By Dr. Shawna Darou, ND
As most of you know, I’m a big fan of lab testing – the ‘test don’t guess’ approach. Here are some scenarios when hormone testing can be extremely helpful:
(1) Getting a hormone baseline
This is helpful especially in your 30’s or even early 40’s to have a baseline before they shift with perimenopause. If you know where you feel best, it’s easy to interpret a shift in hormones through your 40’s and 50’s, and also helps us get your hormones back into balance.
(2) If you’ve noticed a change in your hormones
This can be anything – heavier or lighter flow, more PMS, more acne, hair growth or loss, irregular periods or difficulty conceiving. Any change in your cycle is important to track down. Remember that it’s not always the estrogen and progesterone that are out of balance – it may be caused by thyroid, blood sugar or insulin changes, or stress.
(3) If you have a suspected hormone imbalance
If you have chronically irregular periods, are skipping periods, have hormonal acne, hair thinning, extra hair grown on the body or face, or very heavy periods, it may indicate a hormone imbalance. This can be more specifically diagnosed with lab testing.
(4) If you’re on bio-identical hormones, or hormones to support fertility
It is important to test hormone levels to see if you are in an optimal range for treatment and also safety. Dosing should not be based soley on typical doses and how you feel. There are safe and effective reference ranges that should be followed.
(5) If you have generalized anxiety or depression
The role of hormones may not be obvious, but many women experience fluctuating anxiety and depression with their cycle, and this can be impacted by all hormones – estrogen, progesterone, testosterone, adrenal hormones, thyroid hormones and blood sugar. Supporting your hormones can make a significant difference in your mood, or at least make your other treatments more effective.
(6) If you have unexplained weight gain or loss, or resistant weight loss
If you have been trying to lose weight, and typical strategies like watching portions and exercising more aren’t working, chances are there is something out of balance with your hormones. This can be an extremely effective strategy along with a sensible nutrition plan to support weight loss. Also remember that unexplained weight loss is often related to hormones too.
(7) If you are experiencing a change in memory or cognition
One area (among many others) to look at with memory or cognition changes is all hormones. Alzheimer’s is sometimes called ‘type 3 diabetes’ due to the significant impact of blood sugar and insulin, and in less serious ways the drop in estrogen at menopause also creates some temporary memory changes too. Hormones can also impact brain fog, focus and concentration too.
I each of these situations, hormones may only be partial explanations – nutrition, movement, sleep, nutrient deficiencies, stress, medications and gut health can all impact each of the scenarios above, but hormones are often a significant part too.
How to accurately test hormones
There are some important rules to testing hormones correctly, as random lab values for many of them are meaningless. In almost all cases, I use bloodwork to test hormones – the quantitative level of hormones is easiest to interpret and track over time. In some cases, I might recommend a DUTCH test (dried urine hormone test) which can be helpful for metabolism of estrogen progesterone and cortisol.
When to test
- To check for ovulation, progesterone is tested in day 21-22 of the cycle. This date may be adjusted if you have shorter or longer cycles.
- To check for fertility, FSH and estradiol is tested on day 2 or 3 of the cycle. These hormones may also used to confirm menopause or premature ovarian insufficiency if you have skipped your period for more than 60 days.
- For bone mass, we check peak estradiol on day 11-12 of the cycle.
- Cortisol is most often tested before 9am
- Thyroid hormones are most accurately tested before 10am
- Insulin and glucose are tested morning and fasting, unless you are also doing a glucose tolerance test or insulin-glucose tolerance test which lasts several hours.
- Other hormones can be grouped with these tests, but do not have any specific cycle date or time of day for accurate results
What tests may be helpful
- Day 3 FSH, LH and estradiol – for fertility mostly, but also LH to FSH ratio can help with diagnosis of PCOS. A very high FSH and LH level can indicated that you’re getting closer to menopause (or premature ovarian failure if you’re under 40).
- Day 21 Estradiol and Progesterone – helpful for fertility, PMS, overall hormone baseline.
- Day 10/11 Estradiol “peak estrogen” – may be useful for prediction of bone density loss if it is low
- By 9am (any cycle day): serum cortisol – for fatigue, stress, weight gain
- Morning / fasting insulin, glucose and cholesterol – for weight gain, blood sugar assessment, PCOS and metabolic syndrome.
- Testing androgens for hormone imbalance, PCOS, acne, hirsutism: Any cycle day: testosterone, DHEA, androstenedione, DHT, and possibly 17-OH progesterone to assess for NCAH (non-classic congenital adrenal hyperplasia).
- Thyroid – best tested in the morning. Full thyroid panel includes TSH, free T4, free T3, reverse T3 and thyroid antibodies.
- Prolactin – another pituitary hormone that can cause irregular periods, breast tenderness and sometimes headaches.
- AMH (Anti-mullerian hormone) – useful for fertility as an indicator of ovarian reserve. May also be used as another indicator of PCOS where the AMH level tends to be higher than expected.
A quick note about reference ranges
References ranges for hormone tests are in some cases very accurate, especially ones that don’t need to be on a specific cycle date, but other times are not very useful to diagnose a hormone imbalance. Some hormones will also require an ‘optimal range’ to be useful. Before you check your labs for flags, make sure you review them with someone who understands hormone testing well.
If you are ready to get your hormones tested as a baseline, or to gain important information about your health, please ask during your next visit. We can put together a hormone panel that is best for you. As you can see above, hormone testing can be useful as part of a full health assessment.