Do you know what your hormone levels are? Should I know?
Your body houses more than 50 hormones, chemical messengers that make up the endocrine system, and changes in them can reflect different diseases. For example, low levels of the pancreatic hormone insulin can be a sign of diabetes, while high levels of the stress hormone cortisol can influence obesity.
However, some, such as melatonin, important for sleep, fluctuate naturally throughout the day. Other changes are normal at different stages of life, such as the decrease in the reproductive hormones estrogen and progesterone before menopause in women.
Hormones are in fashion.
The Food and Drug Administration (FDA) announced on November 10 that it has removed the warning on menopausal hormone replacement therapy. Officials said the listed risks, which include breast cancer, do not outweigh the long-term health benefits, such as reduced fractures and cognitive decline.
The news has sparked the interest of women who could be candidates for the therapy. Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, joked that her patients have since gone “crazy.”
In an age where over-the-counter hormone tests abound and supplements promise to alleviate hormonal imbalances, it can be difficult to know if you need hormone testing and treatment or if you are falling victim to bullying tactics. marketing.
Women experiencing perimenopause, which are the years before the last menstrual period, are the target of this type of menoprofiteering either menowashingthe practice of selling pseudoscience to women during their menopause transition, said Dr. Jan Shifren, director of the Midlife Women’s Health Center at Massachusetts General Hospital.
(FDA removes long-standing warning from hormonal menopause drugs)
“I never actually use the words ‘hormonal imbalance’ with my patients,” Shifren said. “There are a lot of people selling very expensive hormone tests, which are not usually covered by insurance, with very broad panels of multiple hormones that, in essence, tell us nothing.”
The U.S. market for endocrine testing, which includes hormone testing, has flourished since the pandemic, according to Grand View Research, an international market research and consulting firm. Its market size was about $4.1 billion in 2022 and is estimated to skyrocket at a compound annual growth rate of 7.7% between 2024 and 2030.
Although hospitals dominated the global endocrine testing market in 2023, laboratories are expected to experience the fastest annual growth through 2030, according to projections.
In the United States, laboratories such as Labcorp and Quest Diagnostics offer over-the-counter options that range from a single $49 test to measure luteinizing hormone, which helps regulate the menstrual cycle, to a comprehensive hormone panel that costs more than $500.
Several telehealth companies offer similar tests, which may require the collection of blood, urine or saliva, and some of them run around $1,000 per panel. HealthLabs.com, for example, offers a “comprehensive female hormone panel” that measures estrogen, thyroid hormones, testosterone, and human growth hormone. The panel, which also includes tests for cholesterol, folic acid and vitamin B12, costs $1,598, but on Nov. 13 it was selling for $799.
“In my practice I always see women who have spent $600 on an online consultation and $600 or $700 every few months on a very broad panel of unnecessary hormone levels,” Shifren said. “Then when they come to see me, I don’t want to check any of those levels. I want to talk to them about what’s troubling them, their symptoms.”
Follow symptoms, not hormone levels
Perimenopause usually begins between ages 45 and 55 and can last up to a decade. Menopause marks a specific time, 12 months after a woman’s last menstruation, which is followed by postmenopause for the rest of the woman’s life.
According to the National Institute on Aging, more than one million women in the United States reach menopause each year, at an average age of 52 years.
“Half the people on this planet will go through menopause if they are lucky enough to live long enough,” Shifren said. “It is an important stage.”
(Why the number of women turning to testosterone has skyrocketed)
It can also be a time of decreased quality of life for women who experience symptoms such as hot flashes and night sweats, confusion, mood swings, being overweight, painful intercourse, breast tenderness, incontinence, insomnia, vaginal dryness, and irregular periods.
When Minkin sees a patient between 40 and 50 years old with these symptoms, her goal is treatment, without the need for hormonal tests.
“In general, I try to discourage people (from getting tested),” Minkin said. “Especially in perimenopause, hormones constantly fluctuate.”
Even a premenopausal woman’s reproductive hormones vary considerably throughout her cycle, said Minkin, who also cautions patients against purchasing hormone panels on their own.
“If I have a 53-year-old patient who hasn’t had her period for three months and wakes up every night, sweating, not sleeping and not feeling well, and she wants to have her hormone levels tested,” he said. “(I) would say, ‘Please go and buy a dress with that money. I can tell you that you are in perimenopause.'”
