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Hormone Testing in Menopause

While there are tests available to tell whether you are in menopause, most women are able to deduce so based on symptoms.  Some of the symptoms that women experience are the following:

A woman is generally considered to be in menopause if she has not had a menstrual period in 12 months.  During this period, the female hormones, primarily estrogen, can fluctuate. However, the blood test for follicle stimulating hormone (FSH) and estradiol can determine whether a woman is in menopause.  

Menopause is a natural stage of aging, but is is also associated with an increase risk of adverse health effects.  Osteoporosis or osteopenia, the latter being a lesser degree of bone loss, can be due to a decreased level of estrogen and increase risk of fractures. Heart disease and unhealthy cholesterol levels can also be risk factors in menopause.

However, there are treatments to provide support for menopause and decrease the risk factors of lowered levels of hormones.  They can be tailored based on lab testing for women to balance hormones effectively.

 

Here are some hormones that can be tested during menopause:

 

ESTROGEN

Estrogen is the predominant female hormone that is responsible for the regulation and development of the female reproductive system.   Unbeknownst to many woman, there are 3 main types of estrogens that can be tested:

 

Estrone (also known as E1)

Estrone is found to be stored in fat and muscle. Estrone does not decrease dramatically in menopause as it is released mainly from fat tissues (adipose) and not the ovaries. This estrogen is protective of bone loss and cardiovascular risks, but is known for it’s contributing factor to cancer.

 

Estradiol (also known as E2)

The strongest of the estrogens, estradiol decreases dramatically in menopause and contributes to hot flashes and night sweats.  Estradiol can protect the brain from cognitive decline and decrease risk of fractures.

 

Estriol (also known as E3)

The weakest of the estrogens, estriol is known as the estrogen in pregnancy.  Estriol has been found to have immune benefits for many disease states including autoimmune, inflammatory, and neurodegenerative conditions. It also aids in vaginal dryness or atrophy.  

 

Metabolites

There are also byproducts, otherwise known as metabolites, of the estrogens.  The metabolites can be tested via urine. Some metabolites are found to be cancer producing by damaging DNA, whereas others are protective.  These estrogen metabolites are helpful to determine biochemical pathway and enzyme function and associated cancer risk.

 

PROGESTERONE

Progesterone is primarily made in the ovaries and produced only upon ovulation, and therefore, decreases during menopause.  Progesterone has many regulatory functions including body temperature, metabolism, and bone health. It relaxes smooth muscles and can improve visual memory.  It also has a sedative, analgesic and immunosuppressive effect.

Progesterone is not readily found in the urine.  Urine testing measures pregnanediol, a reliable marker for progesterone levels.

 

ANDROGENS

Testosterone

Testosterone generally decreases in menopause and can be low after surgical removal of the ovaries.  Low testosterone can lead to symptoms such as low libido, decrease in bone density and lean muscle, decreased strength and metabolism.

 

DHEA

DHEA is touted as the “anti-aging” hormone.  It is highest in the 20’s and decreases as we age.  Since it is a precursor to testosterone, it can be related to low libido, decreases in bone density, lean muscle, strength, and metabolism.   DHEA helps with depressed moods and overall endurance and stamina.

 

Metabolites

There are also byproducts, otherwise known as metabolites, of the testosterone.  The metabolites can be tested via urine, and a few in blood as well. These androgen metabolites are helpful to determine biochemical pathway and enzyme function.  The most commonly known metabolite of testosterone is dihydrotestosterone (DHT).

 

CORTISOL

Cortisol is known as the major stress hormone.  It can also help our immune defense against infection and allergies and asthma.  When cortisol is imbalanced, energy levels fluctuate throughout the day and can affect sleep.  Fatigue, stress and moodiness are commonly seen in women with low cortisol during menopause.

Since normal cortisol levels are highest in the morning and go down at night, testing for cortisol is best completed in four sample collections throughout the day.  This can only be done via dried urine or saliva.

 

MELATONIN

Melatonin is the “sleep” hormone.  It is release from your pineal gland and helps set the circadian rhythm.  As we age, melatonin also decreases and can be related to poor sleep, increased cardiovascular and obesity risks, as well as cancer.

This test is completed via urine.

 

METHODS OF TESTING

Hormone testing can be done in several different methods: saliva, urine, and blood.  Not all of the hormones above can be tested by all means.



URINE

24-hour urine testing

24-hour urine hormone testing has been established as a reliable method for evaluating the production of hormone imbalances commonly seen in menopause.  This method requires collection of urine over a 24-hour period, and from that collection sending a sample to the laboratory for evaluation. These levels correlate well with symptoms of menopause as well as with doses of hormone therapy and symptom control.

In addition, testing the steroid hormones and their metabolites gives insight to risk factors and prevention into conditions such as cancer and osteoporosis.  This hormone testing can measure hormones that are secreted mainly at night, such as melatonin.

The downside of this test is that it does not include cortisol fluctuations throughout the day and does not test progesterone itself, but pregnanediol, a marker of progesterone.




Dried urine testing

Dried urine is a form of collection where patients saturate a filter card with a urine sample. Once dry, urine cards are extremely stable for shipment and storage, and this method eliminates the need for jug urine collection.

The benefit of the dried urine testing is the same as the 24-hour collection with the additional benefit of the 4 collection sample for cortisol.  

 

SALIVA

Saliva is the least invasive and easy method of testing.  It measures free, rather than bound, hormones, and has the benefit of the four-point cortisol testing.  This test is not able to measure metabolites or melatonin.

 

BLOOD

Blood, or serum, testing is the most common among Western medical doctors.  Whereas they are easy to be added to your regular screening blood work, serum hormones are limited as they are only a snapshot of the moment of collection.  This is because bound, and not free, hormones are measured.

Like saliva, this test also does not measure metabolites or melatonin.  

 

All women need regular checkups and screening tests throughout their lives. Women in menopause are recommended to have regular mammograms, Pap tests, screening tests for blood pressure, cholesterol, diabetes and heart disease.  However, hormone testing is not included on the list. For optimal health and well-being, hormone testing should be considered regularly. The method of hormone testing can be decided based on symptoms, treatments, and on your doctor’s recommendation.  

Author
Dr. Minna Yoon, ND, L.Ac.

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