Do this before considering HRT

In this article, we'll explore the benefits of hormone testing in perimenopause, the key markers to consider, and how it can guide personalised recommendations for a healthier, smoother transition.

Perimenopause is a transformative phase, often lasting 2-12 years before a person can achieve menopause (the 12 month anniversary of no period). During this time, hormonal fluctuations can lead to a wide range of symptoms.

Understanding the role of hormones in perimenopause is an important step to be able to managing these symptoms. While hormone replacement therapy (HRT) is a common first approach suggested by GPs it's important to be able to functionally test hormones before considering such treatment to avoid potential side effects. In this article, we'll explore the benefits of hormone testing in perimenopause, the key markers to consider, and how it can guide personalised recommendations for a healthier, smoother transition.

The Benefits of Testing Hormones in Perimenopause

Perimenopause is a complex phase characterised by hormonal changes similar to those experienced during puberty. These changes can have a significant impact on various aspects of health and wellbeing and can look and feel different person to person. A classic picture in early perimenopause is for progesterone to fall off a cliff (hello anxiety, sleep issues and heavy periods) and oestrogen can be up to 3 times higher. Now you can imagine how someone might actually feel a lot worse if they were then to add MORE oestrogen into the mix with a non-personalised HRT prescription. Unfortunately for some people, symptoms can get worse after taking HRT especially if they have underlying insulin resistance or poor oestrogen detoxification.  By testing hormone levels first, we can gain valuable insights into hormone production, balance, metabolism, and the influence of external factors such as stress or nutrient deficiencies. This information allows for targeted interventions, including diet, lifestyle modifications, specific supplements and also personalised bioidentical hormone therapy, to alleviate symptoms and support overall health in a holistic way.

There are no specific tests to diagnose perimenopause, so understanding the symptoms and their patterns are really valuable. Hormone testing plays a complementary role in providing a more accurate picture of hormonal imbalances and their impact on the body. Rather than relying solely on test results, it's important to consider the overall presentation of symptoms and work with a healthcare professional to develop a comprehensive approach to perimenopause management.

FSH Testing Limitations and Other Key Hormone Markers to Consider: Follicle-stimulating hormone (FSH) testing is commonly used by GPs to determine menopausal status. However, it is unreliable for diagnosing perimenopause due to fluctuating hormone levels. FSH levels can vary throughout the perimenopause phase, making it challenging to obtain accurate readings. While FSH testing can rule out other conditions like polycystic ovary syndrome (PCOS), relying solely on this test can miss important information about hormonal imbalances in perimenopause.

Here are the other key markers to consider when testing hormones in perimenopause:

1. Oestrogen Levels and Metabolites
2. Progesterone and Progesterone Metabolites
3. Testosterone Levels
4. DHEA and DHEA-S Levels
5. Androstenedione Levels and Metabolism Pathways
6. Cortisol and Cortisone Levels
7. Cortisol Awakening Response (CAR)
8. Melatonin Levels
9. Comprehensive Testing Beyond Sex Hormones including androgens, cortisol, neuro transmitters and key nurients.

For individuals considering or already on hormone replacement therapy (HRT), hormone testing is a powerful tool for monitoring treatment effectiveness and safety. Testing can assess hormone metabolism, ensure appropriate dosing, and identify potential imbalances that may require adjustments in the treatment plan. Regular testing every six months helps optimise HRT and maximise symptom relief.

Integrating Testing into Perimenopause Management

Testing hormones in perimenopause provides invaluable insights into individual hormone imbalances. By understanding specific imbalances, personalised interventions can be implemented to address symptoms effectively. Whether through dietary and lifestyle modifications, stress management techniques, supplements or hormone therapy, a targeted approach based on test results supports a smoother perimenopause transition.

Case Study: Client's experience of HRT without holistic support

Pippa is 48, she was experiencing anxiety, breast pain and sleep disturbances and went to her GP who prescribed HRT. Within 3 months, she noticed her existing symptoms got worse and she put on 8kg of weight around her middle. She came to work with me after coming off the HRT. We worked together to co-create a health coaching plan that including increasing her nutritional content, blood sugar regulation alongside the emotional support provided through our bi-monthly coaching sessions. Over a 3 month period, she lost 6kg and is now feeling more in control and her symptoms have reduced by 90%. She plans to test to see her hormone status and detoxification pathways before considering HRT in the future.

Case Study : Perimenopause management with holistic support

Amanda is 42, she has noticed new symptoms such as anxiety, heavy periods, increased allergy symptoms, rashes and insomnia. She completed my 6 week Detox, Reset & Go Health Coaching program and at the end of the program her symptoms had reduced by 75% using nutrition, lifestyle and stress management tools.
Amanda did a hormone test as she wanted to understand the root cause behind her remaining symptoms. The test results showed that she had:

• A preference for the 4-OH pathway in phase 1 which is more inflammatory

• A preference for cortisol (rather than cortisone) which can be linked with inflammation

• Possible low B6, which could be contributing to her high histamine causing allergy symptoms and making oestrogen even higher

• Low progesterone (suggesting a lack of ovulation and likely the cause of her anxiety and insomnia)

Her plan included specific supplements, nutritional changes and lifestyle measures to lower cortisol, lower oestrogen and histamine, it also included recommendations to address increasing her dopamine, progesterone and B6. Amanda completed another 6 weeks of health coaching after receiving her test results and is currently symptom-free. 

She has gained life-long tools to use that she says now feel like 'second-nature' to her, along with having a list of trusted holistic practitioners to lean on for years to come. Amanda did not choose to go on HRT but if she did, progesterone only hormone therapy would have been the best fit for her at this time.

I understand the challenges of navigating perimenopause and the need for personalised support. That's why I offer my health coaching program specifically designed for people in perimenopause. This six-month program provides step-by-step guidance, accountability, and support to help manage the ebbs and flow of perimenopause with confidence. 

Written by Alisa Connan