Hormone Testing in Perimenopause: When to Test and What Test Results Mean

Perimenopause can be a rocky time in a woman’s life, marking the years leading up to menopause. In perimenopause women may live with uncontrollable hormone shifts that can bring challenges like mood swings, sleep disturbances, weight gain, and more. 

Understanding and managing these changes is key to maintaining your health and well-being during this phase. One of the most powerful tools at your disposal is hormone testing. 

Functional medicine testing can uncover hidden imbalances that may impact hormone balance. Hormone testing can identify what’s going on with your hormones, while additional tests such as gut health testing or environmental toxin testing can uncover problems that can affect hormone balance.

This testing isn’t just about identifying imbalances—it’s about empowering you to take control of your health by providing objective data that can inform treatment decisions. By understanding what’s happening in your body, you can make informed decisions about treatments, lifestyle changes, and next steps. 

Let’s dive into how testing works, what it reveals, and why it’s essential during perimenopause.

The Role of Gut Health in Hormonal Balance

All health or disease starts in the gut; this is especially true for hormone health. Protecting gut health can help support hormone balance and help perimenopausal women feel healthier.

Why Gut Health Matters

Your gut plays a surprisingly important role in hormone regulation. A healthy gut microbiome—a diverse community of bacteria in your digestive system—helps metabolize and detoxify hormones like estrogen, supporting hormone balance. 

When your gut microbiome is balanced with a robust amount of healthy probiotics, it can regulate hormone levels effectively and reduce symptoms like bloating, mood swings, and fatigue. Conversely, poor gut health can lead to hormonal imbalances, exacerbating perimenopausal symptoms.

The Estrobolome: Estrogen Metabolism and the Microbiome

The estrobolome is a group of gut bacteria that help process estrogen in the body. These bacteria make an enzyme called beta-glucuronidase, which activates estrogen by breaking it down so it can enter the bloodstream and attach to estrogen receptors. 

A healthy and diverse gut microbiome is important for keeping estrogen levels balanced. When the gut bacteria are out of balance (called dysbiosis), it can disrupt this process. 

This can lead to either low estrogen levels which may cause issues like weak bones or heart problems, or high estrogen levels, which can contribute to conditions like endometriosis and certain cancers.

When excess estrogen builds up in the body, it can lead to symptoms like heavy periods, weight gain, and breast tenderness. This makes gut health a foundational piece of the hormone balance puzzle.

How Toxins Affect Hormone Balance

Toxins, especially endocrine-disrupting chemicals (EDCs), can throw off your hormone balance and cause symptoms like irregular periods, weight gain, tiredness, and mood swings. 

EDCs are chemicals found in many everyday items like plastics, pesticides, cosmetics, and food containers. These chemicals interfere with your hormones by either mimicking them or blocking their normal function.

For example, BPA (found in plastics) acts like estrogen, which can lead to symptoms like breast tenderness, heavy periods, and weight gain. 

Phthalates, often used in fragrances and beauty products, can lower testosterone levels, causing fatigue and changes in mood or metabolism. 

Chemicals in pesticides and herbicides may affect your thyroid, leading to tiredness, hair loss, or trouble managing weight.

These toxins also put extra pressure on your liver, the organ responsible for processing and removing hormones and toxins from the body. When the liver is overworked, it may struggle to clear out excess hormones, making hormone imbalances worse.

When to Consider Hormone Testing

Not every perimenopausal woman may need hormone testing. However, for women struggling with symptoms of hormone imbalance, taking a deeper look at hormone levels can shed light on underlying imbalances. 

Recognizing the Symptoms

Perimenopause can bring a range of symptoms that may signal hormonal shifts. Women experiencing any of the following may want to consider hormone testing:

• Irregular or heavy periods, or bleeding between periods

• Hot flashes and night sweats

• Mood swings, irritability, or anxiety

• Changes in libido or sex drive

• Sleep disturbances or challenges

• Unexplained weight gain, particularly around the abdomen

Timing Your Testing

Hormone levels can fluctuate throughout the month, especially during perimenopause. For accurate results, tests should be timed based on your menstrual cycle. For instance, progesterone levels are generally best measured 5-7 days after ovulation. 

If your cycles are irregular or absent, your healthcare provider can guide you on when to test. Repeating tests over time can help track changes and provide a clearer picture of what’s happening.

Essential Tests to Consider During Perimenopause

Depending on what symptoms a woman is living with, the following tests may provide insight into why she’s feeling the way she’s feeling.

Comprehensive Hormone Testing

Comprehensive hormone testing identifies various hormone levels. This testing can be done in urine, blood, or saliva. I often run the DUTCH Plus test, which is a urine test. 

What It Includes

This test often includes estrogen, progesterone, testosterone, DHEA, and cortisol. It may include various forms of estrogen such as estrone, estradiol, estriol, as well as the metabolites of many of these hormones.

What It Reveals

Imbalances in these hormones can explain symptoms like fatigue, weight changes, and low libido. For example, low progesterone levels can lead to sleep issues and anxiety, while high cortisol levels may contribute to weight gain and mood swings.

How It Helps

Test results guide treatments like dietary adjustments, stress management techniques, and in some cases, bioidentical hormone therapy.

Hormone Cycle Mapping

Hormone cycle mapping zooms in on female hormone levels across the menstrual cycle to link problems like infertility, heavy bleeding, or midcycle bleeding. 

What It Includes

Cycle mapping measures key hormones like estrogen and progesterone at multiple points in the menstrual cycle to identify patterns, such as low progesterone during the luteal phase or estrogen surges causing heavy periods. 

