Testing Hormones in Perimenopause
Why you should do this before considering HRT
Perimenopause is a transformative phase, often lasting 2-12 years before a person can achieve menopause (the 12 month anniversary of no period). During this time, hormonal fluctuations can lead to a wide range of symptoms*;
73% experience low mood or depression
72% suffer from increased anxiety
68% notice weight gain around the middle
65% have trouble sleeping
Heavy periods, PMS, gut issues and new allergy symptoms are also very common. With hormone receptors located in the body from top to toe, changing hormone levels can affect people completely differently depending on their unique biology.
Understanding the role of hormones in perimenopause is an important step to be able to managing these symptoms. While hormone replacement therapy (HRT) is a common first approach suggested by GPs (along with anti-depressants but that topic deserves it's own article), it's important to be able to functionally test hormones before considering such treatment to avoid potential side effects. In this article, we'll explore the benefits of hormone testing in perimenopause, the key markers to consider, and how it can guide personalised recommendations for a healthier, smoother transition.
*Results taken from a survey of 3,000 women in a 2022 perimenopause survey by Future Woman
The Importance of Testing Hormones in Perimenopause
Perimenopause is a complex phase characterised by hormonal changes similar to those experienced during puberty. These changes can have a significant impact on various aspects of health and wellbeing and can look and feel different person to person. A classic picture in early perimenopause is for progesterone to fall off a cliff (hello anxiety, sleep issues and heavy periods) and oestrogen can be up to 3 times higher. Now you can imagine how someone might actually feel a lot worse if they were then to add MORE oestrogen into the mix with a non-personalised HRT perscription. Unfortunately for some people, symptoms can get worse after taking HRT especially if they have underlying insulin resistance or poor oestrogen detoxification.
By testing hormone levels first, we can gain valuable insights into hormone production, balance, metabolism, and the influence of external factors such as stress or nutrient deficiencies. This information allows for targeted interventions, including diet, lifestyle modifications, specific supplements and also personalised bioidentical hormone therapy, to alleviate symptoms and support overall health in a holistic way.
If someone is already taking hormone replacement therapy, it's advisable to test every 6 months to optimise HRT, monitor fluctuations and metabolism of these hormones and maximise symptom relief.
Can Testing Diagnose Perimenopause?
There are no specific tests to diagnose perimenopause, so understanding the symptoms and their patterns are really valuable. Hormone testing plays a complementary role in providing a more accurate picture of hormonal imbalances and their impact on the body. Rather than relying solely on test results, it's important to consider the overall presentation of symptoms and work with a healthcare professional to develop a comprehensive approach to perimenopause management. This list of new symptoms by endocrinologist Jerylinn Prior is helpful:
Heavy and/or longer periods
Shorter cycles – 25 days or less
New sore or swollen breasts
Increased period pain
Night sweats, particularly premenstrually
New or increased migraine headaches
New or increased premenstrual mood swings
Weight gain without changes in exercise or eating
The Limitations of FSH Testing
Follicle-stimulating hormone (FSH) testing is commonly used by GPs to determine menopausal status. However, it is unreliable for diagnosing perimenopause due to fluctuating hormone levels. FSH levels can vary throughout the perimenopause phase, making it challenging to obtain accurate readings. While FSH testing can rule out other conditions like polycystic ovary syndrome (PCOS), relying solely on this test can miss important information about hormonal imbalances in perimenopause.
The Benefits of Testing Hormones in Perimenopause
Hormone testing during perimenopause offers valuable insights into hormone production, balance, and metabolism. By understanding these key areas, we can develop personalised recommendations to address specific hormone imbalances and optimise how you feel in your skin day to day. Here are the ten key markers to consider when testing hormones in perimenopause:
1. Oestrogen Levels and Metabolites
Oestrogen plays a vital role in perimenopause, and imbalances can contribute to various symptoms. Testing oestrogen levels, including E1, E2, and E3, provides a comprehensive understanding of oestrogen production. Additionally, evaluating oestrogen metabolites helps assess how well the body is processing and eliminating oestrogen. Imbalances in metabolism pathways can exacerbate symptoms and increase the risk of certain cancers.
