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What labs should you run in perimenoause?

Perimenopause and menopause are natural stages in a woman's life that mark the transition from the reproductive years to the post-reproductive phase. While this phase comes with various changes and symptoms, getting the right lab work can help you better understand and manage your symptoms and health during this time.

I’m getting asked all the time about testing for hormones, so I thought it’s worth sharing this on my blog…

In this article, we will explore the essential lab tests that I recommend during perimenopause and menopause.

The hormonal changes your body is going through can cause annoying symptoms like irritability or mood swings, depression, anxiety, weight gain, lack of energy, hot flashes etc.

Those are the symptoms and they are annoying! However, there’s also a real impact on your health with hormone fluctuations:

  • Risk of heart attack, heart palpitations

  • Osteoporosis

  • Memory lapses and brain inflammation

  • Migraines

  • Risk of breast cancer

  • Fibroids

  • Chronic UTIs or incontinence due to vaginal tissue degradation

So it’s not only about those annoying symptoms or wanting to fit back in your skinny jeans from a couple of years ago, but also about your health in general.

Now, let's explore some essential lab work to consider during perimenopause and menopause:

First off, I don’t actually recommend testing sex hormones in blood serum, because they’re protein-bound, meaning you won’t get an exact picture of the free hormones available. Unless your doctor is able to order free estradiol, estriol, progesterone. From my experience, it’s only done for testosterone. Blood serum still provides an estimated base if you cannot afford to go private and pay for urine or saliva based hormone panels that you can order with me or other functional practitioners.

DUTCH hormone panel

Here is an example of what my favorite urine-based test (DUTCH test) looks like, you’ll agree that it gives you a ton of great information. They also have an option to map out your whole cyle. See image further down.

Urine or saliva:

  • Estradiol, Estriol & Estrone: These are your 3 estrogens that you want to keep an eye on to see how high they are: they are responsible for most of the things I listed above! It’s important that you get at least the first 2 checked and not only estrogen which is a combination of all 3 of them and not really helpful. The best days to test are days 3-5 of your cycle to see if you get a nice rise in estrogen as you should.

  • Progesterone: Progesterone is another important hormone and a lack thereof is the main cause for irritability and anxiety. You want to know how high your levels are 7 days after ovulation - usually around day 19-21 of your cycle (if your cycle is 28-30 days). It’s especially important to keep up the balance of estrogen and progesterone to avoid the nasty symptoms!

  • Testosterone: is important for our sex drive, muscle mass, bone health and self confidence and is declining as all other hormones in this phase. It can be tested anytime since it’s not fluctuating.

  • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH): are both important to see where you stand in the hormone transition. When they increase, you’re getting close(r) to menopause!

  • Cortisol: in perimenopause and menopause our cortisol (stress hormone) levels often increase making us more prone to chronic fatigue and inflammation (and therefore weight gain around the belly), so this is also and important one to keep in mind. The DUTCH test also provides a 24h Cortisol curve which is especially important for women dealing with insomnia to see if their Cortisol levels go up at night to cause that.

  • DHEA is the precursor for all reproductive hormones downstream, and thus plays a critical role in sex hormone production. It also promotes bone growth, so definitely a hormone to keep an eye on during peri and menopause!

DUTCH hormone test cycle map

Blood serum:

  • Lipid profile: Cholesterol levels often increase during menopause due to lower estrogen levels, increasing the risk of heart disease. A lipid profile test measures your cholesterol levels, including LDL (bad) cholesterol, triglycerides and HDL (good) cholesterol. While it’s normal to have higher cholesterol as you age, you certainly don’t want it to be too low, nor to have too much LDL or high triglycerides. I also recommend to test for Apolipoprotein A & B.

  • Liver Function: GOT,GPT & GGT. I cannot repeat enough how important your liver function is for your overall health: it directly impacts your thyroid function and other hormone levels.

  • Inflammation: as I said, in peri our inflammation profile often goes up due to lower sex hormone levels. Regularly checking CRP, hsCRP & Ferritin is important.

  • Also get your iron checked regularly as many women are deficient and can depleted when heavy bleeding is an issue.

  • Thyroid Function: Thyroid disorders often come up with perimenopause or menopause, again due to the lower sex hormone levels you’re experiencing. Check for TSH, Free T3, Free T4, Thyroid antibodies and Thyroglobulin

  • Blood Sugar: Hormonal changes during menopause can affect how your body processes sugar. An HbA1C test (your blood sugar average over the past 3 months) and fasting insulin can help determine your risk of developing diabetes.

  • Vitamin D is essential for bone health, but also a cofactor for hormone production and many women are deficient in it. A simple blood test can measure your vitamin D levels and guide you on the need for supplements.

Bone Health: bone is a living tissue and is constantly remodeling, which means it is always breaking down and building up. This is a normal and necessary process to maintain healthy bones. Estrogen, progesterone, testosterone and DHEA all play a vital role in stimulating bone building and preventing bone loss (estrogen only)

A bone density test, like a DEXA scan, can assess your bone health and determine your risk of fractures. DEXA scans do not measure bone density in the body as a whole but only in the hip, spine, and forearm.

My preferred approach for assessing bone health is to evaluate the hormones that influence bone remodeling as well as a marker that evaluates bone resorption. All of this is included in the Bone Health Panel from Diagnostech: This test assesses estradiol, progesterone, testosterone, DHEA, Cortisol, and Follicle Stimulating Hormone. It also measures Pyrilinks-D from a urine sample.

Pelvic Exams and Pap Smears

It's important to continue regular pelvic exams and Pap smears to screen for cervical cancer. I know that health insurance in Belgium only covers this test every 5 years, but I recommend to go every year to get it done - it’s not a high cost and our risk in perimenopause and menopause is especially elevated.

Perimenopause and menopause are natural phases in a woman's life, but they come with various changes that can affect your health. Getting the right lab work can help you get a sense of where you are in your journey and allow you to monitor and manage your health and symptoms during this time.

Don’t hesitate to reach out if this is something you’d like help with!

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