Lizzy asks: I'm 49. My last period was Septemeber 2023. My question is: Should I have my hormones tested?
My reply:
This “testing” question (misconception, misunderstanding, misinterpretation) comes up a lot, so thank you for asking. Let's set the record straight!
Testing is an “umbrella” term:
Underneath that umbrella, MANY things can be tested, but you used the words “hormones” and “should”…and I will address that below. First, it's important to begin with this:
Testing is ONE tool you and your health care provider have in your tool kits to assess your health.
Testing can be used to confirm or deny a hypothesis i.e. I wonder if Lizzy's fatigue & exhaustion is due to low ferritin or related to her thyroid health? Let's check!
Testing can be used to uncover something that didn't come up in conversation i.e. Lizzy, your lab results just came back and your vitamin D is quite low. Have you noticed any new muscle aches lately? Or a change in mood, new depressed feelings, anything like that?
Testing can and should be used to establish and access key health markers ie. cholesterol
But you asked: “Should I have my hormones tested?” and although thyroid and insulin and cortisol are hormones, I suspect you are referring to estrogen, progesterone and maybe testosterone.
Perimenopause: testing estrogen and progesterone will give you a snapshot in time. Due to hormone fluctuations, any results are expected to change/fluctuate--so results will be different month to month, day to day, even morning to night! Testing is not required in order to provide treatment; age, date of last period and being able to identify symptoms, especially of low progesterone (vs. something else) is key.
Postmenopause: testing estrogen and progesterone will tell you exactly what you see on this chart: declining estrogen and declining progesterone. Testing is not required to provide treatment; age, date of last period and identifying symptoms of low estrogen and low progesterone is key.
NOTE: This illustration is a “generally speaking” look at puberty through postmenopause.
Everyone is different, but this is what we know: both estradiol (purple) and progesterone (green) fluctuate in perimenopause. Generally speaking, estradiol will be high(er) and progesterone begins its decline. And at/after menopause (12 months period free), both estradiol and progesterone are going to be low. And symptoms of hormone decline (the red line) can increase/can be more pronounced as a result.
So why does hormone testing exist?
Hormone testing exists for a reason--one, because it can be used by you and your health team to investigate things we mentioned above, like thyroid, cortisol and vitamin D (Yes, vitamin D is considered both a vitamin and a hormone.)
And hormone testing exists for special cases. I have two examples within my own family. My sister reached menopause at age 36. You can read about her story here. My daughter's period went missing at age 17 and she had hormone testing before she received a diagnosis of PCOS (polycystic ovarian syndrome.)
And some individuals just love numbers. They are unable to make health decisions for themselves unless they see data (whether testing has been recommended or not.)
Bottom line: Testing is not required to determine a hormone therapy protocol. (Page 775 of the 2022 Position Statement from The North American Menopause Society) What is? Your age, date of last period, and telling an informed story of your current experiences (see pages 14-16 here) and future health goals will lead to shared decision making and help your health care provider guide the best treatment plan for YOU 🦋