Should I check my hormones in perimenopause with an at-home test?
TL;DR No. Routine “hormone testing” in perimenopause and menopause is not recommended. At-home urine and saliva tests are not helpful in determining “stage” of perimenopause or need for treatment.
Menopause transition
Menopause is the normal process that occurs when the ovaries stop working. It is marked by the last menstrual period. Since you cannot know that a period was the last one until time passes, someone is considered postmenopausal once they have not had a period for 12 months. This typically occurs between the ages of 45 and 55, with an average age of 51 in the United States.
The time leading up to the final period is considered perimenopause. During perimenopause, hormone levels become irregular. The ovary is “winding down” its normal functions (sex hormone production and ovulation) and doesn’t respond as predictably to the hormone signals from the brain. This results in day-to-day rapid fluctuations of hormones – the peak levels are often higher and the low levels are much lower than they have been in the past. These frequent rapid shifts lead to many of the changes felt during this time including:
- Changes in both frequency and amount of menstrual bleeding
- Hot flashes and night sweats
- Mood changes
- Difficulty sleeping
- Cognitive changes (“Brain fog”)
- Metabolism changes with weight gain and loss of muscle
- Many other symptoms involving all organ systems, such as joints, heart, skin, bowel, and more
Everyone experiences perimenopause differently. Some people feel no symptoms while others experience many symptoms. It can be brief or go on for many years. This is part of what makes perimenopause so frustrating for so many.
Defining menopause if periods have stopped for another reason
If someone is no longer getting periods for another reason (like a previous hysterectomy or hormonal suppression with birth control pills or IUD), the date of the last period is harder to define. In these situations, it is ok that we don’t know the exact date. As long as someone is over 45, if they are having hot flashes or other symptoms often attributed to the menopause transition, we should assume that is what is going on and treat them accordingly. There is a limited role or ability to “prove” someone is in perimenopause with a test. Their symptoms, not a number on a test, should guide their management.
Hormone testing in perimenopause/menopause
The hormones most often tested for using at-home testing are FSH (follicle-stimulating hormone) and estradiol (estrogen). FSH is produced by the brain to tell the ovaries to increase estrogen production. If estrogen levels are low, the brain will produce more FSH to try harder to get the ovary to respond. Eventually, the ovary may respond, but very unpredictably, leading to huge swings in estrogen levels. In fact, during perimenopause, the estrogen level can be low, normal, or even elevated. Estradiol levels can fluctuate wildly from day to day. The same person could be tested every few days, and the resulting levels would be so different each time that it would look like different people were being tested.
In a study of over 2800 subjects, there was NO difference in the average levels of estrogen between those who were pre-menopausal versus peri-menopausal. Additionally, the levels varied widely (more than 2-fold) from person to person. FSH also varied widely and was not found to predict when the last period would be or when perimenopause would begin.
Because of these variations, using these lab tests to try to predict or accurately diagnose the stage of perimenopause is unreliable. Therefore, medical experts and organizations recommend a symptoms-based approach instead. It can be very tempting to just want to know “what your levels are”, but the information gathered is not helpful. It could in fact lead to either unnecessary treatment (if labs are “abnormal” but there are no symptoms) or to the withholding of appropriate treatment that is needed (symptoms are present but labs are “normal”).
Role of hormone testing
There are some situations that warrant hormone testing. This is individualized and should be discussed with your clinician to ensure the right tests and work-up are being completed.
If menopause (the last period) occurs under the age of 45, hormone testing is often needed to rule out other causes of irregular periods and perimenopause symptoms. Menopause earlier than age 45 also has potential longer-term health impacts that need to be considered, such as bone and heart health.
Statistically, if someone is over age 40 and has symptoms typical of perimenopause, that is probably what is happening. While some testing may be needed to rule out other causes of symptoms, managing perimenopause does not have to be justified by hormone testing. In fact, because hormone levels can be so misleading and difficult to interpret, symptoms, not labs, should drive the discussions for management options.
