Cortisol
…because they all affect each other.
IMHO, a good practitioner will consider all 7, plus some foundational nutritional / biochemical markers that influence how your hormones are processed in your body to achieve the balance you really want and avoid the bumps.
Other informative blood tests
These will vary a bit person to person according to symptoms and personal history, but my general wishlist is:
Lipid panel (cholesterols)
ApoA, ApoB, Lp(a) -> especially if you have heart concerns
Homocysteine
hsCRP
Hba1c, fasting glucose
Vitamin B12
Iron, ferritin
Liver & kidney panel
Magnesium
Zinc
Copper
Fasting insulin
Vitamin D
Thyroid panel: TSH, T3, T4
If you’re in the US or a private pay medical system, you can get all of these from one provider.
If you’re in a public health care system (Canada, UK), your GP will usually be able to order everything up to Magnesium for you; for the ones below that, you usually need go through a naturopath / functional medicine / private provider. But it depends a little on who you talk to, so it’s worth trying to get what you can through your GP.
Getting to know all about you(r hormones)
Preamble: Like most elective health measures, testing can be expensive…but certainly worth saving for.
If you’re in Canada, the UK or another public healthcare system, your family doctor will probably be willing to order basic hormone testing via blood work for you if you make the case for why you want testing so they can justify it. Maybe you already have symptoms, or perhaps you are being proactive and want to understand your baselines - either way, make your case and most docs will order the tests at no added cost to you.
*MDs in publicly-funded systems really have their hands tied when it comes to ordering testing for anything that’s not well-justified / absolutely necessary. Their regulatory bodies - the “all-seeing eyes” feared by all - will make their lives miserable and can suspend their career if they deem they are costing taxpayers money unnecessarily by ordering ‘unnecessary’ testing. Sadly, this extends to a lot of what I consider very necessary testing, such as Vitamin D and the thyroid hormones, T3 and T4. This is why you’ll need to go to a naturopath, private practitioner or functional medicine provider for them.
Anyway, the point is that you may be able to get very basic blood testing for “free” in the public system, but it’ll be very basic and only illustrate part of your hormone picture.
Here are 2 of the best ways you can test your hormones. Ideally, you would do both.
1. Basic hormone testing (blood) on a regular basis - Ideally you would do this from the age of ~35, and ideally, 2x/year. This should allow you to assess your baselines before change starts to happen.
2. Comprehensive hormone testing (urine) occasionally - I love the DUTCH Complete. It’s queen of the hormone tests and the gold standard among hormone experts in the Functional Medicine realm in North America.
Please be aware that MDs / standard medical professionals do NOT deal with DUTCH or other comprehensive metabolic hormone testing, and generally don’t know about it.
Yes, it’s amazing, and yes, it’s pricey (~US$500)…but it’s also a bajillion times more informative than blood testing, for a variety of reasons, offering a much more informative and complete picture:
ALL of the sex hormones and their most important, physiologically important metabolites (that we know of)
A variety of vitamins required to support your hormone balance
How your adrenals are functioning (which is incredibly important for hormone production - many women are under such stress that their adrenals are not functioning well)
Melatonin level, oxidative stress & indicators of dopamine and serotonin
Measures levels of a carcinogenic estrogen metabolite (called 4-OH-estrone, or “four-hydroxy-estrone”) which is linked with breast cancer and other issues, AND that can be reduced by simple detox strategies. If breast cancer or other hormone-related cancers run in your family, this is important.
[There are a few ways you can get your hands on the DUTCH test: 1. directly here, 2. through your functional medicine provider / naturopath, or 3. through me. I can get you US$75 off. Shoot me a message.
Some special cases when it comes to testing:
If you’re deep into perimenopause or post-menopausal and would like to start hormone replacement but don’t have a sense for your pre-menopausal hormone signature: Your hormone levels are likely quite low, so you would be better to start with blood testing. Then, 2-3 months after you start supplemental hormones, do a DUTCH test to determine how those supplemental hormones are being used by your body. You want to ensure that your body is not turning the supplemental estrogen you’re taking into harmful forms of estrogen in your body.
If you’re someone who has had the pleasure of difficult periods, PMS, PMDD, PCOS or other hormonal challenges: It may be more important for you to do a DUTCH test sooner rather than later, as your hormone picture may be quite different from the average woman going to the doctor for hormone support. You may have special considerations.
How to get the most out of testing
These guidelines can help ensure you get the most accurate information you can from your your tests:
Cycle-specific:
If you’re still cycling and your period is regular: It’s usually best to test your sex hormones on cycle day 19-22 if possible. This is ~5 days after ovulation, when progesterone should surge. When repeating tests, you want to test as close to the same day of your cycle as you can every time. Don’t test during bleed days or ovulation.
If you’re still cycling but your period is irregular: To know which day to test, please pick up some LH (lutenizing hormone) testing strips from a pharmacy/Amazon. They're simple urine strips used for fertility testing and will show you when you ovulate (LH is a hormone that spikes when the egg is released). Once you get a signal, then wait 5 days to do the test.
[Note: When you get your results, a high progesterone level in this window indicates ovulation and the release of an egg; a low progesterone level suggests the cycle was anovulatory (no egg was produced), which is common later in perimenopause.]If you’re no longer cycling (menopausal, AKA no period for 12 months): test any time.
Don’t check your thyroid (TSH, T3, T4, RT3, antibodies) around ovulation - lots of hormones rise, including TSH (can rise a full 1-2 points!) and cortisol awakening response.
Please avoid the following supplements for 48 hours before blood testing:
- B vitamins such as biotin, niacin and riboflavin
- calcium
- St. John’s wort
- vitamin C
- L-tryptophan
- 5-HTP
Other restrictions apply to DUTCH testing - see leaflet included in test kit.Avoid greasy or fried food and do not drink alcohol 1-2 days prior to the test. (If you have a party the night before the test, it is better to delay the test by 1-2 days.)
Avoid intense exercise for 48 hours prior to blood labs (or your liver and inflammatory markers will be skewed).
Blood levels of most enzymes and hormones can fluctuate during the day, therefore, these blood tests should be done before 10 a.m. Certain tests need to be done by or before 8am (ie. cortisol).
Avoid sunbathing, physical activity (do not do strenuous exercise) and intense stress prior to blood tests. Sit and relax 10-15 minutes prior to the test.
Do not fast for 3 days prior to testing.
Some medications (glucocorticoids, estrogens) and conditions (fever, long bed rest) increase glucose blood levels, so it is best to perform the glucose tests when these factors are not at play.
Do not smoke during the 15 minutes prior to testing.
Ok, I’ll leave this chat here for now. I hope this has been helpful!
❤️
If you’ve made it this far, THANK YOU. I appreciate you being here, empowering yourself with wisdom on this topic.
I hope you’ll share this post and/or have more conversations about women’s health with your doctor and with women and men in your life who you care about. Let’s normalize this conversation! <3
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