You’ve gone to see your health care provider about your symptoms of menopause, and you’re asking yourself why they didn’t order blood work to test your hormone levels. Well, there are good reasons for that.
To start, this information is for women who are going through natural menopause. If you’ve had a hysterectomy and ovaries removed, if you have PCOS, or any other condition, treatment, or medication (including the birth control pill or progesterone infused IUD) that masks or interferes with the menstrual cycle, then this information doesn’t apply. However, if you are going through natural menopause then keep reading.
There are some key hormones responsible for menstrual cycles and their levels change during perimenopause and when you reach menopause. First is the follicle stimulating hormone (FSH) that, among other things, is produced at the start of a menstrual cycle, to stimulate the production and release a follicle, or egg, from the ovary (1). The mature follicle produces estrogen. Other hormones, luteinizing hormone (LH) and progesterone are also part of a woman’s cycle. If an egg is not fertilized, the hormone levels fall, and the woman has a period (2).
The number of follicles, or immature eggs, drop dramatically as women age requiring higher and higher FSH levels to result in a mature follicle. Sometimes there’s not enough FSH to stimulate a follicle and there is no cycle, or a missed period and estrogen levels drop. At other times, there is an overabundance of FSH, and two follicles are stimulated in the same cycle causing a surge in estrogen and an early, heavy period. Over time, fewer and fewer follicles mature, and the woman has irregular periods and fewer periods which are more and more spread out (2).
In other words…your hormones are unstable during this time, to say the least! FSH, estrogen, LH and progesterone levels fluctuate a great deal over the course of a menstrual cycle, and even daily. The levels also vary depending on the laboratory (1).
So, instead of ordering lab work to see if a woman is close to her final menstrual period, health care providers may estimate this based on your menstrual history (2). So, start tracking your periods!
You don’t need hormone levels for treatment either. Think of it this way, treatment for diabetes is based on blood sugars, and thyroid stimulating hormone levels guide the amount of thyroid medication a patient needs. Menopause is a normal, natural process, not a medical condition. Hormone levels don’t provide information about the treatment of symptoms women are experiencing. Menopause hormone therapy isn’t prescribed based on blood work. Instead it is prescribed based on frequency and intensity of hot flashes, for example.
If you are going through natural menopause, then there’s likely no need for you to have your hormone levels tested. Instead, track your periods and work with your health care provider to find a lifestyle strategy or treatment for your menopause symptoms.
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1. Cleveland Clinic. (2023). Follicle-Stimulating Hormone (FSH) https://my.clevelandclinic.org/health/articles/24638-follicle-stimulating-hormone-fsh
2. NAMS. (2019). Menopause Practice. A Clinician’s Guide. 6th Ed.