Jennifer Smith: Welcome to You're Not Crazy. It's perimenopause. If you're a woman over 40 and feeling more anxious, not sleeping well or disconnected from your body, this podcast is for you. I'm your host, Jenny Smith, functional medicine health coach here to help you understand what the heck is happening in perimenopause. Each week we're diving into real life conversations about how our changing hormones impact anxiety, sleep and stress. and I'll share simple strategies to help you feel normal again. So grab a cup of tea or beverage of choice, get comfy and let's dive in. Welcome back to you're not crazy. It's perimenopause. Today we're diving into a question I get asked all the time. Should I have my hormones tested? And the honest answer, it's not a simple yes or no. So today I want to walk you through when testing actually makes sense, when it might not be necessary. And when you test what you test. First things first, you don't need a test. to know if you're in perimenopause. Let's just start there because that's super important. Perimenopause is primarily diagnosed based on your age and your symptoms. So if you're noticing things like increased anxiety or feeling on edge, poor sleep, waking up at two, three o'clock in the morning, mood swings, you're irritable, more anxious than normal, you have brain fog, you can't remember simple words, so, so common. you have a lower stress tolerance, things that used to just kind of roll off your back now feel like a lot weight gain, especially around your belly changes in your cycle, shorter, longer, heavier, or more unpredictable cycles. That alone tells you that you are probably in perimenopause. And the truth of it is when you are in perimenopause, your hormones are fluctuating constantly. So if you have a blood test, a random blood test one day, it's just a snapshot of what's really going on. It doesn't give you the whole picture. So that's why, you know, if you are a cycling woman still, it's not necessary to have your hormones tested. When does it make sense to test your hormones? There are times when testing can be really helpful. One of the biggest... reasons to have your hormones tested is if your cycles have become very irregular. You might be skipping months, your period disappears and comes back. Or if you have no cycle at all, like in my case, I ended up having a uterine ablation and I had no cycle anymore. However, every once in a while I had spotting. That's when I knew that I was still somewhat like cycling, but because I had the uterine ablation, I didn't have a regular period and suddenly that spotting stopped. And then I wondered, I'm like, am I postmenopausal? So that's when testing can give you a better picture of where you are hormonally. So for example, personally for me, one of the tests that confirmed that I was postmenopausal because I had the uterine ablation, I didn't go one year and a day without a period, which is how most women No, if they are post-menopausal, they go a whole year without a period. Because I didn't have cycles anymore, I needed a test to tell me where I was, like to just at least guide me to where I was at. So one of the tests was the FSH, which is our follicle stimulating hormone. FSH is responsible for stimulating the maturation of ovarian follicles. And this hormone rises as our ovarian function declines. And in menopause, the ovaries no longer respond the same way. So the brain continues to signal for more stimulation, raising our FSH levels. So this is a clear indicator of kind of where you are. But again, it can fluctuate. if you're, if you are a cycling woman, your FSH could be fluctuating high and low. So it's not an ideal test when you are having cycles. But for me, because I no longer had cycles, I was able to test several times to see where it was at. So for the fun of it, for this episode, I looked back at my old lab results and in 2022, my FSH was a 10 and in 2024, it had climbed to 80 and that is postmenopausal. My FSH levels came back elevated and this is how I knew that I was postmenopausal. And it wasn't just one test that confirmed it. I had several tests and the FSH number consistently stayed in the high seventies, which was an indicator that I was postmenopausal. Typically levels around 25 to 30 can indicate that you are transitioning into postmenopausal phase, but Post-menopausal is the numbers much higher, but during perimenopause, it can bounce around a lot. So one test doesn't tell the full story. Okay, so the other thing with testing that you have to take into consideration is that your timing matters. So if you're going to test, you need to make sure that you are timing it to your cycle if you're still having cycles. So let's talk about progesterone for a second because this one gets messed up all the time. Pogestrone should be tested in the mid luteal phase, which is about five to seven days after ovulation. And according to organizations like the American College of Obstetricians and Gynecologists and major medical centers like the Mayo Clinic, they state that Pogestrone is best tested about five to seven days after ovulation during the luteal phase because that's when levels naturally peak. For most women, that's around day 19 to 21 of a typical cycle. If you test too early, it can look low even when everything is functioning normally. And then you're told that something's wrong when actually it's not. So it's really important that you focus, that your provider makes sure that they, when they do your testing, that they time it right. Okay, so what doctors, if you were to go to your general practitioner, they will typically do a general panel. So if you go to your primary care provider and ask for lab tests, they're usually going to run the basics like a complete blood count test, a CBC, your