Are your hormones imbalanced? Doctors explain how to know if you need testing

Do you know what your hormone levels are? Should you?

Your body is home to more than 50 hormones – chemical messengers that make up the endocrine system – and hormonal changes can reflect a number of medical problems. For example, low levels of the pancreatic hormone insulin may indicate diabetes, while high levels of the stress hormone cortisol may play a role in obesity.

But certain hormones like melatonin, important for sleep, naturally fluctuate throughout the day. Other hormonal changes are normal at different phases of life, such as a decline in the reproductive hormones estrogen and progesterone in women before menopause.

Hormones are having a moment.

The Food and Drug Administration announced Nov. 10 that it was removing the black box warning on hormone replacement therapy for menopause. Agency leaders said the listed risks, including breast cancer, do not outweigh the treatment’s long-term health benefits, such as reducing bone fractures and cognitive decline.

The news has piqued the interest of women who might be candidates for this therapy. Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, joked that her patients have since “gone crazy.”

In an age where over-the-counter hormone tests are on the rise and supplements tout themselves as helping hormonal imbalances, it can be difficult to know whether you need hormone testing and treatment or are falling prey to marketing schemes.

Dr. Jan Shifren, director of the Midlife Women’s Health Center at Massachusetts General Hospital, said women in perimenopause, the years before their last menstrual period, are a prime target for such “meno-profiting” or “meno-washing,” the practice of selling pseudoscience to women during the menopausal transition.

“I actually never use the words ‘hormonal imbalance’ with my patients,” Shifren said. “There are a lot of people marketing very expensive hormone tests – often not covered by insurance – these very large panels of multiple hormones that basically tell us nothing.”

The U.S. endocrine testing market, which encompasses hormone testing, has thrived since the pandemic, according to Grand View Research, an international consulting and market research firm. Its market size was approximately $4.1 billion in 2022 and is expected to grow at a compound annual growth rate of 7.7% between 2024 and 2030, reflecting global projections.

While hospitals dominated the global endocrine testing market in 2023, commercial laboratories are expected to see the fastest annual growth through 2030, according to projections.

In the United States, commercial laboratories such as Labcorp and Quest Diagnostics offer non-prescription options ranging from a simple $49 test measuring luteinizing hormone, which helps regulate the menstrual cycle, to an in-depth hormone panel exceeding $500.

Many telehealth companies sell similar tests, which may involve collecting blood, urine or saliva, with some approaching $1,000 per panel. HealthLabs.com, for example, offers a “comprehensive female hormone panel” that measures hormones including estrogen, thyroid hormones, testosterone, and human growth hormone. The panel, which also includes cholesterol, folic acid and vitamin B12 tests, has a list price of $1,598, but was on sale for $799 as of November 13.

“I see women in my office all the time who have spent $600 on an online consultation, they’re spending $600 or $700 every few months for a very wide range of unnecessary hormone levels,” Shifren said. “Then when they come to me, I don’t want to look at any of those levels. I want to talk to them about what’s bothering them, what their symptoms are.”

Track symptoms, not hormone levels

Perimenopause usually begins between the ages of 45 and 55 and can last up to a decade. Menopause marks a unique time, 12 months after a woman’s last period, followed by postmenopause for the rest of a woman’s life.

In the United States, more than 1 million women reach menopause each year, at an average age of 52, according to the National Institute on Aging.

“Half of the people on this planet will experience menopause if they are lucky enough to live long enough,” Shifren said. “It’s an important time in life.”

This can also be a time of diminished quality of life for women experiencing symptoms including hot flashes and night sweats, brain fog, mood swings, weight gain, painful sex, breast tenderness, incontinence, insomnia, vaginal dryness, and irregular periods.

When Minkin sees a patient in her 40s or 50s with such symptoms, treatment is the goal — no hormone testing is necessary.

“In general, I try to discourage people [from testing] as much as possible,” Minkin said. “Especially in the perimenopausal situation, hormones are fluctuating everywhere.”

Not to mention, Minkin said, that even a premenopausal woman’s reproductive hormones vary widely throughout her cycle.

Minkin also advises patients against purchasing hormone panels on their own.

“My standard example is: If I have a 53-year-old patient… who hasn’t had her period in three months and she gets up every night, sweats, doesn’t sleep and doesn’t feel well, and she wants her hormone levels tested,” Minkin said. “[I’d] tell her, “Please go out and buy a dress with this money.” I can tell you that you are in perimenopause.

