Are My Hormones Out of Balance?

Lab tests during perimenopause and menopause

With hormones, it’s all about balance.  Just as Ms. Goldilocks taught us, they can’t be too high or too low, they have to be just right.  Otherwise, they cause a lot of problems.

Labs Don’t Lie When it Comes to Hormones

Labs really get to the heart of the matter.  However, in today’s healthcare system, it’s a quick fix to a pill or hormone cream to “fix” your issue. When it comes to hormones, even if your practitioner gets labs, they may come back “normal” and you may be told a few things.  Either, you are depressed, it’s your age or your extra weight may be the cause.  So not helpful when you feel like crap.

I practice functional medicine which dives to the root cause of these hormone challenges.  I look at everything including the body’s natural systems that support healthy hormone balance. Often times, the “run of the mill” labs are not sufficient.  To find your optimal balance, you may need to run some additional labs.

My approach for my perimenopausal/menopausal patients is to look deeply at all of their symptoms.  Below are common symptoms and the labs I order to help get to the root of the problem. When I look at blood levels, I do not just look at what is normal on your lab report, I prefer “optimal levels”.

  1. Cortisol
    1. Potential Symptoms – fatigue, moodiness, depression, anxiety, dizziness when standing up quickly, afternoon headaches, can’t stay asleep, insomnia, weak nailbeds, hair loss, blood sugar levels challenges, allergies, low immunity, inability to lose weight, low libido, inflammation, chronic pain, craving for sweet or salty foods, slow to get going in the morning
    2. Labs – 1. 8 am Serum Cortisol.  Although this is not the best test it does give me a good indication if you are really high or really low.  The lab values may say normal is 6-22, however, “optimal” is 10-15.
    3. The best test to evaluate your Cortisol pattern is the 4 Diurnal Adrenal Stress Index. This is a saliva test (tracks cortisol and HPA (brain-adrenal) axis quality.  Saliva is collected at 4 points throughout the day.  A normal pattern would be higher in the am and then decreasing throughout the day.
  1. DHEAS
    1. Potential Symptoms – similar to the estrogen and testosterone symptoms as this is a precursor to those hormones. Also similar to Cortisol symptoms as it comes from the adrenal system as well.
  1. Thyroid
    1. Potential Symptoms – thinning hair/hair falling out, lack of energy, depression, lack of motivation, headaches in the morning, infrequent/difficult bowel movements, require large amounts of sleep to function at normal level, foggy brain, dry skin, heart palpitations, Shortness of breath, muscle and joint aches
    2. Labs – typical labs are TSH and Free T4 (inactive thyroid hormone). Functional medicine bonus adds thyroid panel to evaluate Free and Total T3 (active thyroid hormone), reverse T3 and thyroid antibodies.  Again, optimal levels are the best here, for instance, a “normal” TSH can be .3-5.0 on some lab reports.  Optimal for most people is between 1.0-2.0.  As a general rule, the optimal usually falls in the middle of the ranges that are on the lab report values.
  1. Estrogen
    1. Potential Symptoms(Too much) – moodiness, heavy menstrual bleeding, lack of mental sharpness, depression, anxiety, migraines, gallbladder issues, quick weight gain, puffiness, bloating, abnormal pap smear, tender breast, trouble sleeping, emotional/teary, bloated/full feeling
    2. (Not enough) – hot flashes, night sweats, Vaginal dryness, night sweats, lethargy, brain fog, painful sex, recurrent bladder infections
  2. Labs– comprehensive blood and salivary hormone panel including all estrogen isomers. I like blood samples to get a baseline and monitor as they can be very accurate, however if you are on hormone replacement creams then getting the saliva or dried urine testing done is more accurate than blood.
  1. Progesterone
    1. Potential Symptoms – agonizing PMS, anxiety, headaches, persistent weight gain, insomnia, tender/painful breasts, infertility, skin issues
    2. Labs – Same as with estrogen, blood samples are accurate but if taking any creams, then the saliva or dried urine testing is best. If you are still menstruating it is vital that you obtain labs in your luteal phase, on days 18-21 of your cycle.
  1. Testosterone
    1. Potential Symptoms
      1. (Too much) – Mid-cycle pain and/or cramping, thinning hair, excessive hair on arms and face, infertility, ovarian cysts, polycystic ovary syndrome (PCOS), acne
      2. (Not enough) – fatigue, low libido (sex-drive), weight gain
    2. Labs – Blood, Saliva, and Dried Urine are all accurate when it comes to testosterone
  1. Insulin
    1. Potential Symptoms – hooked on coffee, shaky or having tremors, increase appetite and thirst, memory challenges, anxious, irritability, sweet cravings, fatigue after meals, frequent urination, difficulty losing weight,
    2. Labs – Serum insulin, c-peptide, fasting blood sugar and HgbA1c

Let’s Wrap it Up

In Functional Medicine philosophy, everything is connected. So, if one hormone is off there is a chance others might be too.  Working closely with your health care provider is a good start.  If your provider will not do these labs, or you are not getting answers, then find a provider that will help you.  It is your body and you are the one in control.

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