electrolytes, your liver enzymes, a metabolic panel, which should be done fasting, a basic cholesterol panel, and that includes total cholesterol, LDL, HDL, and triglycerides, which is not even painting the whole picture. And that's a subject for another podcast episode. but they usually do just a basic cholesterol panel. And all of these are great to have done and tested, but it doesn't give you any clue about what's going on hormonally. So when it comes to hormones specifically, when you want to know what's going on with your female hormones, they may test your estradiol, your progesterone, total testosterone, free testosterone, your sex hormone binding globulin, which is your SH. BG your DHEA and sometimes FSH. That's a lot. It's a lot to take into consideration because of our hormones. It's very complex, right? So there's something that I want you to understand with that, that this is all helpful data, but it doesn't give you a whole picture if you have this done because these labs are giving us a snapshot of what's happening in your body on one specific day. but your hormones, especially in perimenopause are constantly changing. Estrogen can be high one day, low the next. Pogestrone depends on whether or not you ovulated that cycle. And even something like your cortisol and your thyroid function can shift based on your stress levels, how you're sleeping and what's, what's going on in your life. Like that plays a part in your lab results too. So one blood test, doesn't always reflect what's happening day to day in your body. It's just one piece of the puzzle, not the entire story. Your symptoms, your cycle patterns, your sleep, your stress levels and your nutrition are what help you understand what's really going on. So your provider should also take your lab results along with your lifestyle habits and say, okay, this is probably why you have these results. Cause you're telling me you're sleeping four hours a night. you're telling me that you are so stressed beyond belief with your work and you you're taking care of your kids and your parents and all the things that can contribute to what is happening to your symptoms and to your lab results. So that's important to remember. And the other thing is I want to really touch upon our thyroid and our metabolic health because this often gets missed when we go and ask for lab work. And this is important to Factor in what's going on with us. Our thyroid plays a huge role in our energy, our mood, our weight, our hair, our metabolism, our body temperature. And many doctors only run a very basic thyroid markers such as the TSH. And this doesn't tell us much about what's happening with our thyroid and how it's functioning. And take it from somebody who's had hypothyroidism since her early twenties. It wasn't until recently when I went to a functional medicine practitioner, that they started running more thorough lab work on thyroid to better understand what was happening with me. Because up until recently about, you know, seven, seven, eight years ago, I was going to my general practitioner to manage my thyroid and all they ran was a TSH and all the things that I've learned since then is like, ⁓ my gosh, they missed the mark big time. And it's no fault of the doctor because that's not their training. They're not trained in endocrinology. They're not trained in thyroid health. They know how to do the basics. Okay. So we are going to be doing a deeper dive into thyroid next week because it does deserve its own episode. But just know if you're struggling, you also want to have a full thyroid panel, not just the one number of the TSH. You want to know the full thyroid and how it's functioning. You also want to have lab work done on cholesterol, which is the full comprehensive cholesterol panel, which we will talk about another episode. Glucose, your fasting glucose, which means you go in for your lab work fasted. You haven't eaten anything, so you know where you are with your glucose. And then they also should be running an ABA1C. This gets missed a lot, especially considering so many people are pre-diabetic and have no idea. I was one of those people. I found out I was pre-diabetic when I asked for this particular test. the Hebo Globin A1C, I was 5.7. 5.7 is pre-diabetic. It was very alarming. And I had no idea. And my doctors would have had no idea because they weren't going to run the test because on the outside I wasn't struggling. I seemed fine. So they didn't test it. So it's something to consider having run because as we enter into perimenopause, we become more insulin resistant. And then you also want to have a fasting insulin test done because that tends to rise before your glucose and A1C elevate. So if your fasting insulin is high, then that's when you are kind of on the verge of having metabolic issues like pre-diabetes and type 2 diabetes. Functional medicine will usually say fasting insulin above a 10 to 15. is getting a little in the danger zone. So you want to make sure that it's below 10, ideally below five. So these panels matter a lot. The glucose, the Hiboglobin A1C and the fasting insulin can tell you what's going on with your metabolic health. Because as we age, we become more insulin resistant. And let's talk about insulin resistance. I hope that you've heard of this phrase before. It's a big one. Insulin is also a hormone that helps us move sugar from our bloodstream into ourselves so that our body can use it for energy. But over time, especially as we get into our forties and beyond, our cells can become a little less responsive to insulin. And that is when we become insulin resistant. So when insulin is affected, it affects your cholesterol too. So that's why women who never had any cholesterol issues all of a sudden are having cholesterol