Your life is too precious to let menopause ruin it!

Having menopausal symptoms can exceedingly affect your life in a negative way. Not enough women talk about their menopause, and there is still much uncertainty about what menopause means and how it can be managed.

I hope my articles give you the information you need to make informed decisions about any treatment to help turn your menopause into a positive experience that does not negatively impact your life.

Hormonal blood tests are not always necessary to make a diagnosis of perimenopause or menopause, but they can also be useful to monitor the effects of hormone replacement therapy (HRT). I prefer to do them to have values at time zero, as I call it, so that I can have a comparison in the future to the therapeutic change.

 

What is measured when taking a blood test?

The most common reason for having blood tests before hormone therapy for menopause is to check hormone levels in the blood. Specific tests examine levels of estradiol (estrogen), testosterone, DHEAS, and SHBG (sex hormone binding globulin). Optional LH and progesterone.

Estradiol

An estradiol test measures the level of estrogen in the body, but only at the time the blood is drawn. Estradiol can vary and change from day to day-even at different times of the same day. More fluctuations in hormone levels are seen during perimenopause; estradiol levels can be very high and also very low, so they are not an accurate way to diagnose menopause.

SHBG

SHBG is a protein that binds to certain hormones, including testosterone and estradiol, and transports these hormones into the bloodstream. Think of SHBG as a taxi cab: the hormones being transported are the passengers.

When hormones are bound to SHBG, they are not available for use.

If your SHBG levels are low, your body has more free sex hormones available for use. If your SHBG levels are high, your body has less free sex hormones available for use.

Testosterone

Testosterone and SHBG levels are checked at the same time and a ratio is calculated between them (and multiplied by 100) corresponding to the FAI (Free Androgen Index), which is given as a percentage. The FAI score provides the figure on how much available free (unbound) testosterone is present in a woman's body. I personally consider the determination of free testosterone much better.

Follicle stimulating hormone (FSH)

FSH levels are sometimes monitored to help diagnose menopause in younger women. FSH is a hormone produced by the brain in the pituitary gland to stimulate the ovaries to produce estrogen. It is usually high when a woman is menopausal. However, levels of this hormone can fluctuate greatly, and while a high FSH level can be helpful in the diagnostic process, a lower or "normal" level does not rule out the possibility of being perimenopausal or menopausal.

 

Diagnosing perimenopause or menopause

Perimenopause and menopause are usually diagnosed based on a woman's symptoms rather than blood test results. Hormone levels in the blood can be very misleading if they are normal, because it only means that the levels were normal at the time of the blood draw and do not reflect hormonal fluctuations at other times of the day or month. If a woman is over 45 years old, the totality of her symptoms is sufficient to diagnose perimenopause or menopause.

 

Why is it useful to know hormone levels?

Estradiol levels are very useful in checking the adequacy of hormone therapy. They do not turn out to be as accurate, however, if the woman takes estrogen by mouth, but they can be very useful for women who take estrogen in the form of gel creams or sprays, to assess whether enough estradiol is absorbed through the skin into the bloodstream.

It is important to have adequate estrogen levels in the blood to improve symptoms and also reduce the risk of disease in the future. If estradiol levels are too low, an increased risk of heart disease, osteoporosis, diabetes, and dementia persists. Young women often need to have higher doses of estrogen in their HRT to achieve physiological and therefore effective estradiol levels.

By itself, low free testosterone or FAI does not mean that a woman needs to take testosterone. However, if she has symptoms suggestive of testosterone deficiency such as fatigue, memory problems, mental confusion and a sense of dullness, reduced

endurance, muscle and joint pain, and reduced libido, and also has low free testosterone or FAI values, it is likely that she would benefit from taking testosterone. Testosterone and SHBG levels should be performed at regular intervals (at least annually) to verify that levels are maintained in the normal range in women on transdermal testosterone therapy.

What are the reference values?

In most cases, it is good to achieve "physiological" levels, that is, levels similar to those of women still menstruating. Generally, this can mean estradiol levels as low as 100-150 pg/ml in some cases, but some women need higher levels than this to really improve their symptoms.

Testosterone and SHBG levels vary from woman to woman, but generally their FAI should be less than 5%.

 

Why are sometimes higher than usual doses of estrogen needed?

Many women need higher doses of estrogen than those recommended for the drug. This is not dangerous; it is important for women to have adequate hormone dosages to improve their symptoms and protect their health for the future.

Some women do not absorb estrogen in gel, patch, cream or spray as easily as others, so they may need a higher dose of estradiol to penetrate the skin and be absorbed into the bloodstream; sometimes I try to change the base of the hormone.

Other women metabolize hormones at different rates and therefore may need higher doses to reach the same levels.

It is very common in medicine to employ different dosages of drugs and tailor them to the individual. This is especially true for hormones in different women. For example, women with hypothyroidism take different dosages of thyroxine from each other in order to normalize their thyroid hormones: simply put, each person's hormone dosage needs to be adjusted according to their needs and clinical picture, which can vary over time even in the same individual.

That is why measuring hormone levels through a blood draw can be helpful in identifying the most effective and appropriate dosage of HRT.

Because hormones vary so much from day to day, it is always important to consider the whole clinical picture, especially taking into account how a woman feels and how her symptoms change over time, and use this information to decide on the best hormonal course.