I often get ladies wanting to check their hormone levels to see if they are perimenopausal

The truth is that if you are roughly the right age, with the right symptoms of the perimenopause, then we do not need to check your hormone levels. In fact, this can actually be unhelpful. Why?

The perimenopause is a time of great hormonal fluctuation. So, while Oestrogen levels are generally falling, you can suddenly have surges of hormones…even within the same day!

Often a blood test called an FSH or Follicle Stimulating Hormone is done. FSH does start to rise during the perimenopause, and when the menopause is complete it is generally high, but during the transition it can be high, or normal on different days., So, if we see a normal FSH that does not mean you are not going through the Perimenopause. Similarly, if the FSH is high, that does not mean you are all finished and can never get pregnant again! The guidance is therefore that if you are 45 and over with perimenopausal symptoms, we are advised NOT to do an FSH and that the diagnosis can be made on the history and examination. These changes are expected at this time of life. You would not for example, ask for a blood test to confirm your daughter is going through puberty when she gets her period at age 12 would you?

But how will you know how much Oestrogen to give me if you don’t check my Oestrogen levels?  I hear you cry. Well, the range of “normal” Oestrogen is very wide… so what is normal for me is not normal for you. It also varies on the time of the month, and as described above, it can be all over the place during the perimenopause transition. So, it is really easy … we titrate the dose up according to your symptoms. Yup, one woman might only need a 25mcg patch to control her symptoms. of hot flushes, brain fog etc. Another might need 100mcg. One woman might need 1 mg of oral Estradiol, another might need 2mg. It really depends on what you need to control your symptoms. We usually start with a low dose then reassess you a couple of months later and increase the dose if necessary. Remember, if you have a womb or have had Endometriosis, we will need to give you enough progesterone to protect your womb… we have to balance the progesterone dose to the oestrogen dose. Dead simple.

The exception to this is Testosterone. If for some reason a lady needs Testosterone, I would check something called her “Free Androgen Index” prior to starting treatment…. and that isn’t so much to see if she needs it but to have a baseline because with Testosterone we really don’t want to overshoot and give a lady too much…if she starts to get unwanted hair growth and a deep voice then she might think we were trying to make her transition! So, we would recheck Testosterone after starting to make sure she was not getting too much!

As for the Menopause….if you are over 50 and have not had a period for two years…yes, you are post menopausal! No need to confirm that with a blood test unless you want to waste your money! For other articles on The Peri and menopause please check out the other articles in this blog.