Many women undergoing the menopausal transition often consider tests to confirm their stage in this phase, seeking clarity amid the changes they are experiencing.
Yet, the reality of hormone testing for women during this transitional phase is complex. For various reasons, hormonal tests may not always offer the definitive insights expected. This article will delve into common hormone tests and scrutinize their utility in diagnosing menopause, aiming to provide a clearer understanding for women navigating this significant life stage.(1)
Types of Hormone Testing Recommended During the Menopausal Transition
Hormonal fluctuations during menopause affect the levels of several key hormones. Estradiol, a form of estrogen, typically decreases as the ovaries become less responsive to follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In response to this decreased responsiveness, the body produces more FSH and LH in an attempt to stimulate the ovaries. This alteration in hormone levels might provide a rationale for testing hormones like estradiol, FSH, and LH during menopause.(2,3)
However, these hormone levels can fluctuate significantly throughout the day and across the menstrual cycle, making tests unreliable. As a result, symptoms remain the main indicator of menopause. Many physicians diagnose this phase clinically based on the patient's age and symptoms.(2) However, some practitioners may suggest hormonal tests, which are commonly conducted in three main forms:
Blood Tests
Estradiol: During menopause, estrogen production decreases, and this change can be measured in the bloodstream. Estradiol levels lower than 50pg/ml usually indicate menopause, while levels between 50 and 400 pg/ml are typical during perimenopause and the normal menstrual cycle. (4)
However, accurately measuring estrogen levels requires knowledge of a woman's menstrual cycle phase, which can be challenging during perimenopause due to irregular cycles. Low estradiol levels might simply indicate that a woman is at the beginning or end of her cycle.
Follicle-stimulating hormone (FSH): Consistently elevated FSH levels of 30 mIU/mL or higher, coupled with the absence of menstrual periods for a year, may indicate menopause. Yet, interpreting FSH levels during perimenopause can be misleading.(1)
Estrogen production does not decrease steadily, causing both estrogen and FSH levels to fluctuate significantly. A single elevated FSH level is insufficient to confirm menopause and a low FSH level does not rule out perimenopause in women experiencing symptoms like hot flashes and changing periods. Furthermore, FSH tests are not valid for women using certain hormone therapies, such as birth control pills. Elevated FSH levels can occur up to ten years before menopause.
Blood hormone testing for women, particularly for follicle-stimulating hormone (FSH) and estradiol levels, can be helpful in certain clinical situations to diagnose menopause. For example, in women who are amenorrheic due to previous hysterectomy, endometrial ablation, or anovulation, these tests may provide valuable information.(5)
Additionally, in women under 40 experiencing symptoms that could indicate perimenopause, many practitioners prefer to distinguish these symptoms from other conditions with overlapping symptoms, such as thyroid disorders, metabolic syndrome, and nutritional deficiencies. These conditions can be ruled out with routine blood work.
For younger women, testing estrogen and progesterone levels is generally unreliable for determining perimenopausal status. Hormonal testing, of FSH levels for example, is most definitive or helpful when it indicates that a woman is already postmenopausal. In some cases, it may reveal premature ovarian failure in younger women. Despite this, experts often find a symptom diary more useful than female hormone levels for diagnosing menopause in any age group.(6)
Urine Tests
The DUTCH test, short for "dried urine test for comprehensive hormones," was developed to assess hormone levels, including estrogen metabolites. In their active form, hormones act as chemical messengers to control, facilitate, or trigger various processes in the body. As active hormones complete their work and new hormones are produced, active hormones need to be cleared from the body via the urine.(7)
Steroid hormones do not dissolve well in water, so they cannot pass directly into the urine. Instead, they must be broken down in the liver and kidneys to form smaller, water-soluble particles (known as metabolites) that can be excreted. This process is the rationale behind the DUTCH test, as it aims to measure these metabolites to evaluate hormone levels.
Unfortunately, there is no evidence to support its use in managing any medical condition, including menopausal hormone therapy. Besides, the advisory board for this test does not include physicians or menopause specialists.
Additionally, the DUTCH test is costly, with prices ranging from $499 to $700 per test. While the manufacturers claim that this form is superior to other forms of hormone testing for women, patients seeking relief should carefully evaluate the necessity and efficacy of such tests before making a decision.
Saliva Tests
The pursuit of cost-effective and minimally invasive methods for assessing female hormones prompted researchers to explore the potential of saliva as an alternative medium, leading to the development of saliva-based ELISA (Enzyme Linked Immunosorbent Assay) hormone testing.
This non-invasive approach allows individuals to easily collect saliva samples at home for analysis. Despite its convenience, saliva testing has been found to be less accurate than blood tests for evaluating menopause symptoms.(8)
Research indicates that saliva hormone levels often do not correspond with serum blood levels for many female hormones, casting doubt on the reliability of this testing method.
Diagnosing the Menopause Transition
The diagnosis of the menopause transition, or when a woman has entered perimenopause, typically involves a comprehensive medical evaluation by a qualified healthcare professional. This evaluation includes a review of the woman's medical history, menstrual history, and current signs and symptoms.
Keeping a calendar of menstrual cycles and maintaining a symptom tracker can be instrumental in identifying patterns and changes indicative of perimenopause. A symptom score sheet may also be used to measure the severity and impact of menopause symptoms, as well as to assess the response to any interventions.
Should women rely on hormone testing to diagnose menopause?
No reputable medical organization recommends hormone testing for women to diagnose menopause. The rationale behind this consensus is that natural menopause is determined retrospectively by 12 consecutive months of amenorrhea – a lack of menstruation – and hormone levels are not a reliable indicator of menopausal status. Furthermore, the "optimal" hormone levels in postmenopausal women have not been established, and the response of symptoms to hormonal or non hormonal menopause treatment is the only reliable guide. Therefore, testing for hormones or hormone metabolites in blood, urine, or saliva is not advised for defining menopause or making treatment decisions for menopause symptoms.
