Testing

Okay, so let's talk about testing and some of the things to keep in mind if you are testing or if you've had some tests done, or if you want to get some tests done when you're looking at what's going on during this time. First of all, again, I want to preface this section by saying that testing can be really helpful to understand what's going on. But more often than not, I personally, in my practice, use the same symptom picture to tell me what is happening. Testing often, especially with things like blood tests, is often just giving you a snapshot of what's happening in that particular moment. And when it comes to hormones, our hormones are constantly in flux. Even the term hormonal balance isn’t really accurate because they're never going to be balanced — they're always in flux. Obviously, we want them to be harmonious rather than perfectly balanced. Sometimes when you're taking tests, they can give you a bit of a snapshot, but they might not necessarily show you the bigger picture overall. I would always look at tests in conjunction with the symptom picture to give you context. Testing just out of context is going to be really hard to interpret if you don't know what's going on with the person you're working with. So that's one of the things to keep in mind. A lot of times, for example, with functional medicine doctors or general practitioners, they rely so much on tests and not enough on the bigger picture — not looking at you and what you're presenting with. That can make the results and approach a little skewed. It's always important to look at the two together. When it comes to hormone testing, one of the things that I see often is clients coming in and telling me they’ve had tests done because they have hormonal symptoms, and their doctor only tested for estrogen — not progesterone. As we saw in the first couple of modules, estrogen and progesterone need to always be seen together. It's about the ratio between the two and their relationship that tells us if something is off. Often I see clients come back saying, “I did a blood test, and my doctor said my estrogen levels are low, so I was put on estrogen hormone replacement.” And when I ask about progesterone, they say, “They didn’t test for it.” Remember, estrogen can be low in perimenopause and especially after menopause, but if progesterone is even lower than estrogen, you're still going to get that estrogen dominance and those symptoms. It’s not always a case of taking more estrogen — in that case, we’d look at optimizing progesterone. So when you’re having your hormones tested, it’s really important to have estrogen and progesterone tested at the same time. And remember, progesterone is only produced in the second half of the cycle once you’ve ovulated, peaking around seven days after ovulation. So if you’re getting estrogen and progesterone tested, do it when progesterone is at its peak — about seven days after ovulation. If you’re unsure when you’re ovulating or not having regular cycles anymore, it’s a little more difficult to get the right picture. There are other ways of testing progesterone besides blood. When you go to the doctor, they’ll usually test hormones through blood — that’s the general way. But blood is just the highways of the body. What’s happening in the blood isn’t always reflective of what’s happening at a cellular level. There are other ways of testing hormones that normally aren’t done by general practitioners. You can have salivary tests — testing hormones through saliva. Some salivary tests take samples throughout the month, not just one snapshot, so you can see what’s happening with estrogen, progesterone, and cortisol across the month. Another option is a dried urine test, known as the DUTCH test (Dried Urine Test for Comprehensive Hormones). This tests the metabolites — what gets excreted out of the urine once hormones are detoxified. You do this test in the second half of your cycle, about five days after ovulation. You urinate on small pieces of paper, let them dry, and send them off. The test looks at estrogen, progesterone, cortisol, testosterone, and other metabolites. It’s a good option because it shows them all in context together. With the DUTCH test, you need to know when you’ve ovulated so that you take it at the right time to capture that progesterone surge. There’s also a DUTCH cycle mapping option, which takes samples throughout the month and maps your hormone patterns. This is great if you have irregular cycles or are missing periods. These are tests you’d do with a practitioner who offers functional testing. Again, I don’t think they’re necessary for everyone. The symptom picture usually tells you what’s happening already, but some people like to see data. While saliva and urine testing can be more accurate than blood for hormones, they still don’t show what’s happening at a cellular level. Often during perimenopause and menopause, estrogen gets stored in the tissues. Even if blood tests show low estrogen, you may still have estrogen-dominant symptoms because it’s acting in the tissues. There’s one lab that actually tests at the tissue level using hair or nail clippings. They can tell what your hormone levels are at a cellular level, which is fascinating. A practitioner called Kitty Martone once did blood, saliva, urine, and tissue tests on the same day. All tests except the tissue one said her estrogen was low — but the tissue test showed her estrogen was 200 times higher than normal, matching her symptoms of estrogen dominance. The drawback of tissue analysis is cost — it’s very expensive and available from only one lab in Bulgaria. I haven’t used it in my practice, but it’s interesting. Most of the time, I don’t feel the need to test because I can already see what’s going on through symptoms — mood, digestion, libido, sleep, energy. If those are improving, you’re moving in the right direction without needing constant testing. If you do want to test, here’s what I recommend: FSH (Follicle Stimulating Hormone): Often higher in perimenopause or menopause, but can also be high in younger women if the ovaries are struggling. Thyroid Testing: The thyroid is like the third ovary. It affects estrogen and progesterone production. Doctors usually test only TSH, but that’s just what the brain tells the thyroid to do. For a full picture, you need TSH, T4, T3, Reverse T3, and thyroid antibodies. The normal TSH range is wide (0.25–4.25), but optimal is under 2, ideally close to 1. TSH can also be a marker of inflammation — the higher it is, the more potential inflammation. You might make enough T4 but not convert it to T3, which shows poor thyroid activity. Sometimes T3 gets shunted to Reverse T3 under stress, which is inactive. Prolactin: High levels can stop progesterone production and even menstruation, often linked to stress or low thyroid function. Testosterone: Can be tested accurately via blood. HbA1C: Shows your average blood glucose over three months. Cortisol (Saliva Curve): Checks how your cortisol changes through the day. Many women say they’re not stressed, but their cortisol pattern tells another story — like high spikes from skipping breakfast or rushing in the morning. I experienced this myself when my cortisol spike was really high in the morning. Looking back, I was skipping breakfast, doing intense workouts on an empty stomach, and rushing to get my daughter ready for school — I didn’t feel stressed, but my body showed it. So these are the tests I’d consider if you want to explore more. As I said, they’re not always necessary. There’s also a simple at-home test we’ll cover next — one that can help you identify if you’re ovulating, making enough progesterone, and how your metabolism is functioning.