Maybe it was easy to tell when you entered perimenopause—the first stop on the Menopause Express. Perhaps overnight (literally in the middle of the night), you felt like you’d fallen into a raging inferno and, while wiping away pools of sweat from every patch of skin, you seriously considered stripping off your pajamas and diving headfirst into the freshly fallen snow outside your window. Or maybe, if you were lucky, your older sister or your mom warned you about hot flashes so you knew what to expect. Or, like many perimenopausal people, your periods started becoming irregular. If you didn’t chalk that up to too much exercise or stress, you would have had a clue you were entering the stages of menopause. If, however, you weren’t alerted to menopause’s many signs and symptoms, you’re not alone. A surprising number of menopausal mavens enter perimenopause not knowing what in the henhouse is going on, and feel isolated, alone, misunderstood, and/or generally unhealthy. If you’ve started having symptoms like hot flashes, migraines, irregular periods, or any of the other magical manifestations of menopause, one of the best things you can do is to get tested. Knowing that you’re in perimenopause can greatly alter the way you approach your symptoms, and the best way to know that is through hormone, menopause tests.
How Do I Know If I’m in Perimenopause?
Are there tools available to tell if you’ve entered the perimenopause-to-menopause journey? While unable to provide definitive answers and exact markers, menopause tests can give you a big heads up to help you know where you’re at in the three menopausal stages. Doctors used to look at only symptoms and whether a person had hit the average menopause age to determine if they were in perimenopause. Nowadays, though, there are a number of different tests your doctor or even that you can run (thank goodness for mail-order, at-home tests). While there is no one conclusive test that says “Congrats, you’re in menopause! Right this way, please, to the Waiting Room of MidLife,” or “No, you’re not in menopause. Please check back later, good luck figuring out whatever else in the heck might be causing your symptoms,” there are several tests that can measure your hormone levels. Each test can become a piece in the sometimes confusing menopausal jigsaw puzzle that marks your exact menopausal “location,” along with your symptoms and your age.
So, if you’re asking how do you know if you’re in perimenopause, the answer is tests, plural. These tests are best done under your doctor’s, integrated medicine practitioners, functional medicine doctors, OB/GYN’s, naturopath’s, or holistic doctor’s supervision because 1) they normally require a prescription or lab order and 2) any healthcare partner worth his or her salt will want to know your hormone levels so that they can not only tell you if you’re in perimenopause, but also customize a plan of attack to your specific needs. But, if taking them at home is your cup of tea, drink and test away all by your lonesome. You’ve got options! Whatever healthcare route you take, taking advantage of the many available menopause treatments is critical to smelling the metaphorical roses of your menopausal journey. And while you probably haven’t taken this many tests since high school, hey, that’s one way to feel young again!
What Types of Menopause Tests Tell You You’ve Entered Perimenopause?
Wondering what kind of menopause tests are available and what they track? As always, after getting in the right mindset, empowerment and education are the best first steps in managing menopause. Knowing that you have menopause test options and what they are is a great way to take those steps. This section details the four different types of test choices, all of which measure your hormones. And, later in the post, we talk about the importance of tracking all of your symptoms as an added and personal way to test that doesn’t require actual testing or a doctor’s input.
Important note: Since hormone levels fluctuate dramatically during perimenopause, testing is not a definitive answer to knowing where you’re at in your menopausal journey. Keep in mind as you read your test results that hormones in one spot today can be in vastly different places tomorrow. The key is to track your hormones and other symptoms over time and seek medical attention (or other options) if your menopausal maladies are interfering with your daily life.
Now, onto the much anticipated menopause test options.
Option 1: Blood Tests
Most doctors prefer blood tests because, according to the National Heart, Lung, and Blood Institute, “Blood tests show whether the levels of different substances in your blood fall within a normal range.” For example, when I had my menopause levels taken (estrogen, progesterone, and testosterone), I could see if I was in the normal range or if my hormones were higher or lower than normal.
