Should You Test Hormone Levels During the Menopause Transition?

Testing hormone levels isn't the standard of care. Here's why.

Do you ever feel like the universe is nudging you in a certain direction?

I’ve had not one, not two, but three conversations with perimenopausal women this week who asked about getting their hormone levels checked. Was it something they should do? What did I think?

So while I didn’t go into this week planning to post about the topic on Hot & Bothered, here we are.

Without further ado, I invite you to enjoy this repost from the archives, which I originally sent to my newsletter subscribers in early 2023. And which the universe clearly wants you to read again now.

Enjoy!

Menopause is finally having a moment. BUT, that doesn’t mean that there still isn’t an ENORMOUS gap in both appropriate menopause medical care and menopause education. Which means there is room for lots of misinformation as women search for answers on their own. And one big area of misinformation has to do with testing hormones - specifically estrogen - during the menopause transition.

Testing estrogen levels during menopause to determine where you’re at in the transition is not good medical care, nor is it recommended by any menopause medical society in the entire world.

Why?

Because testing your hormones (usually estrogen) during the menopause transition is like gathering one puzzle piece in a 1000 piece puzzle. It’s information. But very, very incomplete information.

Before we enter perimenopause, estrogen and progesterone are rising and falling in a predictable rhythm that creates our menstrual cycle. So even before perimenopause, you’d need frequent blood draws over the course of your 28-day cycle (and maybe even over the course of several cycles) to gather accurate information about what your hormones are doing.

But once you reach perimenopause, your hormones become erratic and unpredictable as they decline. Here is a graph of estrogen levels over a woman’s lifetime:

You can see how erratic estrogen becomes during perimenopause! A random blood draw (or even a few blood draws) to check estrogen levels simply isn’t going to give you any sense of what trajectory your hormones are on, or what the timeline of your menopause transition will be. Levels could be super low or high when you get your blood work done, and then be the opposite a few weeks later.

So why are doctors and other care providers offering blood draws to test estrogen levels?

Mostly because they don’t know better.

For example, my husband, who was in medical training from 1998-2011 (i.e. not that long ago), only received a few hours of menopause education in med school and none in his adult medicine residency or in his cardiology fellowship. And he trained at some of the most prestigious medical institutions in the country, so we can’t blame a substandard medical education for the oversight.

Unless doctors have taken an interest in menopause and chosen to take the NAMS certification course, then they truly most likely don’t know any better!

Without blood work, how do I know if I’m in perimenopause?

Age and symptoms.

Similar to puberty, the general assumption is that by a certain age, your body is doing what all bodies-with-ovaries do: preparing to enter a different phase of ovarian function.

Now if you’re having menopause symptoms really young or are still showing no signs of menopause well past the average age, then you should definitely seek out a specialist to help you figure out what’s going on.

But what about doctors, holistic health practitioners, and health coaches who say that they can personalize hormone therapy to you based on blood work?

I know, right? Their arguments are so compelling. And when you combine persistent messaging with the lack of menopause education, it’s easy to buy into the hype.

But here are a few important questions to ask:

What do these alternative practitioners stand to gain from recommending these tests? The answer is that they financially profit from doing them, and they use the results to sell you unregulated (oftentimes dangerous) compounded hormones (which they also profit from) with the sense of safety that testing supposedly - but doesn’t actually - provide.

And what do NAMS-trained menopause doctors have to gain from not recommending these tests? Literally nothing. In fact, they are losing out on the financial benefits of offering testing. Clearly they wouldn’t take that financial loss without good reason.

But shouldn’t doctors be checking hormone levels if women are taking menopause hormone therapy?

Nope, because if you haven’t officially reached menopause - which is 12-months after your final menstrual period - your body is still making hormones while on MHT, so your hormones are still going to be erratic.

The standard for managing menopause hormone therapy is to start with the lowest dose (which is quite low - much lower than birth control pills) and see how well your symptoms are managed. Your doctor can tweak your dose or delivery method until you feel like you’re in a good place symptom-wise. As long as your doctor is using an FDA-approved dose and your symptoms are well-managed, you're good to go!

I said it earlier but it bears saying again: blood testing and expensive hormone panels (like the DUTCH test) are considered substandard care and are not recommended by any menopause medical society IN THE ENTIRE WORLD.

Thankfully, when you understand the erratic nature of your hormones as they decline it’s easy to say no-thank you to misinformation about testing estrogen during the menopause transition. In fact, you can use it as a way of knowing whether you can trust that particular provider or influencer with your menopause education and care, or if you need to look elsewhere.

xo, Rebecca