We can test many types of hormones in the blood stream with simple laboratory tests. We pretty regularly get the question, “shouldn’t I be checking my hormones?”
Hormones include cortisol, parathyroid hormone, insulin, growth hormone, renin, prolactin, and dopamine - to name a few. So first, let’s talk about what it means when we say hormones by looking at the context. When we’re talking about a teenage child’s hormonally-induced antics, we’re referring to the sex hormones: testosterone, estrogen, and progesterone. When we’re mentioning the thyroid, we’re talking about the thyroid hormones: levothyroxine and triidothyronine. When we’re talking about menopause, we’re back to talking about testosterone, estrogen, and progesterone.
Testing Sex Hormones: Estrogen, Progesterone, and Testosterone
In the context of Perimenopause
A woman who is in her mid to late 40s and experiencing irregular periods, hot flashes, and night sweats is most likely experiencing these because of ovarian dysregulation. An FSH (follicle stimulating hormone) level can be checked if a woman is unsure if her symptoms are related to perimenopause.
In the context of Menopause (one year with no period or after the ovaries are removed)
We don’t need to monitor estrogen or progestogen levels in the blood regularly when patients are prescribed and using FDA-approved estrogen and progestogen products. These products have been studied rigorously and are known to provide adequate levels for the vast majority of women. The FDA does not require or recommend that health care professionals check levels, because doses should be adjusted based on symptoms.
There are a few times when hormone levels may be measured for health reasons.
Testosterone levels can be checked if a menopausal woman is concerned about her libido and is considering testosterone treatment.
Estrogen levels may be measured to determine if a hormone prescription is being absorbed. If a patient is taking an adequate dose of an FDA-approved estrogen and still having hot flashes, a health care professional may check estradiol levels to be sure the estrogen is being absorbed.
What about saliva tests for hormones?
These tests are not reliable because they vary based on diet, time of day, and type of hormone, and they’re not reproducible. Salivary concentrations don’t correlate well with blood concentrations of hormones. Even when salivary tests are marketed, the practitioners using them rely more on symptoms than the saliva test results. 1 There are certain medications that do require drug testing because they have a narrow therapeutic window, hormone replacement therapy While it sounds logical that a regimen individualized for a patient based on clear blood levels would be ideal, it simply isn’t based on a scientific need.
1. Boothby LA, Doering PL, Kipersztok S. Bioidentical hormone therapy: a review. Menopause 2004;11(3):356–67.