Tests….the mere word conjures memories of long-ago school days, folding myself uncomfortably into a tiny desk, preparing to wrangle with a grueling standardized test, my number two lead pencil cracking under the pressure of my intensity. What part of my 5 Steps to Hormone Happiness is this, you ask? Why hormone testing, of course. Fortunately for us, when it comes to testing for hormone levels - no pencil is needed, and you really can't fail!
In order to have a comprehensive evaluation with your doctor regarding your specific perimenopause and menopause journey, it is helpful to have a complete hormone panel performed. This, along with the information you've gathered during Step 3: charting your menopause symptoms, will enable your specialist to create an individualized program to help you achieve hormone happiness. Remember, there is a broad range of what is considered "normal" when it comes to hormone levels. What is "normal" for some may not be normal for you. I highly recommend an integrative approach. This includes consideration of the type and intensity of your symptoms in combination with test results indicating what hormonal or other changes may be at play along with a discussion about genetics including your own and your family's medical history. That's one sentence but quite an undertaking in real time. You're worth it, and each step will bring you closer to hormone happiness and to regaining your quality of life.
Below is our best attempt at distilling the gargantuan amount of data available about testing, both a complete hormone panel and beyond, related to the treatment of your perimenopause and menopause symptoms. Each test and treatment strategy must be discussed with your specialist and considered along with your complete medical history and objective data collected by you using the Menopause Symptoms Chart. With guidance from your specialist, you must weigh the pro's and con's, risks and benefits of each treatment option.
PLEASE NOTE: This information is not intended to be medical advice or a substitute for the necessary conversations and tests chosen in consultation with your specialist. Always ask your doctor's office for a copy of your lab results and keep them in a notebook or folder. You may need to refer back to them later.
If you're still menstruating, have your hormone panel (blood test) done during the first three days of your period.
DHEAS: DHEA sulfate is a hormone that easily converts into other hormones, including estrogen and testosterone. This adrenal hormone triggers puberty and is of the highest concentration of the hormones in the body. DHEAS is the sulfated form of DHEA in the blood. While DHEA levels fluctuate throughout the day, DHEAS blood levels are steadier and more reliable.
Estradiol is the main type of estrogen produced in the body, secreted by the ovaries. Low levels can cause memory lapses resulting in sticky notes aplenty, anxiety, depression, uncontrollable bursts of anger, sleeplessness, night drenches and much more.
Free and Total Testosterone: Free testosterone is unbound and metabolically active, and total testosterone includes both free and bound testosterone. In women, the ovaries' production of testosterone maintains a healthy libido, strong bones, muscle mass and mental stability.
FSH (follicle-stimulating hormone) is a pituitary hormone that stimulates the growth of the ovum (the egg and surrounding cells that produce ovarian hormones). This test can help indicate whether you've entered menopause. However, the suggested normal ranges need to be examined along with your Menopause Symptoms Chart, so that your doctor can properly evaluate the test results. There is no one-size-fits-all correct test result. What is normal for your best friend, sister or mother may not be normal for you.
Progesterone is a hormone that stimulates the uterus and prepares it for pregnancy. It also regulates the menstrual cycle, and low levels of progesterone can cause irritability. Results will vary depending on when the test is done.
Thyroid workups usually include checking your TSH (thyroid-stimulating hormone). If there is an irregularity with your TSH, you may need to get your Total T3 and Free T4 checked as well. (Free means it won't be affected by your estrogen status, not free of charge!) Remember that the symptoms for perimenopause and menopause and a thyroid disorder can be very similar.
Other important tests for women in perimenopause and menopause
Bone density is a measure of calcium and other materials in your bones. Also called a DEXA scan, the bone density test can determine whether you have or are susceptible to osteoporosis. When you enter perimenopause and menopause, the decline in estrogen can trigger a rapid loss of bone mass, so it's important to check. The test measures the strength of the hip and spine. It takes only minutes and exposes you to very little radiation.
CA-125 (cancer antigen 125) is a protein best known as a blood marker for ovarian cancer. It may be elevated with other malignant cancers, including those originating in the endometrium, fallopian tubes, lungs, breasts and gastrointestinal tract. Be sure to talk with your doctor about the pros and cons of this test, as the normal value range varies among laboratories, and the CA-125 test can result in false positives.
Cholesterol is a waxy substance produced by the body. It makes hormones, skin cells, and digestive fluids. Cholesterol levels change in perimenopause and menopause. Too much cholesterol can build up artery plaque, narrowing blood vessels and potentially causing a heart attack. A cholesterol panel usually includes checking your HDL (high-density lipoprotein or the good cholesterol), LDL (low-density lipoprotein or bad cholesterol) and Triglycerides (molecules of fatty acids), and gives you your total cholesterol/HDL ratio. You'll need to fast for this test, so don't eat or drink for 12 hours beforehand.
Vitamin D3 (Cholecalciferol) is the vitamin that helps maintain normal blood levels of calcium and phosphorus, keeping your bones nice and strong.
For a full list of suggested test ranges see pages 57-64 in Shmirshky: the pursuit of hormone happiness.
These are the tests you should discuss with your specialist. Test data is an important part of diagnosis; however, all of these tests may not be necessary depending upon your particular situation. If you have taken the time to educate yourself, you will be better able to ask pertinent questions and to understand what your specialist advises. By this phase of the journey, hopefully, you are well on your way to hormone happiness:
Step 1: You've opened up and decided to take action.
Step 2: You've found a specialist who will be your partner in choosing the right treatment options.
Step 3: You've tracked and charted your menopause symptoms.
And now - you know what tests to discuss with your specialist. I know this is a lot of information, and you can feel like you're back in school on an all-night, caffeine-fueled, cram session during finals week. Breathe, and take a few days to educate yourself about the tests your doctor may recommend. Education is empowerment. It's true that your specialist needs to be your partner in evaluating your health and treatment options, but a partnership takes equal participation. Also, if it helps to relieve some of the pressure or anxiety you may be experiencing about this step of the process, remember … you are not being graded!
Remember: Reaching out is IN! Suffering in silence is OUT!
- Bone Density Tests explained by Mayo Clinic.
- More info on changing hormones from NAMS (The North American Menopause Society).
- Vitamin D deficiency may cause weight gain from CNN's The Chart.
- Thyroid Disorders in Women from Johns Hopkins Medicine.
- Menopause Quiz from MedicineNet.com.