Pros of blood tests? They can reveal many things about what your body is doing. That’s why they tend to be the gold standard among doctors. Cons? Needles and possible bruising. (Granted, the same cons exist while learning to sew.)
Note: See the “What the Tests can Measure” section below for more information on the type of information these tests gather.
Option 2: Saliva Tests
Some experts argue that blood levels of hormones don’t reflect the level of hormones in the actual tissues of the body, where the hormones have their effects. Moreover, while blood tests, by nature, only measure what’s in your blood at a certain moment in time, saliva tests are done from the comfort of your own home (ordered by your doctor) and more frequently (anywhere from four to eight samples taken about three hours apart). This is because hormones are actually secreted by your glands about every two hours, and can vary greatly from hour to hour. It’s that variability that provides a better picture of where you’re at menopausally speaking. So, start drooling, baby! (Hey, maybe it’ll balance out some of the dryness you’re experiencing, err, elsewhere.)
Note: That being said, there are a couple caveats to keep in mind about this method. For one, the North American Menopause Society (NAMS) does not recommend saliva testing, which is often a part of custom-compounded bioidentical hormone therapy, because the jury’s still out on it’s accuracy. It’s hard to tell if that’s because the chance for human error is greater with home administration, there’s a greater possibility of contamination from food residue, bleeding gums, or sores in the mouth, or there’s a possibility of testing equipment not measuring accurately enough for scientific standards. At any rate, says Christiane Northrup, M.D., who some call the “Queen of Menopause,” “there are many clinicians, particularly naturopaths, who use salivary hormone levels with good results.” [source]
Another caveat? Home testing isn’t usually covered by insurance, at least not yet, so if you opt for this option, you may have to shell out as much as several hundred dollars per test. And if you’re paying that much to spit, it should be a lot more fun, no?
Option 3: Pee. Gross but Maybe Easier?
Like saliva tests, these are also done at home with a doctor’s order and more frequently. The NAMS has no stance on urine tests for menopause, but the possibility for contamination and the likelihood of no insurance coverage is similar.
And hey, there are a lot grosser bodily fluids than pee.
Option 4: DUTCH. Dried Pee. Even Grosser, but Maybe Better Than Blood, If You’re Not a Fan of Needles
D.U.T.C.H. stands for Dried Urine Test for Comprehensive Hormones. Like salivary and urinary tests, these are also done at home over a 24-hour period with a doctor’s prescription. You pee on a pad, let it dry, and send your samples in. The company that provides them—Precision Analytics—claims that this is the ultimate test to get the most accurate vaginal hormonal levels and, because it measures more than just hormones, “gives a fuller picture for more precise clinical diagnosis of hormonal imbalances.” However, there appear to be no scientific studies yet that confirm its accuracy, according to Disha Narang, MD, a board-certified gynecologist, and Karl Nadolsky, who is board-certified in endocrinology, diabetes, and metabolism.
Keep in mind that the type of test you take may alter the kinds of hormones that can be measured. For more information on each type of test, check out Dr. Mariza Snyder’s full descriptions of which tests measure what, and the pros and cons of each kind of test.
And, once again, while dried pee is grosser than wet pee, it’s still not the grossest bodily fluid!
Which Test Is Better for Measuring Menopause Hormone Levels: Blood Tests or Saliva Tests?
Wondering which type of test will tell you if you’re in perimenopause? The Health Testing Center differentiates between blood versus saliva testing. “A blood test is one of the most common ways to test hormone levels. This test can detect testosterone, estrogen, cortisol, and thyroid levels. You should order a test that’s specific to your gender, as a woman’s hormone test will look for different levels of sex hormones than a man’s test. A simple saliva test can detect several types of hormones as well. With a saliva test, you can look at your estradiol, progesterone, and testosterone levels.”
