Navigating Hormone Testing During the Menopause Transition: An abundance of options and innovative solutions to fit most women.

Perimenopause, the transitional phase before menopause, can be a challenging journey for many women. The hormonal fluctuations during this time can lead to a myriad of symptoms, affecting both physical and emotional well-being. However, thanks to advancements in medical technology, managing perimenopausal symptoms has become more accessible and personalized than ever before. In this blog post, we'll explore the importance of hormone testing during perimenopause.  We will examine various types of testing from blood sampling, saliva and urine to the newer innovative products available directly to you, that are revolutionizing the way women approach this transformative period in their lives.

Understanding Perimenopause

Perimenopause, often referred to as the "menopausal transition," typically begins in a woman's 40s but can start as early as her mid-30s. During this time, the ovaries function more erratically, resulting in fluctuating estrogen and progesterone levels—ultimately producing less estrogen as menopause arrives. The fluctuating levels lead to irregular menstrual cycles and a range of symptoms such as hot flashes, mood swings, and sleep disturbances for most women. The unpredictability of perimenopausal symptoms can be overwhelming, making it essential for women to have a clear understanding of their hormonal balance.

The Importance of Hormone Testing

Many women will find hormone testing during perimenopause to be crucial for several reasons. Firstly, it provides valuable insights into hormone levels, allowing women and their healthcare providers to tailor treatment plans based on individual needs. Secondly, it helps rule out other medical conditions with similar symptoms, ensuring accurate diagnosis and appropriate management. Lastly, hormone testing can offer reassurance and empower women with the knowledge they need to make informed decisions about their health and well-being.

Hormone Testing Methods

Standard Lab Testing

Traditional blood tests conducted in a medical laboratory are a common method for hormone testing. This type of testing is commonly covered under many insurance plans. These tests measure hormone levels in the blood, providing comprehensive data that can aid healthcare providers in diagnosing hormonal imbalances and determining suitable treatments.

Saliva Testing

Saliva hormone tests are popular with women whose physicians decline to order standard lab testing.  Many compounding pharmacies will run these tests and recommend their compounded products based on results.  Saliva testing is  convenient and non-invasive. These tests measure the levels of hormones like estrogen, progesterone, and cortisol in saliva samples. Saliva testing is often preferred by individuals seeking a more comfortable testing experience. However, women with dry mouth or Sjogren’s disease will find that obtaining the needed amounts of saliva to be difficult.  Accuracy of these tests has been questioned but is improving. For instance, cortisol testing with saliva is quite accurate.  Estrogen, progesterone and testosterone testing through saliva is not as reliable.  Dosing a hormonal transdermal cream based on the saliva results at a compounding pharmacy is not ideal due to limitations of testing and the variability in absorption of the hormone through the skin. 

The cheaper and better studied FDA approved options for hormone therapy will require a prescription. 

Saliva testing and compounded products took off after doctors quit prescribing in the early 2000’s. (See my blog on Estrogen to review this history)

Urine Testing

Now this is where I believe things are becoming more interesting for personalized care plans.  As we learn more about the perimenopause transition, we understand that not only estrogen and progesterone are impacting symptoms. A more complex understanding of the brain, adrenals, ovaries and thyroid are needed to optimize goals.  A non invasive urine test like the DUTCH (Dried Urine Test for Comprehensive Hormones) complete is a valid clinical lab test that provides much more insight than we have had in the past. This test is more accurate than saliva testing when it comes to checking for sex steroid hormone imbalances. It also is a useful way to see averages of hormone levels rather than the one point in time that you get with a blood test. This gives more confidence in choosing appropriate methods and dosing of hormone replacement therapies.  

The cortisol measurement is comparable to saliva and blood. This is collected four times and provides a very useful overview of the stress response.

The Dutch test also covers many more metabolites that may not be relevant to everyone and are also not familiar to most physicians in traditional medicine practices. These metabolites are the break down products of steroid hormones. Because steroid hormones do not dissolve in water, they are broken down in the liver and kidneys to smaller particles (or metabolites) that are then excreted in urine.  They are not readily testable in blood.  The clinical utility is not hashed out at this point as this field is rather new. For this reason, most physicians will not recommend it. That said, for some patients, there is utility.  The testing may be a useful tool to guide the patient on lifestyle changes and integrative techniques that can improve symptoms. The physician would need, for example, to be aware of limitations of testing and the basic science behind Phase 1 estrogen detoxification (also called hydroxylation) and Phase 2 estrogen detoxification (also called methylation).  This testing just dives a little deeper if first line therapies are not effective.

Also interesting and offered in the Dutch test is the organic acid testing. These are measures of neurotransmitter metabolites (3 are included) and nutritional organic acids (6 are included).  A measure of a melatonin metabolite is also provided.

So for patients with symptoms like mood disorders, fatigue and brain fog, the dutch test is a worthy tool to keep in the tool box if current management is not effective. The main caveat, is to work with someone experienced in traditional medicine who can critically evaluate the results of your testing.

There is another dried urine method from ZRT that is similar though more focused on estrogen metabolites. It does include a BPA level, cortisol and melatonin.

Lastly, the New”ish” Kid on the Block

The Clearblue menopause test, from the same company that makes pregnancy tests, has been available for purchase since August 2023. It  collects 5 urine samples over 5 days testing for higher than normal levels of a hormone called FSH which indicates perimenopause.  While not terribly useful, it may help validate the experience of the menopause transition. This can be very reassuring in and of itself, with a minimal cost of $20-30. This test is not for women on any form of hormonal birth control or women with Polycystic Ovarian Syndrome. This test is likely most useful for women who have had a hysterectomy or women in their 30’s with symptoms. The test itself comes with an App that creates a PDF summary that you may share with your doctor. 

An understanding of the various testing methods for hormones during the perimenopausal transition is crucial for women's health and well-being. From blood tests measuring specific hormone levels to advanced techniques like saliva and urine testing, having accurate information about hormonal changes can empower individuals to navigate this natural phase of life with confidence and awareness. By discussing the different testing methods, we hope to have shed light on the diverse options available, enabling women and healthcare professionals to make informed decisions tailored to individual needs. Remember, knowledge is power, and being aware of the testing methods empowers women to take control of their health, embrace the changes, and live their lives to the fullest during the perimenopausal transition.

Wellness always,

Integrative Menopause MD

This blog is intended for educational and entertainment purposes only. Please consult your own health care provider before acting on any information or advice in my blog or on my website. Remember, healthcare and wellness are unique to your personal history and needs.