2. Progesterone and Progesterone Metabolites
Progesterone levels decline in perimenopause, leading to symptoms such as anxiety, poor sleep, and shorter menstrual cycles. Testing progesterone and its metabolites helps determine if ovulation is occurring and if sufficient progesterone is being produced. Understanding progesterone metabolism pathways is crucial, as favouring the beta pathway can reduce the beneficial effects of progesterone.
3. Testosterone Levels
Testing testosterone levels is essential in perimenopause, as imbalances can lead to symptoms like weight gain and mood changes. Testosterone dominance, often observed when both oestrogen and progesterone levels are low, can worsen insulin resistance and exacerbate perimenopause symptoms. By assessing testosterone levels, appropriate interventions can be implemented to address imbalances.
4. DHEA and DHEA-S Levels
DHEA and DHEA-S are hormones predominantly produced in the adrenal glands that can convert to testosterone. Monitoring these levels is crucial to evaluate testosterone dominance and its impact on perimenopause symptoms. Elevated DHEA and DHEA-S levels can contribute to imbalances and should be addressed to alleviate symptoms effectively.
5. Androstenedione Levels and Metabolism Pathways
Androstenedione is a hormone that can convert into both testosterone and oestrogen. Testing androstenedione levels helps identify imbalances in these hormones and provides insights into potential symptoms. Additionally, evaluating metabolism pathways, specifically the 5a and 5b pathways, helps determine the likelihood of experiencing specific symptoms like weight gain and mood changes.
6. Cortisol and Cortisone Levels
Assessing cortisol and cortisone levels helps evaluate the functioning of the hypothalamus-pituitary-adrenal (HPA) axis. Poor communication within the HPA axis during perimenopause can lead to increased stress, weight gain, hormone imbalances, sleep disturbances, and mood changes. Understanding cortisol patterns and responses to stress can guide interventions and support hormone balance.
7. Cortisol Awakening Response (CAR)
The cortisol awakening response (CAR) is a valuable indicator of the body's stress response throughout the day. Elevated CAR results suggest an overactive HPA axis, which can worsen perimenopause symptoms. Monitoring CAR helps identify the impact of stress on hormonal imbalances and guides stress management strategies for better symptom management.
8. Melatonin Levels
Melatonin, the darkness hormone, is essential for quality sleep. As melatonin levels naturally decline with age, lower levels can worsen sleep issues in perimenopause. Evaluating melatonin levels helps identify potential sleep-related symptoms and guides interventions to improve sleep quality.
9. Comprehensive Testing Beyond Sex Hormones
Comprehensive hormone testing should include markers beyond just oestrogen and progesterone. Assessing androgens, cortisol, neurotransmitters, and key nutrients provides a holistic understanding of hormone health. These additional markers contribute to a comprehensive evaluation of overall hormone balance and guide personalised interventions.
10. Monitoring Hormone Therapy
For individuals considering or already on hormone replacement therapy (HRT), hormone testing is a powerful tool for monitoring treatment effectiveness and safety. Testing can assess hormone metabolism, ensure appropriate dosing, and identify potential imbalances that may require adjustments in the treatment plan. Regular testing every six months helps optimise HRT and maximise symptom relief.
Integrating Testing into Perimenopause Management
Testing hormones in perimenopause provides invaluable insights into individual hormone imbalances. By understanding specific imbalances, personalised interventions can be implemented to address symptoms effectively. Whether through dietary and lifestyle modifications, stress management techniques, supplements or hormone therapy, a targeted approach based on test results supports a smoother perimenopause transition.
Case Study: Client's experience of HRT without holistic support
Pippa is 48
She was experiencing anxiety, breast pain and sleep disturbances and went to her GP who prescribed HRT
Within 3 months, she noticed her existing symptoms got worse and she put on 8kg of weight around her middle
She came to work with me after coming off the HRT
We worked together to co-create a health coaching plan that including increasing her nutritional content, blood sugar regulation alongside the emotional support provided through our bi-monthly coaching sessions
Over a 3 month period, she lost 6kg and is now feeling more in control and her symptoms have reduced by 90%
She plans to test to see her hormone status and detoxification pathways before considering HRT in the future
Case Study 2: Perimenopause management with holistic support
Amanda is 42
She has noticed new symptoms such as anxiety, heavy periods, increased allergy symptoms, rashes and insomnia.
