“It must be my hormones,” is a common statement. But assessing whether your hormones are involved in your health issue is not as straightforward as, for example, getting your cholesterol tested.
Hormones are powerful messengers that control every system in the body. Hormones regulate the menstrual cycle, mood, sleep, heart rate, body weight, temperature, fertility and much more. Hormone testing is also complicated by the fact that some hormones are better tested in urine or saliva than blood. In menstruating women, the ebb and flow of hormones must be taken into consideration when choosing what day to test and when evaluating results. And in Canada saliva and 24-hour urine testing of the female hormones, estrogen, testosterone and progesterone are not covered by provincial health plans so there is an added cost.
The best approach to evaluating hormone imbalance is a combination of hormone tests, charting menstrual cycles and symptom questionnaires. If we pay attention to our symptoms, we can learn valuable information about our hormones. There are great apps you can download on your phone to track your menstrual cycle too.
Normal Menstrual Cycle
Period problems are one of the earliest warning signs that your hormones are out of balance. Heavy periods, irregular periods, long and short cycles, painful periods, scant periods are all related to your hormones. The menstrual cycle is divided into two phases, the follicular phase and the luteal phase, and it is regulated by complex interactions among the hormones secreted by the hypothalamus, pituitary and the ovaries. A regular cycle usually lasts 28 days and returns regularly every 28 days or so. Women suffering with heavy periods often have too much unopposed estrogen making their uterine lining thicker. Women with spotting throughout the cycle may not have enough progesterone to keep the uterine lining intact. Due to fluctuation in hormones blood testing often does not give us very good information. This is where symptom questionnaires can tell you a lot. If you have more than three of the symptoms in a section, hormone imbalance may be present, and laboratory tests, such as saliva hormone, and/or urine and or blood tests can help provide a clearer picture of your hormone issues.
Excess Estrogen (check boxes)
Low Estrogen
Excess progesterone
Low Progesterone
Excess Testosterone/DHEA
Low testosterone/DHEA
Saliva Hormone Testing
Saliva hormone tests are very sensitive. Saliva hormone tests for women can measure estrogens estradiol, estriol and estrone accurately as well as progesterone, testosterone, cortisol and DHEAS. The one exception is free testosterone which can only be measured by blood tests. Unlike blood tests, saliva hormone tests measure the amount of steroid hormone not bound to carrier proteins in the blood. Saliva hormone testing is also convenient and non-invasive compared to blood draws done in labs, especially when hormones have to be tested at different times of the day.
Each women is unique, and saliva hormone testing labs provide a detailed interpretation with results that not only look at hormone levels in saliva but cross-reference the data with the symptoms provide on the symptom questionnaires that are provided with the saliva hormone test kit.
Urine Hormone Tests
Urine testing is another method of evaluating hormone status. One downside is that the 24-hour urine collection can be challenging for people who are rarely at home for 24 hours. Hormones that are in the urine have already been processed by the liver, and these are the hormones the body is excreting. Urinary hormone testing can survey a wide range of hormones and metabolites. It can also show how the liver is handling the detoxification process of hormones which is an important factor. Urine testing is thought to be the gold standard of hormone tests.
Blood Hormone Tests
The standard blood test for determining menopause is the FSH tests. FSH levels go up at menopause (menopause means one year with no periods). However, FSH levels may also be elevated in perimenopausal women who are still menstruating. The confusion of this traditional lab tests means that even though these women are still having regular periods, they are told they are in menopause – when they are not. You do not need a test to tell you if you are in menopause because one year with no periods is the defining symptom. What is difficult, however, is determining what hormonal changes are related to the symptoms of perimenopause.
Blood levels of progesterone, progesterone 17-OH, testosterone, and DHEAS can give an overall indication of hormone imbalances, but they have their limitations because they measure hormones bound to blood proteins, which are inactive hormones. Also, blood tests do not measure estriol. Menstruating women must note the day in their cycle when the blood is drawn, or the information will not be useful. Estradiol is the dominant form of estrogen in a woman’s body. It is normally produced by the ovary, the adrenal gland, and by peripheral conversion of adrenal androgens. This blood test is a poor indicator of low levels of estrogen in women. Medications containing estradiol also confound the results. All in all, blood levels of estradiol alone do not give an accurate picture of hormone problems which is why many doctors do not want to perform estrogen blood tests.
Progesterone testing in menstruating women is best tested on days 20 to 22 of the menstrual cycle.
There is no one hormone test on the market, be it blood, urine or saliva, that can tell you all that you need to know about your hormones. Hormone testing is only an aid to the diagnostic process. The body is amazing at telling us what is wrong by the symptoms we are experiencing. Listen to your body. If you come to the conclusion, through observation and testing, that you have less than optimal hormone levels, a variety of treatment options are available including dietary supplements, herbs, nutritional and lifestyle changes, with or without additional treatment with bioidentical hormones.
Lorna R. Vanderhaeghe, MS is a women’s natural health expert who has been researching and writing on nutritional medicine for over 35 years. She is the author of 13 books including A Smart Woman’s Guide to Hormones. Her website is www.lornahealth.com where you can sign up for her newsletter.
