Menopause Testing: Which Tests Make Sense?
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I have many women arrive at my office asking me to test their hormones in menopause. I often tell them that though I think blood work is a good idea, they may be surprised to learn that hormones aren’t on the top of my list. If a woman is menopausal, meaning it has been a full year without her period, then I can guess with good accuracy what her serum (blood) hormones are currently. Her estradiol (estrogen) and progesterone will both be low and her FSH and LH will be high. In complex hormone cases (e.g. endometriosis, PCOS, early menopause), I will sometimes order a comprehensive urine hormone test to get an overview of a woman’s hormone picture. This test is called a DUTCH test and is a topic for another article, but for most women it is fairly predictable where their reproductive hormones are at in menopause. Let’s break down these hormones for a better understanding.
Estradiol
Estrogen comes in three forms: estradiol, estrone, and estriol. We are most interested in estradiol because the majority of women’s estrogen comes in this form. It is made mostly by the ovaries but also in small amounts by the adrenal glands and fat tissue. Many symptoms experienced in menopause are due to a lack of estradiol, when the ovaries are no longer producing this hormone. I don’t usually test estradiol unless we are discussing Hormone Replacement Therapy (HRT) or a woman is taking HRT. This is because the vast majority of menopausal women will have an estradiol level of below 40, and knowing a menopausal woman’s estradiol level doesn’t give us any additional clinical insight.
Progesterone
Progesterone is another female hormone made by the ovaries that drops significantly after menopause. Progesterone can help with sleep, is supportive of healthy mood, and lowers inflammation. Similar to estradiol, I don’t test this in menopausal women unless we are considering HRT. In menopausal women progesterone will be low because the ovaries aren’t producing this hormone.
Luteinizing Horomone (LH) & Follicle Stimulating Hormone (FSH)
These hormones are produced by the pituitary gland in the brain at different times during the menstrual cycle. They stimulate the ovaries and control the “rhythm” of a woman’s cycle. When a woman is in menopause, LH and FSH increase because the pituitary gland is still trying to control the ovaries but the ovaries are in retirement and are no longer answering the door. So we expect these hormones to be elevated in menopausal women. Keep in mind that high levels of these hormones don’t guarantee that ovulation is over – they’re just showing us that at the time of testing, the ovaries were not responding to the pituitary gland. A surprise ovulation could always take place and these hormone levels could drop. It is uncommon but menopausal women have gotten pregnant.
Helpful Tests for a Menopausal Woman
Even though reproductive hormone levels don’t give us deep insight into what is happening during menopause, there are a number of blood tests that are quite useful. I usually recommend that women have the following tests done after going without a menstrual period for one year: CBC, ferritin, TIBC, TSH, T3, T4, cholesterol panel, CRP, HbA1C, Vitamin B12, and Vitamin D. A panel like this can give us great insight into a woman’s health status! Many biologic and metabolic parameters change in menopause and having quantifiable numbers for these changes is important.
In short, having blood work is important when a woman enters menopause but it usually isn’t the kind of blood work women think they need. Having your hormone levels tested during menopause really only makes sense if you’re planning on changing your hormonal landscape with HRT. Talk to your healthcare provider about what menopause tests make sense for you depending on your symptoms, health and family history.
Dr. Angela Hunt is a Naturopathic Doctor and NAMS Certified Menopause Practitioner. She manages the Bioidentical Hormone Program at KIHC and facilitates the popular Menopause Group Classes, designed for current naturopathic patients.
*Photo by lucas Favre on Unsplash