Likewise, older women often don’t benefit from sex hormone testing, Shifren said.

“There is absolutely no reason to check estradiol [a form of estrogen] or progesterone in a postmenopausal woman,” Shifren said. “We can tell them – before they spend money – that these levels are low.”

Who benefits from hormone testing?

When it comes to perimenopause symptoms, age matters, said Dr. Shamita Misra, clinical professor of family and community medicine at the University of Missouri School of Medicine.

Menopause occurring between the ages of 40 and 45 is considered early, while reaching the milestone before age 40 constitutes premature menopause. According to the Federal Office of Women’s Health, approximately 5 percent of women reach early menopause naturally, as opposed to a condition brought on by surgical or other medical procedures.

Since early or premature menopause is associated with a higher risk of diseases, including heart disease and osteoporosis, a patient under 40 reporting perimenopausal symptoms may benefit from hormone testing, Misra said.

“Is premature menopause suspected or is there another endocrine problem? » said Misra. “We need to be open and not just focus on perimenopause. We also need to [the patient’s] history.”

On the other hand, if you’re of perimenopausal age and experiencing symptoms, don’t hesitate to discuss any hormonal issues you may have with your health care provider, Misra said. Shared, informed decision-making is your safest option.

“Some women don’t talk openly about their symptoms,” Misra said.

If your doctor recommends hormone testing, keep in mind that certain medications, including birth control, can affect your levels.

“You will need to stop using birth control for 90 days – a minimum of three months – before your hormones return to baseline,” Misra said. “When a person is breastfeeding, for example, when they are already taking an oral contraceptive or already taking certain hormones, it is impossible to accurately check hormone levels.”

Risks of Unnecessary Hormone Tests

It’s natural to be curious about hormone levels — reproductive or otherwise — whether you’re symptomatic or not, doctors say. Some of Dr. Debra Bell’s patients have told her they need data to feel comfortable about their health, even when she doesn’t need it to treat them.

“My approach is: How will this test help us in our decision-making regarding your situation? said Bell, director of education at the Osher Center for Integrative Health at the University of Washington School of Medicine. “That doesn’t always help.”

But just because hormone tests aren’t generally beneficial for peri- and postmenopausal women, doesn’t mean they’re harmless, Bell said. One of these harms is cost.

“I know people who have maxed out their credit cards on this type of thing,” Bell said.

Not all over-the-counter menopause diagnostics are expensive. For example, drugstore chains and big box stores sell rapid menopause test sticks for around $30, sometimes less.

The questions then become: how accurate are the results and who interprets them?

“If [a patient has] I’ve done the test, and then I’ll interpret it for them,” Bell said. “A lot of times what the test shows is what we might already assume based on the symptoms they’re having and what’s going on with their menstrual cycle.”

Another danger of self-testing is self-treating your perceived hormonal imbalance, Bell said. Unlike prescription drugs, the FDA does not approve dietary and herbal supplements for their safety or effectiveness before they hit store shelves.

Last year, the global menopause market was worth nearly $18 billion, Grand View Research reports, with dietary supplements holding a 94% share.

As a practitioner of integrative medicine, Bell is hardly anti-supplementation. But be sure to discuss any supplements you’re considering with your doctor, she said. Even supplements marketed as natural can be toxic depending on your lifestyle, medical history, and other medications you take.

Hot flash treatments, in particular, have a high placebo effect rate in clinical trials, about 30 to 35 percent, Minkin estimated. For this reason, she said she has no problem with patients who claim that home remedies such as evening primrose oil relieve symptoms.

“As long as it’s something I know is pretty safe,” Minkin said. “[If] she says it’s arsenic, I’d say, “That’s probably not a good idea.” So I have to look at the potential toxicity of what she might be using.

Minkin is thrilled that menopause, once taboo, is not only making headlines but also being celebrated — an “estrogen festival,” she called. However, she warned that some wellness companies are spoiling the party, hoping to make money from middle-aged women.

“For 20 years, we couldn’t attribute anything to menopause; it was a dirty subject,” Minkin said. “But at this point I think we tend to say that All it’s perimenopause, because perimenopause is very amorphous.

“You can’t really test it. »