--- title: "Hormone Testing in Perimenopause and Post-Menopause" entity: "blog" canonical_url: "https://www.saskatoonnaturopathic.com/blog/hormone-testing-in-perimenopause-and-post-menopause" markdown_url: "https://www.saskatoonnaturopathic.com/llms/blog/hormone-testing-in-perimenopause-and-post-menopause" lastmod: "2026-11-04T10:52:45.000Z" --- # 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 Disclaimer: The information provided in this blog post is for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.