She completed my 6 week Detox, Reset & Go Health Coaching program
At the end of the program her symptoms had reduced by 75% using nutrition, lifestyle and stress management tools
Amanda did a hormone test as she wanted to understand the root cause behind her remaining symptoms
The test results showed that she had:
A preference fro the 4-OH pathway in phase 1 which is more inflammatory
A preference for cortisol (rather than cortisone) which can be linked with inflammation
Possible low B6, which could be contributing to her high histamine causing allergy symptoms and making oestrogen even higher
Low progesterone (suggesting a lack of ovulation and likely the cause of her anxiety and insomnia)
Her plan included specific supplements, nutritional tweaks and lifestyle measures to lower cortisol, lower oestrogen and histamine, it also included recommendations to address increasing her dopamine, progesterone and B6.
Amanda completed another 6 weeks of health coaching after receiving her test results and is currently symptom-free.
She has gained life-long tools and hacks to use that she says now feel like 'second-nature' to her, along with having a list of trusted holistic practitioners to lean on for years to come. Setting up this kind of support bubble for beautiful human's like Amanda is one of the favourite parts of my work as a health coach - we all deserve a little village.
Amanda did not choose to go on HRT but if she did, progesterone only hormone therapy would have been the best fit for her at this time.
Introducing My New Health Coaching Program for Perimenopause
I understand the challenges of navigating perimenopause and the need for personalised support. That's why I'm so excited to announce my new health coaching program specifically designed for people in perimenopause. This six-month program provides step-by-step guidance, accountability, and support to help manage the ebbs and flow of perimenopause with confidence.
4 x 1:1 sessions with me (in person or online) to get you educated about hormones, reduce symptoms and feel stronger in your body
Advanced functional testing to understand your unique hormone levels and detox pathways, including oestrogen, progesterone, testosterone, DHEA + organic acids (including gut, inflammation and certain vitamin markers)
30min joint consultation with myself and an expert women's functional practitioner to go through individualised lifestyle and supplement recommendations
4 x 1:1 follow-up sessions with me to implement changes based on your unique test results
In our health coaching sessions you will
Learn about nutrition, blood sugar balance, cortisol and stress management hacks
Learn how your body clears toxins, why it’s so important for hormonal health and how to reduce your toxic load
Learn how to tune into your cycle (even if you don't have one), how to manage stubborn weight gain and how to switch the body into a healing, anti-inflammatory state
Formulate and commit to goals and be held accountable
Lifetime access to supporting resources: recipes, nutritional guides and meal planner
Create clarity, get rooted and plan what you need for you AND your family
An individualised action plan that’s achievable and will set in stone habits to last a lifetime
Access to me, my brain & my black book for 6 months
By working to address blood sugar balance, detoxification pathways, mindset, functional hormone testing and more, together, we'll create a holistic plan tailored to your unique needs for a smoother perimenopause journey.
"Alisa is amazing! She helped me improve my health and learn more about my menopause stage. I was amazed by how much progress I made and the knowledge I gained in such a short amount of time. Alisa gave me more than health advice, she also shared useful tips for shopping and better living and also recommended some amazing specialists to support my family and I in other areas. I'm still on my journey, but I feel confident and prepared with Alisa's wonderful guidance and life tools."
Olivia, 1:1 Health Coaching Client
Join the waitlist by dropping me an email with the subject line TESTING to embark on a transformative journey to reclaim your health and wellbeing during perimenopause.
I also offer a free 15 min clarity call if you prefer to jump on the phone and talk it out.
Recipes for Hormone-Friendly Meals
Introducing healthy hormone foods is can be a game-changer during perimenopause. Here are three of my favourite hormone-friendly recipes this season:
During the first half of the cycle or the follicular phase (typically day 1 - 14) our bodies are more sensitive to & therefore need less glucose.