issues, it's because your body has to produce more and more insulin to do the job and that impacts your cholesterol levels. When you are insulin resistant and your body is having to produce more and more insulin, you're going to have feelings of being tired after eating. You might get cravings, especially for sugar and carbs for energy. You might feel a little bit more shaky and irritable if you go too long without eating. and you're gaining weight, especially around your belly. Those are symptoms of insulin resistance. Not only do we want to have our basic panel done that I mentioned, the CBC, the electrolytes, the liver enzymes, the basic cholesterol, the basic thyroid TSH, we also want to have our metabolic panel done, which is our total, like our, our full comprehensive cholesterol, fasting insulin, fasting glucose, and our metabolic hemoglobin A1C. As you can see, So much goes into testing and looking at the whole picture. But this is why I preach lifestyle habits because regardless of testing, many practitioners, depending on where you're at, are going to recommend medication. So for me, when I was pre-diabetic, my doctor at the time said, nothing to worry about. You're not, you're not diabetic yet. You don't have type two diabetes yet. We don't have to medicate you. Okay. Well, what can I do to get this number down? Because I don't want to go there. I don't want to go there because I lost my dad to complications from type two diabetes. I saw what it did to him. He had a massive heart attack and he died young because of unmanaged type two diabetes, because they managed it with medications. No lifestyle was addressed with that. I see this all the time with the people that I work with. They are not really giving clear guidance and you have to change your lifestyle. If you want these numbers on the test to change, you must address your lifestyle habits. And this is why I really talk about all of it. The food, how we're managing our stress, how we're sleeping, and are you moving your body? All of that impacts your health and can manipulate your numbers in favor of what you want. And especially in perimenopause, we are more sensitive to how we're caring for our body. So we have to really take it seriously. and make sure that we are supporting our body in the way that it needs in this new season of life. All right, so let's talk about the different types of testing. You might have heard of blood test, saliva test, or even the Dutch test. the Dutch is a dried urine test. This stands for dried urine test for comprehensive hormones. This offers a very comprehensive, functional, alternative to traditional blood tests. Blood tests provide a snapshot of our free hormones while the Dutch test measures urinary metabolites, providing a more detailed 24 hour look at our hormone production, what it's doing, how it's getting metabolized, all of that. And it also really looks closely at our cortisol patterns throughout the day, which is super important. I've had this test done in the past. It provided a lot of information, which was wonderful. It is not a typical test done by your general practitioner. It's typically done by practitioners who are interested in doing alternative types of testing, but just know that it's a little bit more expensive because it's not covered by insurance. It's just a really thorough test for the provider to find out what's going on with your body and how your body is using hormones. So each one of these tests, the blood tests, saliva tests, and the Dutch tests have pros and cons to them. This is why it's super helpful to work with the provider who is trained in menopause care and understands how to interpret these in context because results without context, they don't mean much. They need to see the whole picture, your lifestyle, stress, sleeping, all of that in addition to your labs. So blood draw is testing what is in the bloodstream. The hormones are actually in the bloodstream. Saliva is a tricky test because it only looks at the free form of are hormones and it changes throughout the day. And the Dutch chess is very comprehensive. I would say the pros are it's super comprehensive and it gives you a very detailed picture of what's going on. The cons are it's expensive and not very many people know how to read this test. You want to make sure that if you have this test done, that it's evaluated and interpreted by somebody who knows what they're doing. So I want to share a little bit about my personal experience and I think that this is something that you can certainly relate to. When I first asked my doctor to run more comprehensive testing, there was resistance to it. They're like, why? We can just manage your symptoms. Testing isn't going to do much for you. And I felt really, I felt shut down and I was persistent because I wanted to know. I had a strong feeling that I was post-menopausal because I did, had the uterine ablation. So I had no idea if I was you know, had gone a whole year and a day without my period. I just know that my spotting had stopped and I was curious and I just wanted, I wanted to know. So I, I told the doctor, I said, I appreciate that you want to manage my symptoms with, you know, supplements they were throwing at me that had crappy ingredients in it. said, but I really want to know where I'm at. And so I advocated for myself and I, told them I need the test, I want the test, it's not going to cost you any money. And it didn't even cost me any money. My insurance paid for it. So it was just something that I wanted for my own personal preference. I wanted to know where I was at and I had the test done. And that's when I knew that my FSH was really high and that I was the most likely post-sometaposal. So I want you to advocate for yourself in that way. If you're you