Perimenopausal But Blood Tests Show Your Hormones Are “Normal”?

I get it, you’re a 40 something, you’re starting to feel anxious or low, your periods are changing and you’re gaining weight. You think you might be perimenopausal. So, you took yourself off to the doctor for a blood test and they told you “your results are normal, but you can have the coil, an antidepressant or HRT if you really want it”. You wanted answers, not a prescription to mask the symptoms.

To confirm menopause (end of menstruation), the blood tests are looking for lower levels of estradiol ([o]estrogen), a spike in Follicle Stimulating Hormone (FSH), and Luteinising Hormone (LH) which happens closer to menopause, as they control the function of your ovaries and fertility. When it comes to perimenopause, blood tests do not always show enough information.

In the early perimenopause stages, hormones are fluctuating, and the UK NICE guidelines state that women aged 45 or over do not need blood tests, and that GPs (general practitioners) can prescribe medication based on symptoms. For women under 45, blood tests are useful if periods have changed to exclude other possible causes, but they do not find everything you need to know. 

Hormone imbalance can impact your whole body

Over my years in practice working with my female clients, I’ve learnt that if your steroid hormones are out of balance, it can affect every other system in your body. In perimenopause it’s not always as simple as declining estrogen or progesterone causing your symptoms, we need to look at your testosterone, androgens, and cortisol (stress hormone). 

Having low estrogen levels can cause brain fog, fatigue, insomnia, lack of libido, anxiety, and low moods. However, so can excess estrogen and cortisol imbalance. Low testosterone can also be linked to low mood, anxiety, worry, muscle aches and pain, plus no sex drive.

While laboratory tests won’t cure you, test results can provide data on where your body is out of balance or struggling, enabling you to make some simple changes to improve symptoms or seek further medical investigations. In my experience, testing your hormones (instead of guessing) is crucial to feeling better.That’s why I use the DUTCH Complete test with my peri or postmenopausal age clients. 

What is the DUTCH test? 

The DUTCH test a simple “dried urine” test which you can do in the privacy of your own home to test for comprehensive hormones. Plus it can be used by women taking HRT (Hormone Replacement Therapy) to check how they are metabolizing the estrogens.  

The DUTCH test measures your hormones and their metabolites to assess your hormone production and their breakdown, plus the following: 

• Total metabolized cortisol: this shows you how much cortisol your body is making over the entire day, and can be very different to the free cortisol level. The amount of cortisol you are producing will help to guide your treatment plan
• Total cortisone: tells us how quickly your body is deactivating cortisol to cortisone
• Free cortisol: this shows you the active levels of cortisol in your body, the level, and rhythm of free cortisol will help to guide your treatment plan
• Free cortisone: plus the metabolites of cortisone to show how quickly cortisol is getting deactivated to cortisone. This will help to guide the best treatment strategy for you
• Tetrahydrocortisone: this is a metabolite of cortisone;
  A-tetrahydrocortisol: this is a metabolite of cortisol;
  B-tetrahydrocortisol: this is a metabolite of cortisol
• DHEAs: a precursor to testosterone and estrogen. A high level can indicate PCOS and inflammation, while a low level can indicate adrenal insufficiency
• Testosterone: there is an optimal range for men and women which is associated with vitality and wellbeing. Low levels can affect mood, fertility, libido, and athletic performance
• Progesterone metabolites: (a-pregnanediol, b-pregnanediol) will indicate your total progesterone levels. These are also precursors to make the neurotransmitter GABA. Low progesterone levels can lead to PMS symptoms and infertility
• Androgen metabolites of DHEAS and testosterone: this is important to assess how well your body is processing testosterone. If it is metabolized down the 5a-DHT pathway this can cause hair loss, skin problems, aggression, and even increase prostate cancer risk in men
• Estrogens: which includes estrone, estradiol, and estriol. The balance between estrogen and progesterone is important for fertility, PMS, and menopausal symptoms
• Estrogen metabolites: these metabolites show how your body is detoxifying estrogen and if this is not done correctly it can increase your risk of breast cancer, prostate cancer, cysts, and fibroids
• 6-OH-melatonin-sulfate: which assesses melatonin production. Low melatonin can affect sleep quality, making it difficult to fall asleep or stay asleep. Melatonin also has antioxidant effects which can help to protect the brain and improve mood
• Just added to the DUTCH test are markers for neurotransmitters, B12, B6, and glutathione

Hormones indicate what’s going on with your body

A little bit like a jigsaw puzzle, by looking at these hormone levels, together with your symptoms, diet and lifestyle, you can figure out what is going on for you and make some simple changes.

For some women, medication such as HRT or the mirena coil can be the right answer. For others, using a holistic approach, adding in nutrition, herbs, natural medicine, mindset techniques, or lifestyle changes works for them.

There are options when it comes to peri or postmenopause. Understanding your levels can help you to understand the root cause of those pesky symptoms.