Do you know what your hormone levels are? Should you?
Your body contains more than 50 hormones—the chemical messengers that make up the endocrine system—and hormonal changes can reflect any number of medical conditions. For example, low levels of the pancreatic hormone insulin may indicate diabetesalthough high levels of the stress hormone cortisol may play a role in obesity.
But some hormones such as melatoninwhat's important for sleep fluctuates naturally throughout the day. Other hormonal changes are normal at different stages of life, such as a woman's decline in the reproductive hormones estrogen and progesterone before menopause.
Hormones are having a moment.
The Food and Drug Administration announced on November 10 that it removing black box warning about hormone replacement therapy during menopause. Agency leaders said the risks listed, including breast cancer, do not outweigh the effectiveness of the treatment. long term health benefitssuch as reducing the incidence of bone fractures and cognitive decline.
This news has sparked interest among women who may be candidates for the therapy. Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, joked that her patients have been “going crazy” ever since.
In an era when over-the-counter hormonal tests are a dime a dozen and supplements boast of relieving hormonal imbalances, it can be difficult to know if you need hormonal testing and treatment or if you're falling victim to a marketing scheme.
Dr. Jan Shifren, director of the Center for Midlife Women's Health at Massachusetts General Hospital, says women experiencing perimenopauseThe years leading up to the last menstrual period are a prime target for such “meno-speculation” or “meno-erasure,” the practice of selling pseudoscience to women in the menopausal transition.
“I actually never use the words ‘hormonal imbalance’ with my patients,” Shifren said. “There are a lot of people who sell very expensive hormone tests—often not covered by insurance—these very large panels of multiple hormones that essentially tell us nothing.”
The U.S. endocrine testing market, which includes hormonal tests, is thriving post-pandemic, according to Grand View Research, an international market research consulting firm. Its market size in 2022 was approximately $4.1 billion and is estimated to grow at a compound annual growth rate of 7.7% between 2024 and 2030, reflecting global forecasts.
While hospitals led the global endocrine testing market in 2023, commercial laboratories are expected to experience the fastest annual growth through 2030, according to forecasts.
In the US, commercial labs such as Labcorp and Quest Diagnostics offer over-the-counter options ranging from a single $49 test that measures luteinizing hormone, which helps regulate the menstrual cycle, to an in-depth hormone panel costing more than $500.
Numerous telemedicine companies sell similar tests that may involve collecting blood, urine or saliva, some of which cost close to $1,000 per panel. HealthLabs.com, for example, offers a “comprehensive female hormone panel” that measures hormone levels, including estrogens, thyroid hormones, testosterone And human growth hormone. Panel, which also includes tests for cholesterol, folic acid and vitamin B12, list price is $1,598, but as of November 13 it was on sale for $799.
“In my practice, I see women all the time who spent $600 on an online consultation, they spend $600 or $700 every few months on a very large panel of unnecessary hormone levels,” Shifren said. “Then when they come to me, I don't want to look at any of those levels. I want to talk to them about what's bothering them, what their symptoms are.”
Monitor symptoms, not hormone levels
Perimenopause usually begins between the ages of 45 and 55 and can last up to ten years. Menopause marks a single point in time, 12 months after a woman's last menstrual period, followed by postmenopause for the rest of the woman's life.
More than 1 million women in the United States reach menopause each year, on average at age 52, according to the National Institute on Aging.
“Half of all people on this planet will experience menopause if they are lucky enough to live long enough,” Shifren said. “This is an important period in life.”
This may also be a time when the quality of life of women experiencing symptoms worsens, which may include tides and night sweats brain fogmood swings, weight gain, painful sex, breast tenderness, incontinence, insomnia, vaginal dryness and irregular periods.
When Minkin sees a patient in their 40s or 50s with these symptoms, the goal is treatment—no hormonal testing is required.
“In general, I try to dissuade people [from testing] “As much as possible,” Minkin said, “Especially in perimenopause, hormones are all over the place.”
Not to mention, Minkin says, even premenopausal women's reproductive hormones vary greatly throughout their cycle.
Minkin also does not advise patients to purchase hormonal panels on their own.