are working with a doctor who is being resistant to testing your hormones, who's telling you, don't need to, or it's really hard. And it is hard. It's complex. Just like I shared in the very beginning of this episode, if you are a cycling woman, it's really hard to determine where you're at because of what's happening with your cycles. However, there are other tests that you can have run to determine where you are metabolically and hormonally. Just based on this episode, Take this information as education only. As a reminder, I am not a doctor. I am not a licensed medical practitioner. I am a board certified functional medicine health coach who has personally gone through this and who has studied this so much that I am able to understand it way more than I did when I was first going through this, which is why I'm wanting to share this with you because I think you need to know what your options are and what to ask your providers. So you don't want to ask for every test under the sun. That's going to be overwhelming, but you want to be able to feel confident asking questions and being part of the conversation. And you have the right to ask for testing. And it's super important for you to find someone who is willing to listen to you and knows what they're doing. So where can you find these providers, these practitioners who are knowledgeable in doing these tests? You want to work with somebody who has been trained in hormone health and knows what they're doing. So you can start with organizations such as the Menopause Society. my personal favorite is the Institute for Functional Medicine. I will link in the show notes, the IFM find a practitioner link that has a directory of trained providers. And if you are a listener outside of the United States, you can also connect with the International Menopause Society. That's where you can find people that have an idea and are trained on women's health. So even with the right provider, I want you to be mindful that labs are just one piece of the puzzle. The best practitioners will look at symptoms and labs. They're going to consider your lifestyle, your stress and your nutrition. They're not going to jump. straight to you need medication or let's put you on birth control pills to regulate your cycles or your labs are normal, you're fine. They're going to listen to you because you're not feeling fine and you are certainly not feeling normal. The providers that will listen to you and dig deeper are the ones you want to stick with. What are some of the questions that you can ask a provider? Let's say you're going to a new doctor and you're going to interview them, which you should because you're hiring them. you're hiring them to manage your health and you are working as a team. I just want you to remember that, that you should be a team player when it comes to your health. So some of the questions you might want to ask, ask the doctor, do you test more than just a TSH for thyroid? If they say yes, great. Do you check progesterone based on cycle timing? That's another check on the box. Make sure that they are checking it based on your cycle. How do you approach perimenopause symptoms? Are they going to talk to you about lifestyle habits and changing some of those habits? Or are they going to tell you, ⁓ you're dealing with anxiety and depression. Here's a medication for that. So many women are misdiagnosed with depression when it's really just their hormones that are off. And it is usually a quick fix with lifestyle changes and how we're taking care of ourselves. And then the other question is, do you look at the full picture or just lab ranges versus do they look at lifestyle? what's happening, what you're eating. If you're exercising versus just labs, you want them to look at you comprehensively, not just by numbers on a test. Okay. So if the provider seems rushed, dismissive, or says, we don't test that, or the labs are normal, but you feel like shit, that's a red flag and you need to either push for more testing or for more support, or you need to trust your gut. and find someone else because you deserve to be in the hands of someone who listens to you and values what you have to say about your body. Let's recap. So should you have your hormones tested? The nuanced answer is you don't need testing to know if you're in perimenopause. Your symptoms will tell you a lot, but testing can be super helpful if your cycles are regular. If you want a clearer picture of where you are, on your menopause journey, or if you're working with a provider to create a more personalized plan and they need your labs as a baseline. It's always great to have a starting baseline of where you're at. If you've had a horrible experience getting your provider to listen to you and support you, please send me a message on Instagram. I'd love to hear from you. I'm at jennyaz underscore simple, and I also will link this in the show notes. Reach out to me. Let me know if you have any questions about this episode. I plan to dig into a little bit deeper about some of this, these, you know, testings that we want to have done. And I hope to have some functional holistic doctors on in future episodes who are well versed and trained in women's health and hormones to talk to us from a medical expert point of view and what we should be looking forward providers and how we can get the support that we need. So if you found this episode helpful to better understand what's going on in your body and whether or not you should have testing, please share this with a friend who you think might also find this information helpful. And next week we are going to be diving into thyroid and why it's often the missing piece for so many women. So that's it for today. Thank you so much for tuning in and I will see you next week.