Is Hormone Testing in Perimenopause and during Post-menopause helpful?

Every day in practice patients ask me if we can test their hormones.

As a naturopathic doctor who supports women during mid-life, my answer is always

“Yes, of course we can.” But I follow this response with a discussion that clinical context

is important to consider when deciding what information we are looking for, which

hormones should be tested, when to test, and whether to test in blood, urine and/or

saliva.

I spend a lot of my clinical days supporting women through the perimenopause and

menopause transition. I have been fortunate to have had access to consistent

continuing education in perimenopause and menopause over the past 25 years of

practice. During all these years, MHT (menopause hormone therapy) was not

commonly prescribed for women. Women needing support often turned to naturopathic

doctors for assessment and an individualized plan using herbs and nutritional supports.

With health authorities having lifted the black box warning on applicable estrogen

products, many (not all) women are seeking out hormone therapy options for both

symptomatic relief and preventative support for bone density. (1)

Although I have additional training in therapeutic prescribing, prescribing

pharmaceuticals, including hormones, is not currently in the scope of practice for

Naturopathic Doctors in Saskatchewan. However, my patients experiencing this

hormone transition find having an ND as part of their healthcare team beneficial for

many reasons. Testing options is one of them.

Healthcare practitioners agree that symptoms in the perimenopausal and menopausal

transition are going to be most helpful in guiding treatment. However, hormone testing

may provide useful information to help optimize a treatment plan and facilitate patient

understanding and engagement.

Hormone testing options may include:

1. Serum blood testing of hormones can provide a snapshot of total hormone

levels, bound and unbound. Blood levels can be measured at certain times of an

individual’s menstrual cycle for general information during that cycle or during

flares in symptoms to understand how hormone changes happening at that time

relate to the symptoms the patient is experiencing. Post-menopausally, blood

hormone levels are more stable. Serum hormone testing is standard of care to

monitor oral MHT, pellets or patches.

2. Saliva testing is an option that is an easy collection without requiring a blood

draw. It provides an option to assess free, bioavailable hormone levels (rather

than total, bound and un-bound hormone) reflecting tissue-level availability

because only free hormones cross into saliva. It is also a convenient option to test

hormones at more than one time of the day. This is particularly helpful for

assessing cortisol hormone levels.

Saliva hormone testing has limitations with oral MHT intake as oral MHT may

contaminate the salivary reservoir. It’s a consideration for those on topical

creams or gels however it’s generally not recommended by medical authorities to

manage patient on MHT.

3. Urine testing offers a broader look at how hormones are being cleared and

measures their breakdown metabolites which are biologically active as well and

can also be contributing to symptoms. This sample can also be collected at home

and mailed off to a private laboratory.

Other testing is also an essential part of a thorough work up for mid-life health.

This includes:

a. A more comprehensive assessment of health parameters that can affect

ovarian hormone levels or contribute to symptoms in mid-life. Examples

include thyroid hormones, adrenal hormone, dhea, iron and ferritin, and

vitamins B12 and D.

b. Testing for contributors of weight gain which is a common during the

perimenopause transition. Examples include fasting insulin, cortisol and

comprehensive thyroid testing.

c. Testing for markers of cardiovascular health such as lipids, homocysteine

and crp to inform on an individualized preventative plan.

Here is some more explanation of when I find testing hormones to be

helpful:

During Perimenopause

During the reproductive years, estrogen and progesterone follow patterns that are linked

to the menstrual cycle.

As ovarian function begins to change, that predictability often starts to disappear.

Ovulation may occur regularly one month and not the next. Progesterone can therefore

vary considerably depending on whether ovulation occurred. Estrogen can also rise and

fall throughout the transition.

At the same time, the brain is sending stronger signals to the ovaries through hormones

such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Cycle length,

the amount of blood loss and hormonal symptoms can vary and give information about

the changing hormone levels.

Hormone testing when concerning symptoms are present or testing hormones more

than once a month can be very helpful in directing treatment. This can be particularly

helpful during perimenopause when there is no bleed due to an ablation or an IUD.

Once menopause has occurred

Once a woman is postmenopausal (over 12 months without a bleed), we know that both

estrogen and progesterone levels are going to be more stable with a substantially lower

baseline that the premenopausal years. The priority in care shifts to managing

symptoms that haven’t resolved with the transition through menopause while focusing

on preventative health.

Symptoms assessed include hot flashes, sleep, night sweats, mood, vaginal or urinary

discomfort, and libido. When MHT is being considered or adjusted, symptom response

is an critical part of the decision.

The North American Menopause Society emphasizes that hormone therapy should be

individualized according to the woman's symptoms, health profile, treatment goals,

dose, duration, regimen, and route of administration, with periodic reassessment of

benefits and risks.(2) The current clinical guidance does not recommend titrating

systemic menopausal hormone therapy to a particular serum hormone level.(2)

A laboratory value is not the guiding information for a prescription of MRT which is a

small amount of hormone compared to physiological levels in menstruating years. It is

important that the progesterone dose is proportionate to the estrogen dose to oppose

the proliferative effects of estrogen on the uterine lining.

And let’s not forget about testosterone. Testosterone plays an important role in energy,

cognition, sexual health and body composition. Testing dhea (the adrenal hormone

precursor) and testosterone can help provide more direction for actionable supports.

Testing different androgens (male hormones) can give helpful insight into symptoms

such as hair loss and acne during a woman’s hormone transition.

The most important measurement may be how you feel, however for optimal health now and as you get older, hormone testing can be helpful.

If you would like to understand what your body is telling you and feel confident that you

are supporting your hormone balance optimally during perimenopause and through the

menopause transition, you may find a relationship with a Naturopathic Doctor and some

testing to be a helpful support.

References

1. Int Journal of Mol Sci. Menopausal Hormone Therapy-Risks, Benefits and

Emerging Options: A Narrative Review. Ana Maria Arnautu, Vanda Roxana

Nimigean, Claudia Alexandra Nacea-Radu, Dana Mihaela Tilici, Diana Loreta

PaunEditor: Jacques J Tremblay 2025 Nov 17,26(22):11098. Doi:

10.3390/ijms262211098

2. The North American Menopause Society Advisory Panel. The 2022 hormone

therapy position statement of The North American Menopause Society.

Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028. PubMed: 2022 NAMS Hormone Therapy Position Statement

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