“My standard example is if I have a patient who's 53 years old… she hasn't had her period for three months and she's been up every night and she's sweating and not sleeping and not feeling well, and she wants to check her hormone levels,” Minkin said. “[I’d] tell her: “Please go and buy a dress with this money.” I can tell you that you are perimenopausal.”
Likewise, older women don't often benefit from sex hormone testing, Shifren says.
“There is absolutely no point in checking estradiol [a form of estrogen] or progesterone in postmenopausal women,” Shifren said. “We can tell them—before they spend money—that these levels are low.”
Who would benefit from hormone testing?
When it comes to perimenopausal symptoms, age matters, says Dr. Shamita Misra, clinical professor of family and community medicine at the University of Missouri School of Medicine.
Menopause occurring between the ages of 40 and 45 is considered early, and reaching this milestone before the age of 40 constitutes premature menopause. Approximately 5% of women beat early menopause naturally, as opposed to a condition caused by surgery or other medical intervention, according to the federal Women's Health Administration.
Because early or premature menopause is associated with a higher risk of diseases, including heart disease And osteoporosis, A patient under the age of 40 who reports perimenopausal symptoms may benefit from hormonal testing, Misra said.
“Do we suspect premature menopause or are there other endocrine problems?” Mishra said. “We need to be open-minded and not just focus on perimenopause. [the patient’s] story”.
On the other hand, if you are at a normal age in perimenopause and have symptoms, don't shy away from discussing any hormonal issues you may have with your doctor, Misra said. Shared, informed decision making is your safest option.
“Some women are not open about their symptoms,” Misra said.
If your doctor recommends hormone testing, keep in mind that some medications, including birth controlmay affect your levels.
“You will have to go off birth control for 90 days—a minimum of three months—before your hormones return to baseline,” Misra said. “When a person is breastfeeding, for example when a person is taking oral contraceptives or is already taking some kind of hormones, it is impossible to accurately check hormone levels.”
Risks of Unnecessary Hormone Testing
Doctors say it's natural to wonder about your hormone levels—reproductive or otherwise—whether you have symptoms or not. Some of Dr. Debra Bell's patients have told her that they need data to feel comfortable about their health, even if she doesn't need data to treat them.
“My approach is: How will this test help us make a decision in your situation?” said Bell, director of education at the Osher Center for Integrative Health at the University of Washington School of Medicine. “It doesn't always help.”
But just because hormonal testing typically doesn't benefit peri- and postmenopausal women doesn't mean it's harmless, Bell says. Cost is one of these harms.
“I know people who have maxed out their credit cards for things like this,” Bell said.
Not all over-the-counter menopause diagnostics are expensive. For example, pharmacy chains and big box stores sell rapid menopause tests for about $30, and sometimes less.
The questions then arise: how accurate are the results and who interprets them?
“If [a patient has] did the test, then I interpret it for them,” Bell said. “In many cases, the test shows what we might have already suspected based on the symptoms they are experiencing and what is happening with their menstrual cycle.”
Another danger of self-testing is self-medicating for a suspected hormonal imbalance, Bell said. Unlike prescription drugs, the FDA does not approve the safety and effectiveness of herbal and dietary supplements before they hit store shelves.
The global menopause market was worth nearly $18 billion last year, with dietary supplements accounting for 94%, according to Grand View Research.
As an integrative medicine practitioner, Bell is unlikely to argue against supplements. But be sure to discuss any supplements you're considering with your doctor, she said. Even supplements sold as natural may be toxic depending on your lifestyle, medical history and other medications you take.
In particular, hot flash treatment has high level of placebo effect in clinical trials, Minkin estimates from 30% to 35%. For this reason, she said she has no problem with patients who claim that home remedies such as evening primrose oil provide symptom relief.
“For now, this is something that I know is pretty safe,” Minkin said. “[If] she says it's arsenic, I'd say, “That's probably not a good idea.” So I need to evaluate the potential toxicity of what she might be using.”
Minkin is thrilled that menopause, once taboo, is not only making headlines but is being celebrated—an “estrogen festival,” as she calls it. However, she warned that some wellness companies are crashing parties in hopes of making money off middle-aged women.
“For 20 years we couldn't attribute anything to menopause; it was a dirty subject,” Minkin said. “But for now, I think we're inclined to say that All “This is perimenopause, because perimenopause is very amorphous.”
“You can't really test it.”
