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What Happens to Your Hormones During Perimenopause and Should You Test Your Hormones?

October 16, 2023

It is often helpful to understand exactly how hormonal fluctuations are responsible for the symptoms you’re experiencing during perimopause. That’s why we’re diving into the details behind these symptoms and how to use this knowledge.

During our 20s and 30s, hormones follow a predictable ebb and flow throughout the menstrual cycle. After menopause (defined as one year without a period), also known as  “postmenopause”, hormone levels are low but steady. However, in perimenopause (the years leading up to menopause), there is a long rollercoaster ride of hormonal fluctuation. The levels of key female hormones, estrogen and progesterone, vary a lot.  Additionally, testosterone is also involved and slowly declines. Other hormones, FSH (follicle-stimulating hormone) and LH (luteinizing hormone) work together to regulate your menstrual cycle. FSH helps mature the eggs in your ovaries, while LH triggers the release of the egg. However, during perimenopause, estradiol, progesterone and FSH levels fluctuate significantly, causing the entire process to get out of balance.

You might be curious about whether you should test your hormone levels to determine when you’ll reach menopause. The reality is that hormone levels fluctuate daily during perimenopause, and may fluctuate between cycles. So, we do not use blood levels of hormones to decide whether someone is perimenopausal or when they will reach menopause. The diagnosis is based on age and symptoms: if someone is in their 40’s has irregular periods, and hot flashes, then she is in perimenopause. Similarly, to quote Dr. Jen Gunter in The Menopause Manifesto: “We don’t need hormone levels to know if a twelve year old girl who is growing in height and developing breasts is in puberty”.

Hormone testing is often useful to assess women under 40 who have irregular periods or infertility, or for research purposes,  or other medical conditions, but not for the general population of women in their 40s and 50s. Also, saliva tests are not a valid or evidence based way to diagnose menopause as saliva contents do not reflect blood levels of hormones. Although the new Clearblue menopause stage indicator home kit is getting a lot of press lately, it too is not recommended for diagnosing perimenopause.

Written By:

Dr. Ariel Dalfen

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