Lab Tests & Menopause
During perimenopause, hormone tests are generally not helpful because hormone levels change throughout the menstrual cycle. Sometimes testing is done to check specific hormone levels, especially to evaluate fertility problems or when periods stop at an early age. This can help women make decisions about beginning or adjusting treatment. For some women, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease.
What about Saliva Testing?
The Menopause Society states that “Salivary hormone level tests are expensive, are not accurate, and should not be used to evaluate or treat menopause symptoms”.
What about Follicle-Stimulating Hormone Testing?
Sometimes your healthcare practitioner will check a follicle-stimulating hormone (FSH) level to confirm menopause. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.
However, a single FSH level can be misleading in perimenopause because estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels can vary greatly during perimenopause. More important, a low FSH level in a woman who is having hot flashes and irregular periods does not eliminate the likelihood that she is still in perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), a FSH test is not valid. Over-the-counter urine tests for menopause that measure FSH levels are often advertised but are expensive and not informative, for the same reasons discussed earlier.
What Lab Tests Should I Request to Ensure I am Optimizing my Health at my Menopause Appointment?
When a woman suspects she’s in perimenopause, it is an excellent time to have a complete medical examination by a healthcare practitioner. The diagnosis of perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms.
If you want to be proactive about optimizing your health in perimenopause, menopause, and post-menopause, there are key lab tests to request that any healthcare practitioner can order.
Standard Tests:
Complete Blood Count (CBC) - the CBC measures different features of your blood, including red blood cells, white blood cells, platelets, hemoglobin, and hematocrit. It is important for the diagnosis of anemia, and it is also a screening test for immune system issues and different types of cancer.
Comprehensive Metabolic Panel (CMP) - the CMP reveals information about your overall metabolism, including kidney and liver function and type 2 diabetes risk. It also looks at electrolytes like sodium, calcium, and potassium, which can indicate whether you’re dehydrated, and it’s a screening test for your liver and kidney function. This panel measures the blood levels of albumin, blood urea nitrogen, calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium, total bilirubin and protein, and liver enzymes.
Lipid Panel - the lipid panel, usually drawn while fasting, is a broad picture of heart health, which is a measure of your HDL (“good”) cholesterol, LDL (“bad”) cholesterol, and triglycerides. One of the strongest predictors for preventing heart disease is having a good HDL-to-triglycerides ratio. Your HDL should be higher than or equal to triglycerides.
Hemoglobin A1C (HbA1C) - this test is a more powerful indicator of blood sugar dysregulation than a single fasting glucose level. The HbA1c test measures the percentage of red blood cells saturated with glucose. The higher your A1C, the higher the estimated average blood glucose over the past 6 weeks. A high HbA1C marker may also increase your risk of Alzheimer’s disease and cancer— potentially making the test a good predictor of overall longevity.
Thyroid Panel - thyroid disorders are incredibly common, affecting one in 10 women, and about 60% of people with a thyroid problem are unaware of their condition—and thus, unable to manage it appropriately. The TSH is a great screening test, but a more comprehensive thyroid panel is needed for women experiencing unexplainable weight gain or loss, chronic fatigue, cold intolerance, hair loss, forgetfulness, constipation, and feeling generally depressed. Ask for a TSH, free T4, free T3, reverse T3, and two types of thyroid antibody levels called anti-TPO and anti-thyroglobulin. A more comprehensive panel can spot issues early while they can still be addressed with lifestyle changes.
Anemia Panel (iron, ferritin, folate, and vitamin B12) - anemia is a major cause of chronic fatigue. Low vitamin B12 is common among vegetarians and vegans but can also exist among omnivores due to nutrient malabsorption issues caused by antibiotic overuse or celiac or Crohn’s disease. Folate plays a crucial role in healthy pregnancy and preventing birth defects but often is not screened. Low iron can present as anemia or even hypothyroidism. Even if you’re not anemic (which can be tested for with a CBC), you can still be iron deficient—which is why testing for iron and ferritin separately is important.
Nutritional Deficiencies:
Vitamin D - 42% of patients, on average, have low Vitamin D, and this number gets worse with age and menopause. This deficiency can be due to geography limiting sun exposure, darker skin limiting absorption, a genetic issue, absorption issue, or kidney disease. Vitamin D has MULTIPLE roles in the body: it is a hormone precursor that plays a key role in immune function and mood. Deficiencies in vitamin D can also be a factor in autoimmune diseases and certain cancers. Be sure to ask for it if you have mood disorders or fatigue.
Zinc - zinc is used by your body in cell production and immune functions. When you’re zinc deficient, your body can’t produce healthy, new cells. This deficiency leads to symptoms such as unexplained weight loss, wounds that won’t heal, lack of alertness, and decreased sense of smell and taste.
Magnesium - deficiency of magnesium is linked to poor sleep, nerve problems, mood disorders, fatigue, muscle cramping, headaches, and brittle hair and nails. It is also important for heart health and blood pressure and keeping your thyroid balanced.
Chronic Inflammation Testing:
High Sensitivity C-Reactive Protein (HsCRP) - this protein is naturally produced in the liver in response to inflammation. A high level of CRP in your blood can occur due to several inflammatory conditions.
Erythrocyte Sedimentation Rate (ESR) - this test is rarely performed alone, as it doesn’t help pinpoint specific causes of inflammation. Instead, it can help your doctor identify that inflammation is occurring. It can also help them monitor your condition.
The HsCRP and ESR are great ways to see if you are inflamed and then use them as a marker after nutrition/lifestyle changes to track progress. However, these markers are nonspecific, meaning that abnormal levels can show that something is wrong but not what is wrong. Since healthy nutrition and lifestyle changes improve many causes of chronic inflammation – it is worth testing.
In conclusion:
There is nothing more critical than understanding what is going on in your body to make the best choices for your future self.