This anti-inflammatory golden beetroot soup paired with my happy hormone easy-peasy homemade bread really hits the spot on a chilly afternoon or evening. The soup takes 15 mins prep and then the slow cooker does the rest.
3 golden beetroots
2 white onions
1 medium carrot
3 cloves of garlic
4cm knob of ginger
1 medium apple
500 mls of chicken bone broth (recipe here) or veggie stock
1/2 teaspoon of cumin
1/2 teaspoon of turmeric
Pinch of good quality salt
1 can of organic full fat coconut milk
A little coconut oil to sauté the onions
Chop all the veg and soften on the stove for 10 mins on low.
Chuck everything into a slow cooker with the spices, salt and stock and cook on low for 6 + hours.
Whizz with a handheld blender until smooth or in a glass blender.
Stir in coconut milk & serve with kefir, extra virgin olive oil and pumpkin seeds.
Serve with toasted Rosemary Keto bread with lashings of butter (recipe below).
Happy Hormone Bread
I challenge you not to love this easy to make rosemary bread. It’s keto friendly, gluten free and hormone friendly and it’s smashing with lashings of butter, marmite and nut butter. Check out this gluten free marmite alternative that isn’t full of junk.
1 ½ cups (240 g) whole golden flaxseeds
4 Tbsp (40 g) psyllium husk powder
2 tsp Gluten Free baking powder
½ tsp good quality salt
1 cup (250 ml) hot water
1/3 cup (70g) melted coconut oil
1 Tbsp of ACV
1 Tbsp of fresh rosemary, chopped
Preheat the oven to 180 °C and line a bread tin with plastic free parchment paper
Blend the whole flaxseeds in a Nutribullet (or similar high speed blender or grinder) until floury. Transfer the flaxseed meal to a medium sized bowl
Add the remaining dry ingredients and stir with a spoon
Pour in the hot water, ACV & melted coconut oil and mix with the spoon. Option step: once it’s cool enough to handle, turn onto a clean surface with a little gluten free flour, kneading with your hands for 30 secs. If you're short of time, skip that and go to the next instruction and just push the mixture down with the spoon.
Transfer the bread dough to a bread tin lined with parchment paper.
Brush the top of the dough with a whisked egg or milk and sprinkle with extra seeds. Sesame are really yummy but use whatever you have including more flax.
Bake the bread for about 50 minutes, until it doubles (or even triples) in size and has a golden brown crust. It might take longer as each oven is different.
Transfer it to a wire rack to cool completely before slicing. Enjoy!
During the second half of the mentral cycle or the luteal phase (typically day 15 - 28), our bodies need more complex carbohydrates to support optimal progesterone production.
Spiced Pumpkin Soup
This pumpkin soup recipe (inspired by deliciously ella), paired with brown sourdough bread, is comforting and a totally delicious way to support your lovely hormones (especially so in the second half of a cycle).
2 cloves garlic, peeled & finely chopped
5cm piece ginger, finely chopped
1 red chilli, finely chopped
500g pumpkin, peeled, deseeded & chopped into small bite-sized pieces
1 tsp ground cumin
1 tsp ground coriander
½ tsp ground turmeric
1 x 400g organic tinned butter beans, rinced and drained
1 litre of bone broth or veggie stock
1 lemon, juiced
pinch of sea salt & black pepper
Topped with kefir yoghurt, fresh parsley, grated raw beetroot & black sesame seeds (optional).
Place a large heavy-bottomed saucepan over medium–high heat and add a heat stable oil (like coconut oil, ghee or avocado oil).
Add the onion, garlic, ginger and chilli and a sprinkle of salt and pepper. Cook, stirring frequently for 4-5 minutes, until softened.
Add the pumpkin, cumin, coriander, turmeric, butter beans and vegetable stock; bring to a simmer. Leave to bubble gently, stirring occasionally for 30–35 minutes, until the pumpkin can easily be pierced with a fork.
Blitz the soup, using either a glass blender or hand blender, until smooth and creamy. Add the lemon juice, stir through and adjust the seasoning to taste.
Serve with optional toppings like kefir, fresh parsley, black sesame seeds, raw grated beetroot and olive oil.
Let's take care of you.