Understanding Hormone Testing in Perimenopause: A Comprehensive Guide

Perimenopause is a transitional phase that precedes menopause where our ovarian function slowly starts to decline. It is characterized by hormonal fluctuations and can last anywhere from 5 to 15 years before menopause occurs. During this time, the levels of various hormones in a woman's body undergo significant changes, which can have a profound impact on her overall well-being. In my naturopathic practice, in order to assess and manage these hormonal changes effectively, I often recommend hormone testing. In this blog post, we will explore the importance of hormone testing in perimenopause and discuss various hormones that are commonly evaluated, including day 3 estradiol, day 3 FSH, day 21 progesterone, thyroid and cortisol testing.

Hormones Testing in Perimenopause

Day 3 Estradiol

Estradiol is the primary form of estrogen produced by the ovaries. During perimenopause, the levels of estradiol start to dramatically fluctuate and eventually decline as we get closer to menopause. Testing estradiol levels on day 3 of your menstrual cycle helps in assessing the ovarian function and can provide insight into the stage of perimenopause a woman is experiencing. Imbalances in estrogen during menopause may contribute to symptoms such as hot flashes, mood swings, and changes in menstrual patterns.

Day 3 FSH

Follicle-stimulating hormone (FSH) is responsible for stimulating the growth and development of ovarian follicles, which contain eggs. As a woman approaches menopause, the ovaries become less responsive to FSH, leading to higher levels of FSH in the blood. Measuring day 3 FSH levels can help determine the ovarian reserve and in perimenopause help determine how close you are to menopause.

Day 21 Progesterone

Progesterone is a hormone that plays a crucial role in preparing the uterus for pregnancy. During the perimenopausal years, progesterone helps to control the amount of bleeding you have with each menstrual cycle, and also has an impact on sleep quality and mood. Measuring progesterone on day 21 of your menstrual cycle (or 7 days before your expected period) assesses whether ovulation has occurred. In perimenopause, ovulation becomes more irregular, which results in lower progesterone levels. Progesterone is the first sex hormone to decline in this transitional period.

Thyroid Panel (TSH, fT3, fT4, TPO)

The thyroid gland produces hormones that regulate metabolism, energy levels, and body temperature. Abnormalities in thyroid function can also impact menstrual irregularity. Hypothyroidism symptoms can mimic common perimenopausal symptoms such as irregular menstruation, fatigue, weight gain and mood swings - that’s why it’s important to evaluate thyroid function during the perimenopausal period. A thyroid panel consisting of TSH (thyroid stimulating hormone), fT3 (free triiodothyronine), fT4 (free thyroxine), and TPO (thyroid peroxidase antibodies) can provide a comprehensive assessment of thyroid function. Elevated TSH levels indicate hypothyroidism, while elevated TPO antibodies may indicate Hashimoto’s thyroiditis, and imbalances in fT3 and fT4 levels can provide additional insights into thyroid health.

4 Point Cortisol Test

Cortisol is a hormone released by the adrenal glands in response to stress. Imbalances in cortisol due to acute and chronic stress can contribute to symptoms such as fatigue, burnout, anxiety, and sleep disturbances. During the perimenopausal period, stress is a common concern as we often have many demands in our lives including vigorous work schedules and managing family life. A four point cortisol test measures cortisol levels at different times of the day, providing a more comprehensive assessment of the body's stress response. Monitoring cortisol levels can help identify potential issues with adrenal function and guide appropriate interventions to support stress management.

Conclusion

Hormone testing plays a vital role in understanding and managing the hormonal fluctuations that occur during perimenopause. By evaluating key hormones such as day 3 estradiol, day 3 FSH, day 21 progesterone, a thyroid panel (TSH, fT3, fT4, TPO), and a 4 point cortisol test, healthcare providers can gain valuable insight into a woman's hormonal status and tailor treatment plans accordingly. Please note that with very irregular or infrequent menstrual cycles, these tests can be done on any day of your cycle. Customizing your treatment plan according to your hormone levels can help alleviate symptoms, optimize overall well-being, and support a smoother transition through perimenopause into menopause. If you're experiencing symptoms or have concerns, please don’t hesitate to book in at Juniper Family Health. We are here to help!

In health and happiness,

Dr. Meghan van Drimmelen | Naturopath Victoria BC