Perimenopause - Part 3: Empower Yourself with Data!
Tl;dr: Your sex and metabolic hormones will change (probably wildly) throughout perimenopause and into postmenopause.
Every woman is different in the ways her hormones will shift. Your unique hormones will dictate 1. the symptoms you experience, and 2. how you can best treat those symptoms.
Since your ‘hormone signature’ will look different from the gal next door, it’s important to get your hormones tested. You can do this through a combination of blood tests and ideally, at least one comprehensive panel (ie. DUTCH test).
When you understand your hormonal baselines and see which hormones have changed over time, you and your doctor can make more informed - and likely more successful - choices in deciding which hormones may want to replace (or not), or support naturally through nutrition, supplements, etc. The more guesswork you can remove from the equation, the less you’ll struggle.
Welcome back! <3
In the previous 2 posts in this series on perimenopause, I outlined the current general paradigm in perimenopausal healthcare (= sad face) and what to expect if you go to your family doctor for help.
If you’ve read them, 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 in the cards):
Get your hormones tested ASAP.
Testing allows you to see your unique hormone levels and their relative ratios.
This is important because there are at least 4 different hormones to consider - though I would actually include 7. Most will shift dramatically through perimenopause and post-menopause.
4 of these are sex hormones:
Progesterone
Estrogen
Testosterone
DHEA
And the other 3 are metabolic:
Insulin
Thyroid
Cortisol
IMHO, a good practitioner will consider all 7, plus some foundational nutritional / biochemical markers that influence how your hormones are made, broken down and recycled to achieve the balance your body really wants and avoid the bumps.
Getting to know all about you(r hormones)
Preamble: Like most elective health measures, testing can be expensive…but it’s certainly worth saving for if you can.
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 an informed 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 comply and you can get this testing done at no cost to you.
(MDs in the public system really have their hands tied when it comes to ordering testing for anything that’s not well-justified or absolutely necessary. Their regulatory body - the “all-seeing eye” feared by all - will make a doc’s like 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 very necessary testing, such as Vitamin D and the thyroid hormones, T3 and T4.)
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’m gonna confidently say here that the comprehensive hormone panel (in North America) is the DUTCH Complete. It’s queen of the hormone tests and the gold standard among hormone experts in the Functional Medicine realm.
However, be aware that MDs / standard medical professionals do NOT deal with DUTCH testing, and generally don’t even know about it.
Yes, it’s the best and yes, it’s pricey (~US$500-$650)…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 to note 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 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 the harmful form 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.
Get the most out of testing
Get the most accurate information from your tests by preparing according to these guidelines:
If you’re still cycling: You want to test as close to the same day of your cycle as you can every time. Generally, the first 10 days or last 10 days of your cycle, never during bleed days. I generally advise day day 21-23 if possible. This is roughly 7 days after ovulation, when progesterone should surge. 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 as perimenopause progresses.
Don’t check your thyroid 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.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 it here for now. I hope this has been helpful! I’ll be sharing a list of blood tests to ask your doctor for very soon, and will link it here.
Stay tuned: more blogs like this coming your way, including “Easing the perimenopause transition: natural ways you can support your hormones.”
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 leave a comment, 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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