In short, both test types provide valuable information in helping a person know whether they are entering or are already in any of menopause’s stages. As always, consult with your doctor if you are unsure or want to know which type of test is best for you.
What the Tests Can Measure
You might be surprised by the number of hormones you have floating around in your body besides the Big 3: estrogen, progesterone, and testosterone. You and your doctor should pick and choose which of all your hormones are best measured given your age, symptoms, birth control history, medical history, etc.
- Estrogen: This hormone, which is produced in your ovaries, has been your buddy for most of your life up until now, right? It’s helped keep your reproductive organs healthy, your vajayjay nice and moist, and generally helped a lot of systems in your body chug along. But perimenopause tends to make estrogen indecisive, which can, as Amanda Thebe, fitness trainer and author of Menopocalypse, warns: “leave women feeling as though they’ve been hit by a truck that’s then reversed and run them over again for good measure.” [source]
- Progesterone: Because estrogen and progesterone play off of each other, estrogen’s indecisiveness tends to confuse progesterone. Think of it as the peacemaker, and when estrogen gets too “loud,” progesterone tends to decline, leading to something called “estrogen dominance.” Darn estrogen. Low levels of progesterone in your body may indicate that where you need to start is progesterone therapy.
- Testosterone: Although you may think of testosterone as just a male hormone, women have it too, just in lower quantities. It tends to be the body builder of the three main hormones, working with estrogen and progesterone to keep our bones strong and healthy and making us horny. If both your estrogen and progesterone are low compared to your testosterone, that may explain why all of your body fat is gathering on your belly.
- FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone): These are two of the hormones that stimulate ovulation. They’re released cyclically each month during perimenopause. The more FSH and LH you have, the less you’ll ovulate. Once your FSH levels have reached 30 IU/1 or higher, and your LH levels are greater than 40 IU/1, your ovulation “boat” has sailed. Since perimenopause is marked by fluctuating FSH and LH, among other things, these levels will have to be assessed more than once to get the truest, fullest picture.
- TSH (Thyroid-Stimulating Hormone), T3, and T4: Your pituitary gland makes this hormone, which sets off the production of T4 and T3 in your thyroid. Dr. Mariza Snyder, a functional medicine practitioner and author of The Essential Oils Menopause Solution, summarizes how these three hormones work together and what a deficiency in any of them can reveal:
“If your thyroid is functioning optimally, it is able to easily maintain a stable balance of T3 and T4. When levels drop, the pituitary releases TSH to trigger the thyroid to produce T4, which converts to T3. As soon as T3 and T4 are back to normal levels, TSH production slows and everything holds steady. When it’s not functioning optimally, an underproduction of these hormones will slow down the body’s metabolism, causing hypothyroidism.” [source] Likewise, overproduction will speed up metabolism, resulting in hyperthyroidism. Blood tests are the best way to assess thyroid hormone levels precisely because they offer a snapshot of where they are at any one time.
- DHEA-S (Dehydroepiandrosterone sulfate): Your adrenal gland and ovaries produce this precursor to estrogen and progesterone, so if it’s low, chances are your estrogen and progesterone levels are low too. One more way to assess your menopausal state of mind!
- Anti-Müllerian Hormone (AMH): According to Medlineplus.gov, an AMH test shows how many eggs are left in a woman’s ovarian reserve. Since the number of eggs declines as a woman gets older, low levels of AMH can be another indicator of menopause. Levels of AMH are determined by a certain kind of blood test called the PicoAMH Elisa test, which was approved by the FDA in 2018, as long as it’s used in conjunction with other clinical assessments and laboratory findings.
There are a number of other hormones related to each of these main hormones, all of which can also be tested if your initial tests of these hormones show anything wonky. Again, Dr. Snyder’s checklist may provide helpful information on those.
You can probably see now how multiple tests are really a necessity, not a luxury. Looking at just your estrogen or DHEA levels, for instance, won’t tell you exactly where your progesterone levels are at. That’d be like trying to determine the shape of something by looking at its shadow, or the potential fuzziness of a dog by only looking at its cage.
