Your gynecologist will either tell you that blood tests to check your hormone levels in health are useless, which would be truthful, or he/she will tell you blood FSH is the only blood test necessary to figure out how close you are to menopause.
After over almost 20 years of working with bioidentical/natural/human identical hormones in wellness and disease prevention and 35 years of being a doctor, I beg to differ with the usefulness of blood testing in general and FSH in particular.
FSH-Follicle Stimulating Hormone is a useless test unless you are 30 and trying to get pregnant. Depending on what time of the month the test is done, if you are taking hormonal contraceptives, if it’s just an off month for whatever reasons, the result may scare you into thinking you are menopausal and your ability to get pregnant is permanently impaired.
I can’t tell you how many devastated 30 something year olds have come to me with the diagnosis of ovarian failure based on absent periods and elevated FSH levels. The same women who months later even got pregnant while under my care on the proper bioidentical hormones and thyroid regimen.
Other hormone levels tested in the blood tests include: LH, Prolactin, DHEA-S, Estradiol (E2), Estriol (E1), Estrone (E3), Progesterone (Total/Free), Testosterone (Total/Free), cortisol, T3, T4, TSH and RT3 (reverse T3 not FDA approved). Depending on what time of the month, week or time of day the blood is drawn, the results may either fit your symptoms or not.
If the results fit your symptoms, your doctor can use the blood tests as guideline in your hormonal treatment. If the results are not in concert with the symptoms, what happens next depends on you and your doctor. If you are working with a doctor who pays attention to you, the blood tests stay in your chart for future reference.
The way we do it in my office is to make sure we do these blood tests the first time you come in to see me and then repeat them when we got your hormone balance perfectly tuned. Then, when you are feeling great and we repeat the blood tests, we can use them as guide for what levels we are looking for to keep you feeling optimal.
If your doctor doesn’t listen to you and doesn’t want to follow this type of direction in your care, my advice is to change doctors and ignore his/her comments.
A more useful, expensive and excessive way to use blood tests, is to have samples drawn at days 1, 15, 25 of your cycle and see how the hormone fluctuations compare to your symptoms if you are still menstruating.
If your periods have stopped or if we are only looking to treat your symptoms and improve your hormone balance, have the bloods taken on day 16-17 of the cycle or 17 days after you started a period if your periods are irregular.
In our practice we use blood tests to help us navigate the distance between health and discomfort and accordingly adjust the treatment plans.
I repeat bloods once a year for many patients I work with on a regular basis. Call it the conventional medicine backbone of my training. I do temper my urge to order blood tests especially when my patients remind me of the exorbitant cost of “maybe” and probably “useless” information.
24 hour urine tests to measure excretion of the metabolized waste products of the hormones we use are often a method of testing employed by endocrinologists in search of serious illnesses. So far, this method has not caught on in the treatment of hormonally challenged women unless you are outside New York state where the test isn’t performed or you are a difficult case making it important for the doctor to figure out how your body metabolizes (breaks down) estrogen, progesterone and testosterone once it is absorbed in your body.
For the results to mean anything at all, you have to insure collection of every drop of urine you generated for 24 hours. Most women have better things to do with their lives. Use this test only if you have addressed everything else; from diet, to exercise, to stress management, to working with a caring, knowledgeable MD with the right supplements, vitamins and bioidentical hormones and your symptoms still persist.
I am not a fan of this method of testing either. And I must tell you, many have tried to convince me to jump on board of this co-called “best method to monitor bioidentical hormone therapy”.
I am not really clear what saliva testing brings to the table. I know it makes the people who promote and perform it make money without a physician’s prescription, but I am not sure it helps you or your doctor understand the root cause of your symptoms any better, or treat you more effectively.
Saliva testing is easy to perform and isn’t expensive. You don’t need a doctor to order it so the marketing expert has the upper hand. It measures the amount of hormones present in your saliva, supposedly a direct reflection of how much of the particular hormone is freely circulating in your blood stream. Only it isn’t measuring anything in your blood stream, it is your saliva. Confusing? Yep!
Many patients I see bring the tests to me and tell me their compounding pharmacists have encouraged them to take them. I am not moved. The only scientifically proven use for saliva testing is to check three point cortisol levels - morning, noon and night. The test does correlate well to adrenal function in this case.
My verdict on the tests is the following:
Depends on who you work with when balancing your hormones and your life.
Ask questions and make sure the answers make sense to you. Nothing is too complex or above your head. This is your life and you need to be in control of it to be successful and enjoy it! Anyone who talks down to you or acts as though you cannot understand what they are doing is not worth following. They probably won’t help you.
Finally, when it comes to testing there is an over the counter Do It Yourself kit to measure your FSH levels to determine if you are menopausal or not. Don’t waste your money on it. Instead, go buy yourself a present and have fun!