It is a very common question and it makes perfect sense: you’re not feeling great, your hormones seem all over the place, shouldn’t you get them tested?
You may have asked your doc this very question at your last appointment and you may have been met with a host of confusing, dismissive responses. Or you may have been given a lab slip to test on a random day of your cycle and left wondering what the result even means.
This is so often the case as many women are demanding to have their concerns heard and requesting more testing. It’s unfortunate women have to fight so hard to get answers and to not have their concerns dismissed. Gaslighting of women in medicine is very much alive and well, but women are taking a stand.
Women have more testing in their hands than in years past, however, as I always say on the Dr. Brooke Show: your testing is only as good as the interpretation of your results. So we can demand testing, but without a provider able to interpret this test in light of your history, goals, and current symptom presentation as well as being very up to date on modern menopause medicine, you are likely still left with little direction towards strategies to feel better.
Alternative providers are guilty of adding to this confusion for women as well. There is a lot of misinformation around more functional medicine type testing too (i.e. the popular DUTCH test). This article will help you sift through both sides of the issue.
Common Provider Responses To “Can You Test My Hormones”?
#1 If you’re a woman in your 40s or 50s and having symptoms you think might be related to your hormones, this question has likely been met with one of these responses:
- Women’s hormones vary too much so there’s no point in testing them.
- Sure, here’s the lab order — with no specific day indicated for testing.
#2 If you are using HRT or about to start using HRT and you’ve asked for testing, you have likely heard:
- We don’t base dosing off testing so there’s no need to run any tests.
- Sure, I’ll run them but if your estrogen isn’t low then you don’t need to start estrogen. Or sure, I’ll run them but there won’t be a change in dose even though you have all these low estrogen symptoms unless your test shows low estrogen.
#3 If you’re seeing a more alternative minded coach or clinician you may have been told this when you asked for hormone testing:
- Blood tests are worthless so we only do urine or saliva testing for women’s hormones.
- DUTCH testing is the only way to diagnosis hormone issues like perimenopause.
#4 When you’ve asked your OBGYN or family practice doc about testing for hormones via saliva or urine you’ve most likely received this response:
- That’s ridiculous and not accurate, blood testing is the gold standard.
A LOT to unpack here, grab a cup of tea….we’re going through this point by point.
#1 You Don’t Need Testing & Timing Doesn’t Matter
First, yes women’s hormones fluctuate wildly during perimenopause this is true. It is not true though that testing is unhelpful.
Also, timing of testing matters – even with fluctuations.
Testing needs to be done on appropriate days: day 3 or 5 for estrogen (when levels should be their lowest) and again on day 19 OR if you know when you ovulate 7-10 days after that. We should test estrogen both days.
This day 19-day 21 window is when progesterone should be highest. This is the best time to test progesterone and it is ideal to test estrogen then as well so we can glean not only an appropriate level or not but also the ratio of estrogen compared to progesterone day 19.
Progesterone is the first hormone to fall during perimenopause and this decline can be seen as early as age 35. So knowing both a progesterone level when it should be it’s highest about a week after ovulation shows us the health of your corpus luteum (the follicle that ovulated and then became the producer of progesterone in your ovaries if you don’t become pregnant). If it’s low we know ovulation either didn’t happen or progesterone output was not sustained and we can address that. As well if progesterone is low or high compared to expected values for estrogen on day 19 we can address that as well. In this last scenario you may be experiencing symptoms of what’s called estrogen dominance, where estrogen isn’t necessarily high but it feels high because progesterone is so low. Symptoms can look like breakouts, heavier bleeding, an earlier period, water retention or mood issues.
With my patients, I often review their progesterone to estrogen ratio (P:E2). I cover that topic on this episode of the Dr Brooke Show.
So yes, there is a lot of variationin levels throughout a cycle – espeically in perimenopause – but put together with your symptoms, testing can be helpful to better support you through this phase of fluctuating hormones.
On the other hand, androgens are more consistent throughout the month and there is merit in testing both total and free testosterone as well as DHEA-S to assess if you need more support with these two hormones in addition to estrogen and progesterone. Blood testing is the more accurate way to test adrogens, while urine markers for estrogen and progesterone have been shown to correlate accurately to serum levels, they do not correlate as closely for testosterone.
Note also, that saliva testing is not considered accurate for any sex hormones.
So yes, blood testing is useful however, it is not the end of the story as hormones break down into metabolites that have hormone activity as well and often the cause of your symptoms or imbalances if a result of these vs. just a hormone level being too high or too low on any one day. Those we can see with more functional medicine testing like the DUTCH test (more on that below).
#2 The Levels Of Hormones On Testing Don’t Matter
Currently, most HRT prescribers do not base starting estrogen or upping your dose of estrogen on a lab value, instead prescribing is largely based on symptoms of low estrogen such as:
- Depression or mood issues
- Joint pain
- Brain fog or memory loss
- Less frequent periods or much lighter periods
- Hot flashes or night sweats”]
If you are experiencing symptoms of fluctuating or low estrogen during perimenopause and your doctor insists that you can only start estrogen when you are no longer having a period or if your estrogen is overtly low on a blood test, they are simply not up to date on current menopause medicine and the latest research on HRT.
It is worth investigating both serum or blood testing for estrogen and progesterone, as well as metabolism of these hormones with other methods of testing – more on that below.
And again, I do not recommend presciribng DHEA or testosterone without blood testing – those two hormones SHOULD alwasy be tested before beginning using these hormones, whereas estrogen and progesterone is commonly ecommended based on symptoms as they are more in flux than our androgens like testosterone or DHEA. There is so much nuance to here and this is exactly what I do in my practice, so please reach out for more help.