This can help understand how hormone changes impact symptoms like mood swings, irregular periods, fatigue, and sleep disturbances, especially during perimenopause.

What It Reveals

Cycle mapping offers a detailed view of hormone trends, uncovering imbalances that single tests might miss and distinguishing hormonal from non-hormonal symptom causes.

How It Helps

It guides targeted treatments and lifestyle support to help rebalance and optimize hormone levels across the menstrual cycle.

Thyroid Testing

Comprehensive thyroid testing can point out thyroid imbalances that cause uncomfortable or unpleasant symptoms like brain fog, fatigue, or weight gain. 

What It Includes

Tests for TSH (thyroid-stimulating hormone), Free T3, Free T4, reverse T3 and thyroid antibodies.

What It Reveals

Thyroid dysfunction is common during perimenopause and can mimic or worsen symptoms like fatigue, weight gain, and mood changes.

How It Helps

Results can lead to treatments such as thyroid hormone replacement, tailored diets, or supplements like selenium and iodine.

Micronutrient Testing

It’s too easy for people to become nutrient-depleted in our modern world, where much of our food is calorie-rich and nutrient-poor. Also, perimenopausal women who are struggling with new weight gain can restrict their calorie intake, which can also increase the risk of nutrient depletion.

I like Spectracell’s micronutrient test, although other great companies also offer micronutrient testing.  

What It Includes

A comprehensive look at key nutrients like iron, vitamin D, magnesium, and zinc.

What It Reveals

Deficiencies in these nutrients can directly impact hormone production, energy levels, and overall health. For example, low iron levels can cause fatigue and hair thinning, while insufficient vitamin D can disrupt hormone balance.

How It Helps

Insights from micronutrient testing can inform dietary strategies and supplementation to address deficiencies and support overall health.

Comprehensive Stool Testing

Comprehensive stool testing is a great way to assess the status of a person’s microbiome as well as digestive function.

What It Includes

Assessment of gut flora balance, digestion efficiency, inflammation markers, and potential pathogens.

What It Reveals

This test can identify imbalances in gut bacteria, inflammation, or poor digestion can impair hormone metabolism and detoxification.

How It Helps

Results guide natural digestive support like probiotics, anti-inflammatory diets, or digestive enzymes to restore gut health and enhance hormone balance.

Environmental Toxin Testing

Various companies offer tests to assess the presence of toxins that can cause cellular harm and hormone imbalance.

What It Includes 

Tests may assess levels of heavy metals, endocrine-disrupting chemicals, and other toxins.

What It Reveals

Exposure to toxins can interfere with hormonal balance, contributing to symptoms like fatigue, weight gain, and irregular periods.

How It Helps

Results guide detoxification strategies and lifestyle changes, such as switching to clean beauty products or filtered water.

Comprehensive Cardiometabolic Testing

Insulin resistance can be associated with inflammation and hormone imbalance symptoms.

What It Includes

Comprehensive cardiometabolic testing often includes tests such as fasting glucose and insulin levels, hemoglobin A1c, a comprehensive lipid profile and markers of inflammation like CRP.

What It Reveals

Poor metabolic health can worsen perimenopausal symptoms and increase the risk of chronic diseases like diabetes and heart disease.

How It Helps

Insights guide lifestyle changes like adopting a Mediterranean diet or incorporating strength training to support metabolic and hormonal health.

Interpreting Test Results

Proper interpretation of these test results is essential to reap the benefits of functional medicine testing. 

For years I’ve spoken with patients who’ve invested thousands of dollars in great tests, but whose practitioners spent 5 minutes or less going through their results. I love helping patients connect the dots between their symptoms and their test results, and create individualized treatment protocols to help them feel better. 

It’s really important to review your tests with a licensed medical provider who can help you understand the implications of your test results and create an individualized treatment for you. 

Understanding Your Hormone Levels

Hormone test results can be eye-opening. For instance:

• Low estrogen may cause hot flashes, vaginal dryness, and memory issues.

• Low progesterone may be associated with sleep problems, anxiety, or mid-cycle bleeding.

• High cortisol could explain weight gain and mood swings.

• Low thyroid hormone levels might be behind persistent fatigue, brain fog, and weight gain.

Next Steps After Testing

Once you have your results, consider these steps:

• Work with a healthcare provider to interpret findings and develop a treatment plan.

• Explore lifestyle adjustments such as stress management, diet changes, or targeted supplements.

• For significant imbalances, discuss bioidentical hormone therapy or other medical interventions.

Practical Steps for Women in Perimenopause

Work with a licensed healthcare professional to better understand your symptoms and create targeted therapies specific to you. 

Track Your Symptoms

Keep a symptom diary to identify patterns and determine when testing may be needed. Note changes in mood, energy levels, sleep quality, and menstrual cycles.

Partner with a Professional

Consulting a functional medicine expert can help you navigate the complexities of hormone testing and treatment. They can design a personalized plan tailored to your symptoms, test results, and health goals.

Make Lifestyle Changes that Last

Simple shifts can make a big difference:

• Eat a balanced diet with plenty of fiber, lean protein, and healthy fats.

• Incorporate regular exercise, including strength training and yoga to support hormone levels like testosterone and cortisol.

• Prioritize sleep by creating a relaxing bedtime routine.

• Reduce or eliminate alcohol to help manage symptoms.

Conclusion

Hormone testing during perimenopause is a way to take charge of your health during this transformative time. By understanding your hormone levels and their impact on your symptoms, you can make informed decisions to improve your well-being.

If you’re experiencing perimenopausal symptoms, consider working with a functional medicine expert to explore testing options and develop a personalized plan. With the right insights and support, you can navigate perimenopause with confidence and vitality.

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