Our bodies change constantly, and one of the most valuable tools that the physician uses to assess your health is the laboratory Blood test. These tests are ordered, and the results are used by your physician to pinpoint or to support diagnosis, monitor or determine treatment, or to screen for undiagnosed conditions. Blood tests take an internal and dynamic 'snapshot' of you, at the time of the test. Everyone needs to have their Blood tested periodically.
A laboratory Blood test is helpful in evaluating the current health status. Blood tests help us to realize that Blood test results may be outside of a normal range for the general population, but perfectly normal for you. This anomalous Blood test result might show for many reasons. These variations may be due to such things as: foods recently eaten; recent drinking; stress; sex; menstrual cycle; age; physical activity just before the Blood test; poor Blood sample collection and/or handling of the Blood test specimen; common drugs, such as aspirin, cold medication, vitamins, etc. taken in the days before the Blood test; prescription drugs, and non-illness-related Blood-test-related factors. Abnormal Blood testing results should be carefully and thoroughly discussed with your physician or qualified medical professional.
In general, if you're still getting a period, most doctors recommend that you get your blood levels taken on day 3 of your cycle -- that is, the third day of your period. If you no longer are getting a period, then you can get tested at any time.
-- Because hormone levels can and do fluctuate, many doctors advise getting tested more than once -- about a month apart. This is particularly important if you are still getting your period and/or have few symptoms, as there is a slim chance you're experiencing what is sometimes called "temporary menopause" -- a condition sometimes brought on by traumatic stress among other things. It's also important if your hormone levels come back normal, but you are experiencing definite symptoms, since you may indeed be beginning menopause, but your hormone levels didn't show it at that particular time.
Here, then, are the specific tests you may want to consider asking for:
Estrogen (Estradiol) Levels
Estradiol is the primary human estrogen -- and when your ovaries begin to fail, your circulating estradiol levels drop. This is why we often give you a serum estradiol concentration test to measure the amount of estradiol in your blood. In this case, we are looking to see if your estrogen levels are lower than normal -- again, a signal of ovarian failure, or, in other words, early menopause.
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Normal estradiol Day 3 value -- 25-75 pg/ml
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In spite of the above number, generally, estradiol levels about 30 or below -- in conjunction with a high FSH level (high in this case, meaning in the post-menopausal range, i.e. 30-40 or higher) -- is considered menopausal. (Important note: If your FSH hasn't reached post-menopausal levels and your estradiol is on the low side, you are not considered POF or EM. There can be other reasons for low estradiol, including excessive exercise, low body fat, and diminished ovarian reserve.) This is because estradiol levels tend to drop over time. During the first 2 to 5 years following menopause or ovarian failure, blood levels of estradiol drop to an average range of about 25 to 35 pg/ml. Women not on HRT generally will see this number drop even more over time; after about five years, it's common for menopausal women who aren't on HRT to have estradiol levels below 25.
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If your estradiol levels are lower than 50 picograms per milliliter, you may still be having a period, but also may be experiencing symptoms of low estrogen -- including hot flashes, vaginal dryness, and sleep difficulties.
| Non-menopausal: |
|
Follicular Phase |
24-138 |
Luteal Phase |
19-164 |
Periovulatory |
107-402 |
| Postmenopausal: |
|
No HRT |
<36 |
With HRT |
18-361 |
(Note: Generally, it is recommended that you raise estradiol levels to a minimum of 40 to 50 pg/mL to prevent bone loss, but 60 pg/mL or higher is optimal -- with many specialists advocating levels of about 100 pg/mL for younger women.)
Other Ovarian Hormones
It's not necessary to determine whether you are definitely menopausal or not, but -- depending on your symptoms -- you may also want to test your levels of the other major ovarian hormones: testosterone, progesterone, and luetinizing hormone (LH).
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Testosterone: There has been more attention paid recently to testosterone -- and more doctors and studies have been concluding that low levels are often a problem for a woman with premature ovarian failure or early menopause (particularly women who've undergone surgical menopause).
The general rule of thumb is that total testosterone levels that are 25 ng/dL or less is indicative of a deficiency, as are free testosterone levels of 1.5 pg/mL or less. (Women over age 50 are considered to have a deficiency at a lower level -- 1.0 pg/mL or less.) But if you're just a little bit above these levels -- and have symptoms of low testosterone such as a lagging libido or excessive fatigue -- then you may still benefit from testosterone supplementation. (Some doctors and labs also test bioavailable testosterone levels. Normal ranges for this are 0.6 - 5.0 ng/dl for premenopausal women and 0.22-4.3 ng/dl for postmenopausal women who aren't on HRT.)
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Progesterone: Most labs and studies state that menopausal levels are about .03-.3 ng/ml. By way of comparison, premenopausal women will have progesterone levels at about 7-38 ng/ml during their luteal phase.
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Leutinizing Hormone (LH): normal day 3 LH levels are 5-20 mlU/ml. If your LH levels are high in ratio to your FSH levels, this could indicate that you aren't in menopause or going through premature ovarian failure, but instead have polycystic ovarian syndrome (PCOS) which can cause some similar symptoms.
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Finally, there's DHEA, another androgen. This often isn't tested unless you have been exhibiting symptoms of low androgens (as with testosterone, the symptoms include decrease in libido and energy levels). For women under 50, DHEA levels of less than 150 ng/dL are considered low.
Thyroid
We recommend that you have your thyroid tested when you suspect menopause. This makes sense for two reasons: First, many women in premature menopause also are at a higher risk for thyroid problems. Second, many symptoms of thyroid disease overlap with menopausal symptoms. In fact, thyroid diseases often interfere with menstruation. Testing your thyroid, then, will help determine whether you are in premature menopause -- or instead have thyroid disease. In this case, we will probably check your thyroxine and thyrotrophin levels.
Salivary Hormone Tests
This isn't as widely used as blood testing, but it is quicker, less expensive and reliable. With salivary testing, we take samples of your saliva to see the levels of hormones you are producing and to determine if you have any deficiencies. Unlike the blood tests, the saliva hormone tests will show the levels of "free" hormones in your body -- that is, the hormones that aren't bound to proteins but instead are able to move into cells. Because about 95% or more of your blood hormones are bound, the saliva tests measure only the remaining 1 to 5% -- so the results may be markedly lower than that which you see on your blood test results.
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