Feeling overwhelmed yet? Don’t worry. We’re here for you. Take a few deep breaths (remember, in AND out) and start by identifying the menopause symptoms that are interfering with your day-to-day life. Then, decide which kind of doctor, practitioner, or specialist you want to see. Studying your options one by one can be an effective way to break this new journey down into manageable pieces. Like the old saying goes: How do you eat an elephant? One bite at a time. And while you won’t be eating any elephants, the same is true for eating cake, and tackling stressful situations.
All of this said, it’s important to note that menopausal symptoms do not necessarily correlate well with hormone levels. A person with low testosterone levels, for instance, can have a normal libido. As helpful as hormone tests can be, paying attention to your symptoms and even knowing what’s causing them can be a better indicator of what you need to do to lessen them. And that’s where tracking comes in.
How and Why Should I Track My Menopause Symptoms?
Say you’re at your doctor’s office, ready to ask them about which tests you should take and what you should have tested, and they ask when your last period was or how often you experience hot flashes. In the menopausal fog of juggling all of the demands of life, it can be easy to say “I think it was June” and “I dunno.” However, if you start logging your symptoms either in a notebook or in a menopause tracking app, you and your doctor are better able to spot patterns and see more clearly what’s bothering you the most.
If you’re more of a DIY, I’ll-come-up-with-my-own-charts-thank-you-very-much type person, spreadsheets or Smartsheets can come in really handy too. I know I get a gleam in my eye when I start thinking about all those rows (i.e., my menopause signs and symptoms) and columns (toggle boxes for severity on any one day, like “easy-peasy,” “bothersome but I can handle it,” “Man, this is ANNOYING,” and “MAKE IT STOP.”). If spreadsheets make your eyes glaze over, check out these “menopause tracking apps” and download and use your favorite one. You’ll be surprised how many options are available! It makes you wonder, how did people handle menopause without the help of smart phones?!
Whatever way you choose to track, picture yourself showing your chicken-scratch notes, chart, satirical cartoons, or full-on PowerPoint presentation to your doctor—actual data with your specific symptoms—and seeing their eyes widen in amazement and gratitude. Tracking is the best way to help the pros put their expertise to work to get you the help you need.
Is There a Simple Quiz to Tell Me If I’m in Perimenopause?
Aren’t getting what you need from the menopause tests? Don’t want to track everyday? Or, looking for a fast and easy way to tell where you’re at in your menopausal journey? I get it. Perimenopause can feel overwhelming and figuring out which test to take and tracking day after day may feel like one more thing in an already long list of things. If that’s the case, take this menopause quiz, which will give you a great idea of where you’re at today. It’s just a quick check-in to give you data about what you’re experiencing and what those signs and symptoms might indicate.
It’s a Wrap!
Even though determining whether you are in perimenopause (or on another stop on your menopausal journey) may seem overwhelming, you’ve got options. I’m talking about four different kinds of menopause tests, daily tracking in whatever format works best for you, and a menopause quiz.
Remember: Menopause manifests in many ways, not just with hot flashes, night sweats, and other common symptoms. I’m talking about signs and symptoms like (cue karaoke track to Billy Joel’s “We Didn’t Start the Fire”) 🎵joint pain, migraines, tinnitus, bleeding gums, heart palpitations, and overall loss of mojo.🎵 The more you realize how many ways menopause can make your life more “interesting,” and the more you test, track, or take a quiz (whichever way works best for you) to get in tune with your menopausal maladies, the better advocate you will be for yourself in getting the care you need.
- Northrup, C. (2001). The wisdom of menopause. Bantam Books.
- Snyder, M. (2021. Essential Oils Menopause Solution. Rodale Books.
- Thebe, A. (2020). Menopocalypse: How I learned to thrive during menopause and how you can too. Greystone.
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