Female hormones affect menstruation, fertility, and libido. An imbalance in hormones like progesterone and estrogen can affect the entire body. Hormone testing is often performed for women who are experiencing menopausal symptoms that are the result of a hormone imbalance. Testing can determine what hormones are low or high and the right dosage of hormone therapy needed to restore balance. For women who are entering menopause, hormone replacement therapy (HRT) can be an effective way to reduce symptoms.

Blood, saliva, and urine tests are used to determine whether HRT is needed and to monitor dosages. Dr. John R. Lee, who was a renowned expert on HRT, developed a quick test to determine if symptoms might be due to a hormone imbalance. If a woman meets these criteria she may benefit from having tests performed to see what kind of hormone therapy can help her.

Testing is important for finding the right dosages of hormones to prescribe when starting therapy. It is also important for monitoring how HRT is affecting hormone balance. The “normal” hormone range can have variations between women but there are some basic standards of what are low and high levels. Each kind of testing has its own advantages and a combination of tests likely is necessary to prescribe the most effective HRT regimen. For each woman, a unique formulation of hormones will need to be prescribed based on her hormone levels.

Types of Hormone Imbalance Testing

Blood Spot Testing

Blood spot testing involves pricking the finger with a small lancet and putting a few drops of blood on paper. This test can be done at home and should be done before eating and drinking, first thing in the morning. Blood tests performed at a lab by drawing blood are still sometimes used but most women find the at-home spot test easier.

Blood testing is ideal for testing levels of follicle stimulating hormone (FSH) – a hormone that stimulates production of sex hormones. An FSH blood test is one of the most commonly used blood tests for premenopausal women with symptoms of hormone imbalance. The level of FSH varies through a woman’s menstrual cycle so knowing the first day of the last period is necessary. This test can be useful for determining if there is some kind of hormone imbalance or if a woman is in menopause, but not for determining dosages for HRT. Consistent levels of FSH > 30mIU/mL and no period for 12 months is an accepted determination of menopause. Levels of FSH will remain high indefinitely after menopause as the body continues to attempt to produce hormones.

While the FSH test is useful, blood testing is not the most accurate for measuring levels of sex hormones to determine HRT dosages. Most blood tests measure the total hormone level and not the amount that is available to be used. Additionally, certain hormones like progesterone when applied topically do not have a large impact on blood serum levels but do increase levels in saliva. This may lead to blood serum results that show a lower amount of hormones than are actually being used by cells.

Saliva Testing

Salivary hormone tests detect active hormones in the body. This provides the level of hormones that are bioavailable at the cellular level versus free to be used in the blood stream. The level of bioavailable hormones is more clinically relevant than the amount of bound hormones. Many doctors consider this to be the most accurate way of measuring hormone balance. For hormone therapy applied transdermally, saliva is the preferred testing method. Transdermal application does not tend to affect blood serum levels in the same way. If a doctor prescribes hormone therapy based on normal serum levels but uses a saliva test to determine dosage, it will result in an overdose of hormones.

Saliva testing also has the benefit of being widely available and easy to use. It does not require drawing blood or sending out for blood tests. There are different kinds of saliva tests for both female and male hormones including estradiol, progesterone, testosterone, DHEA, and cortisol.

Example saliva test combinations

• Estrogen Dominance: Progesterone and Estradiol (E2)
• Major Reproductive Hormones: Estradiol (E2), Progesterone, and Testosterone
• Adrenal Stress Profile: DHEA and four Cortisol tests (morning, noon, evening, and night)

Urine Testing

Urine tests are not used as much for hormone replacement therapy as they do not detect hormones. For understanding how hormones are processed in the body, however, urine tests can be useful. If levels of other kinds of tests are normal but a woman is still experiencing symptoms, a urine test may show that there is a problem with metabolism. A urine test is sometimes taken first thing in the morning when hormone production peaks. A more accurate collection method includes a 24-hour profile to factor in hormone fluctuations. This provides a better perspective about available hormones and how they are being metabolized.

Prescribing for HRT

Doctors who prescribe hormone replacement monitor symptoms to determine optimal levels of hormones. Most will not just base their prescribing decisions on one test result. Each kind of test may show a different hormone imbalance. The most accurate results come from a series of tests. The goal of HRT is not to get the perfect number on a test, but to relieve symptoms of hormone imbalance effectively with the least side effects.