If you are in perimenopause, or suspect that you might be, you may feel your hormones are shifting from month to month. Some cycles may feel fine while others bring disrupted sleep, anxiety, breast tenderness or heavier bleeding. With so much variation, it’s natural to wonder whether hormone testing in perimenopause can really give you an accurate picture.
The short answer is yes. With the right kind of testing and a thorough interpretation, hormone testing can be valuable during perimenopause, even when your estrogen and progesterone are fluctuating. The key is understanding what we are testing and how we interpret it.
Are your hormones really fluctuating from cycle to cycle?
Before we dive into how we interpret test results for women with hormone levels that are fluctuating from month to month, let’s first establish if this is definitely the case for you by answering two key questions.
Which stage of perimenopause are you in?
We typically see perimenopause happening across four distinct stages.
In the first stage of perimenopause, most women still have regular cycles, perhaps a few days shorter than before. Progesterone begins to decline first, which can create subtle changes such as heavier periods, poorer sleep or reduced resilience to stress. At this stage we don’t typically see much variation from cycle to cycle making test interpretation straightforward.
In the later stages, as cycles become more irregular, the variation from one month to the next is more pronounced. Ovulation might not be occurring every cycle meaning progesterone can appear normal one month and low the next. Estrogen can also be fluctuating high and low, sometimes in the same cycle. If this sounds like you, then read on to discover how we interpret your results in the context of month to month variation.
Are you on HRT?
If you’re on HRT, then hormone testing in perimenopause is a popular option to check you’re on the right type and dose, and to investigate whether you’re metabolising your hormone therapy safely and effectively.
Combined body-identical HRT, as prescribed by the NHS in the UK, may mask your own hormone production in comprehensive urine testing such as the Advanced Hormone Test. This means that any variation between cycles won’t be detectable, making test interpretation easier.
If you’re on bio-identical HRT and have been prescribed a formulation specifically tailored to your needs and at a lower dosage than you might find on the NHS, or in a singular format (e.g. progesterone only), then your own hormone production may still be detectable. If this is you, then read on to discover how we interpret your results.
How our practitioners interpret test results when hormones are fluctuating cycle to cycle
1) Hormone metabolites reveal a longer term pattern
One of the benefits of comprehensive urine testing, as we use in our Advanced Hormone Test, is that testing captures not only hormone levels but also their metabolites. These are the compounds your body produces when it processes and detoxifies estrogen, progesterone and other hormones.
Metabolites act a bit like a trail of evidence. They reflect what your hormones have been doing over time rather than just on the day you collect your samples.
To share a recent example, Lauren was 47 and had all the symptoms of high estrogen – irritability, heavy bleeding and skin breakouts – but she had also started to experience more variation from cycle to cycle. When we got her results back, her estrogen tested at the low end of the reference range. But we could see from her estrogen metabolite markers that she’d likely been experiencing estrogen surges in previous cycles. By focusing on improving her estrogen metabolism with the right supplements, we were able to modulate the wild swings of estrogen she was experiencing and help her feel a lot better.
Ensuring you test both absolute hormone levels and hormone metabolites is therefore key when hormone testing in perimenopause. Metabolites are not detectable in blood serum.
2) Comprehensive perimenopause testing looks at more than just estrogen and progesterone
While estrogen and progesterone may vary from cycle to cycle they only reveal part of the picture in perimenopause. In fact many perimenopause symptoms are often driven or worsened by deeper issues that can be exposed by shifting hormone patterns. Useful markers for testing in perimenopause that remain stable from month to month and can be tested in the Advanced Hormone Test, include:
- Free and metabolised cortisol
- Hormone metabolites
- Inflammation markers
- Oxidative stress
- Insulin resistance
- Gut dysbiosis
- Melatonin
All of these can be tested reliably throughout the cycle and when addressed by the right supplement, diet and lifestyle changes, can make a significant difference to your perimenopause symptoms.
As lead nutritionist Francesca Lyon explains, “Perimenopause tends to expose underlying issues that have been rumbling under the surface for a while. When we identify these issues in testing, whether that’s stress, inflammation or high oxidative stress, we can help women feel significantly better even when their estrogen and progesterone are unpredictable.”
This is why our Advanced Hormone Test is so popular for women in perimenopause. It gives insight into the wider hormonal environment.
3) Your results should always be interpreted in the context of your symptoms
And finally, at FUTURE WOMAN we never interpret your raw results in isolation. Your symptoms, personal history, perimenopause stage, lifestyle, supplements and any medications all shape how we understand your results.
For Alison, another recent client, her progesterone looked normal in testing suggesting ovulation had taken place.
But we knew from her cycle history (her previous cycle was 25 days vs. the current cycle which was 34) and symptoms (anxiety, poor sleep and allergies) that she likely wasn’t ovulating every month meaning her progesterone levels were under pressure.
“When I turned 41, I suddenly felt like I couldn’t cope with anything and I was having regular panic attacks when I had to do any kind of public speaking, which used to be fine. My estrogen and progesterone levels looked normal in my test, but my practitioner recommended supplements to support my progesterone levels as it was clear this wasn’t the case every cycle. I did my first public event a few weeks ago and felt so much more in control.”
By looking at your results in context we can provide an accurate and meaningful interpretation, even in a phase where the month to month experience feels unpredictable.
How do I pick the right day for testing?
At FUTURE WOMAN we aim to test around 5-7 days after ovulation to get the best reading of your estrogen and progesterone levels. But if your cycles are irregular, you may be concerned about how to identify the right testing day. We provide plenty of support to help you accurately choose the right testing window in perimenopause. Check out our guide on how to pick the right day for testing.
What about fluctuations on the day of testing itself?
Regardless of whether or not you’re in perimenopause, your hormone levels fluctuate throughout the day. Our hormones are pulsed into our bodies, they’re not released in a steady stream. Progesterone levels, in particular, vary significantly across a 24 hour period depending on when you test.
Fortunately you can rule out any intraday variations by collecting multiple samples across the day. This is another reason we use urine testing in the Advanced Hormone Test as it’s easy for you to collect five dried urine samples across the day and then we can take a simple average. This provides a much more accurate snapshot of your hormones than a single blood test.
So is testing accurate during perimenopause?
Yes. When the test is comprehensive and when the interpretation considers the bigger picture, testing becomes one of the most helpful tools for navigating perimenopause. It identifies the root causes of your symptoms and helps inform a clear and detailed plan to feel better.
If you would like to understand your own hormonal picture, learn more about our Advanced Hormone Test, which comes with an expert interpretation and a personalised 12 week plan.