Older women also typically don’t benefit from sex hormone testing, Shifren said.
“There is no reason to check levels of estradiol (a form of estrogen) or progesterone in a postmenopausal woman,” he said. “We can tell them, before they spend money, that those levels are low.”
Who benefits from testing?
When it comes to perimenopause symptoms, age matters, said Dr. Shamita Misra, clinical professor of family and community medicine at the University of Missouri School of Medicine.
Menopause that occurs between the ages of 40 and 45 is considered early, if it is reached before the age of 40 it is premature. About 5% of women experience early menopause naturally, as opposed to the condition induced by surgery or other medical interventions, according to the federal Office on Women’s Health.
Because early or premature menopause is associated with an increased risk of diseases such as heart disease and osteoporosis, a patient under 40 years of age who presents with symptoms of perimenopause may benefit from hormonal testing, Misra said.
“Do we suspect that it is a premature menopause or is there some other endocrine problem?” he asked. “We have to be open and not focus only on perimenopause. We also have to know (the patient’s) history.”
If you are in the normal age of perimenopause and have symptoms, don’t hesitate to talk to your doctor about any hormonal concerns, Misra said. The safest option is to make informed decisions.
“Some women don’t talk candidly about their symptoms,” she said.
If your doctor recommends hormone testing, keep in mind that some medications, including birth control, can affect your levels.
“You would have to stop taking birth control for 90 days, at least three months, before your hormones return to normal levels,” Misra explained. “When a person is breastfeeding, for example, if they are taking oral contraceptives or some hormones, it is impossible to check hormone levels accurately.”
The risks of unnecessary testing
It’s natural to be curious about hormone levels, whether reproductive or otherwise, whether symptoms occur or not, according to doctors. Some of Dr. Debra Bell’s patients have told her that they need that information to feel reassured about their health, even when she doesn’t need it to treat them.
“My focus is: How will this test help us make a decision about your situation?” said Bell, director of education at the Osher Center for Integrative Health at the University of Washington School of Medicine. “It’s not always helpful.”
But just because hormone testing isn’t entirely beneficial for perimenopause and postmenopause women doesn’t mean it’s harmless, Bell said. The price is one of those drawbacks.
(All birth control methods with hormones increase the risk of breast cancer, according to a new study)
“I know people who have maxed out their credit card because of this,” he said.
Not all over-the-counter menopause diagnostic tests are expensive. For example, drugstore chains and big-box stores sell some for about $30, sometimes less.
So the question is: how accurate are the results and who interprets them?
“If (a patient) has had the test, I interpret it for her,” Bell said. “Many times, what it shows is what we could already assume based on the symptoms you present and what happens with your menstrual cycle.”
Another danger is self-treatment of a suspected hormonal imbalance, according to Bell. Unlike prescription drugs, the FDA does not approve dietary or herbal supplements for safety or effectiveness before they reach retail shelves.
By 2024, the global menopause products market will reach nearly $18 billion, Grand View Research reported, with dietary supplements taking 94% of the market share.
As an integrative medicine practitioner, Bell is not against supplements. However, it is recommended to consult with your doctor beforehand. Even those marketed as natural can be toxic depending on lifestyle, medical history, and other medications being taken.
Hot flash treatments, in particular, have a high placebo effect rate in clinical trials, between 30% and 35%, Minkin estimated. Because of this, she said she has no problem with patients who claim that home remedies, such as evening primrose oil, relieve their symptoms.
“As long as it’s something that I know is pretty safe,” he said. “If she tells me it’s arsenic, I’d say, ‘That’s probably not a good idea.’ So I have to look at the potential toxicity of what she might be using.”
Minkin is delighted that menopause, once taboo, is not only making headlines, but also celebrating what she calls an “estrogen festival.” However, she warned that some companies are crashing the party, hoping to make money at the expense of middle-aged women.
“For 20 years, we couldn’t attribute anything to menopause; it was a taboo subject,” she said. “But now I think we’re leaning toward saying it’s all perimenopause, because perimenopause is so amorphous.”
“In reality, no test can be done to detect it,” he concluded.
