“You’re just getting older” is not something anyone wants to hear. Confiding in your doctor about your change in moods, energy, and libido should warrant some lab testing, but unfortunately, that is not always the case.
It may feel like pulling teeth to get your doctor to order lab tests sometimes, but labs can be crucial to really understand what’s going on in your body. As I discussed before, perimenopause is a clinical diagnosis, but that doesn’t mean your doctor shouldn’t order lab tests to rule other things out. And there are some lab tests that, while not definitive, can help point you in the right direction.
So let’s cover some basic lab tests that should be run to better know if perimenopause is the reason for your symptoms.
Female hormones
The most commonly ordered test for perimenopause is called FSH and LH. FSH stands for follicle stimulating hormone and it does exactly that, it stimulates the follicles in your ovary, which are essentially the little sacs that help nourish a growing egg to maturity so it can be ovulated. FSH also stimulates the follicle to produce estrogen, one of our female sex hormones.
LH stands for luteinizing hormone, and it is associated with ovulation. Once the egg ovulates due to a surge of LH, it also stimulates what remains of the follicle sans egg, called the corpus luteum, to start making progesterone, another female sex hormone.
To keep it simple, I usually describe it to patients that FSH and LH are essentially telling your ovaries what time of the month it is.
Generally (though not always), FSH will start rising in perimenopause. Since your ovaries are starting to go into retirement, they’re not keeping up the hormone production like before, so your brain releases more and more FSH to encourage production of the hormones. It’s as though your brain starts raising its voice like you would if your kids don’t listen when you have asked them to clean their room several times.
That being said, FSH can vary, so if it’s still low, you can’t rule out perimenopause. However, if it’s elevated outside of the range, that is a big clue that you are possibly in perimenopause.
We can also test estrogen and progesterone. Estrogen is most commonly tested as estradiol as that is the most potent form of estrogen and elevated during our reproductive years.
Estradiol is more predominant around the first half of our cycles and around ovulation. Estradiol is what grows back the uterine lining that sheds each month during a period as well as a host of other functions.
Progesterone, on the other hand, is more predominant in the second half of our cycle. Progesterone helps to thicken the uterine lining, preparing it for a pregnancy, whether that happens or not. Even though estrogen typically gets all the fanfare, progesterone has its own benefits outside of our reproductive parts.
Like FSH and LH, estradiol and progesterone can vary as well, but a common pattern I see in perimenopause is either normal or elevated estradiol and lower progesterone. As we move closer to menopause, the final period, progesterone usually continues to plummet while estradiol keeps changing.
Now because these are cycle specific, timing of getting these hormones tested is important. I generally recommend testing around day 21 of a 28-day cycle or getting them about a week prior to your next predicted period. If your cycle is irregular, that can be a little tricky, but you do your best guess and then can always work backwards once your period arrives.
Androgens
Another important test for perimenopause is DHEA-sulfate (commonly written as DHEA-s for short). 95% of DHEA-s is made from your adrenal glands and is a precursor to testosterone, which then ultimately becomes estrogen.
There are some studies that suggest DHEA-s starts rising about a year prior to your period’s final bow but that can be difficult to interpret as there are other reasons why DHEA-s can be elevated or too low.
What I look at DHEA-s for is to see how the adrenals are doing in general. DHEA-s gradually declines as we age but if I have a patient that’s on the very low end of the range, we know that adrenal support is crucial.
Thyroid
The last set of tests that I commonly run for women in whom I suspect perimenopause is a thorough thyroid panel.
While your thyroid is not directly implicated in perimenopause, having a dysfunctional thyroid, especially if it’s under-active, can cause a lot of symptoms very similar to perimenopause such as fatigue, brain fog, irregular menses, and weight gain to name a few.
We also know that it’s common for the thyroid to become more under-active as we age, so in a lot of cases, women are going through perimenopause and have low thyroid hormones.
While there are several other tests that I run to fully evaluate the overall health of a woman in perimenopause, these particular lab tests are a great place to start to help answer the question of is perimenopause the cause of your frustrating symptoms.