Getting Tested for Menopause (and Fertility)
Let’s talk about those out-of-whack hormones.
Fortunately for us, when it comes to testing for hormone levels, no pencil is needed, and you really can’t fail. For those of you squeamish about needles, rest assured you can get most of these done with a single blood draw. You might find that you don’t need all these or that you need a test or two that I haven’t listed. More is not necessarily merrier when it comes to medical testing, so you’ll want to discuss all of the options with your menopause specialist.
It is not unheard of that a women’s hormone numbers will appear normal while her menopause symptoms are through the roof, because every woman lives differently and at different hormone levels. What is normal for one woman may not be functional for another. Be sure to bring your Menopause Symptoms Chart in with you to help you explain how you feel to your specialist because this helps determine what the test results mean for your body and how best to approach your individual situation.
Please note: If a woman is using certain hormone therapies (such as birth control pills), your hormone tests will not be valid. A doctor may ask you to stop taking birth control pills for several months before conducting tests. If you’re still menstruating, have your hormone testing done during the first three days of your period.
Here are the tests that I found helpful in my own menopause journey:
- Follicle-Stimulating hormone (FSH) Test Follicle-stimulating hormone (FSH) levels are sometimes measured to confirm menopause. This test is also used to determine a woman’s likelihood of conceiving a child. The test is generally repeated over several months to account for fluctuations in hormone levels that may be occurring. After several tests, if a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause. Some doctors prefer to test the anti-mullerian hormone (AMH) levels instead. The AMH levels are decreased in perimenopause. Fertility doctors have been using this test for years as they find that the levels are not affected by taking birth control pills.
- DHEAS DHEA sulfate is a hormone that easily converts into other hormones, including estrogen and testosterone.
- Estradiol This is the main type of estrogen produced in the body, secreted by the ovaries. Low levels can cause memory lapses, anxiety, depression, uncontrollable bursts of anger, sleeplessness, night sweats and more.
- Free and Total Testosterone Free testosterone is unbound and metabolically active, and total testosterone includes both free and bound testosterone. (No, this has nothing to do with 50 Shades of Grey.) In women, the ovaries’ production of testosterone maintains a healthy libido, strong bones, muscle mass and mental stability.
- Progesterone Low levels of progesterone can cause irritability, breast swelling and tenderness, mood swings, “fuzzy thinking,” sleeplessness, water retention, PMS and free membership to the sisterhood of the shrinking pants (weight gain).
- TSH (thyroid-stimulating hormone) According to the North American Menopause Society, menopause symptoms are similar to those of other conditions, such as thyroid disease. For some women, it may make sense to undergo medical tests to rule out such conditions as well. If there is an irregularity with your TSH, you may need to get your Total T3 and Free T4 checked as well.
Once you’ve determined that you actually are in the midst of perimenopause or menopause, here are other important tests to consider:
- Bone Density Test Also called a bone scan or DEXA scan, this test can determine whether you have osteopenia (low bone density) or osteoporosis (very low bone density). When you enter perimenopause and menopause, the decline in estrogen can trigger a rapid loss of bone mass. The scan takes only minutes and exposes you to very little radiation. If you do have low bone density, your doctor may recommend you increase your intake of dietary calcium (found in food) or to take calcium supplements to avoid fractures.
- CA-125 Cancer antigen 125 is a protein best known as a blood marker for ovarian cancer. It may be elevated with other malignant cancers, including those originating in the endometrium, fallopian tubes, lungs, breasts and gastrointestinal tract. Note that this test can result in false positives.
- Cholesterol Panel Cholesterol levels change in perimenopause and menopause. Too much cholesterol can build up artery plaque, narrowing blood vessels and potentially causing a heart attack. A cholesterol panel usually includes checking your HDL (high-density lipoprotein or the good cholesterol), LDL (low-density lipoprotein or bad cholesterol) and triglycerides (molecules of fatty acids). You’ll need to fast for 12 hours before this test.
- Vitamin D3 This vitamin helps maintain normal blood levels of calcium and phosphorus, keeping your bones nice and strong. Women taking a combination of hormone therapy and calcium and vitamin D tablets after menopause were less likely to fracture their hip than those not taking hormones or supplements, according to one study.
However, a study from the Women’s Health Initiative (WHI) shows no significant connection between vitamin D levels and menopause symptoms.
Testing for Fertility
If you are more in the grandma stage of life than the mom stage, please share this information with the young women in your life who are in their childbearing years.
Our baby makers don’t work forever. Thank goodness. Can you imagine if they did? But if we keep an eye on our fertility clock, we can help make sure that when our lives are ready for pregnancy, childproofing, and dirty little handprints all over our walls (and our hearts), so are our bodies. Perimenopause may start earlier than you think, so too does your fertility begin to wane earlier than is commonly known. In order to take charge of your fertility and family planning, here are some tips for you:
About 95 percent of 30-year-old women have only 12 percent of their original number of ovarian follicular cells, which can develop into eggs. And at 40, only 3 percent of the cells remain, according to research from the University of Edinburgh. Now, the good news: The research says that before birth, females have roughly 600,000 ovarian follicular cells. That means that even if you lose 88 percent of them by the time you blow out 30 candles, you can still celebrate having 72,000 cells left.
While it’s easiest for women to become pregnant before age 35, all egg-laying ovaries are not created equal, says David B. Smotrich, M.D., a Diplomate of the American Board of Obstetrics and Gynecology specializing in Reproductive Endocrinology and Fertility. During your early 30s, your eggs can decline in quality and you might begin ovulating less frequently, even if you are having regular periods, according to Smotrich. A 30-year-old woman has a 20 percent chance of getting pregnant per cycle, but by the time she’s 40, her odds drop to 5 percent per cycle, according to the American Society for Reproductive Medicine. That’s where some newfangled fertility tests come in.
If you plan to have a baby in the great “someday,” Smotrich recommends treating yourself to a baseline exam or two for your 30th birthday. Follow-up with yearly tests until age 35, semi-annual tests (I suggest you time them with the Victoria’s Secret semi-annual sales!) until 39, and quarterly tests thereafter to monitor your fertility.
Here are some of your fertility testing options, some of which overlap the tests for menopause:
- Follicle-Stimulating Hormone (FSH) Test (See above for details.)
- 25-Hydroxy Vitamin D TestA blood test that determines if your body is deficient in calcidiol, your body’s main form of stored vitamin D. Calcidiol levels generally decline with age, and deficiencies can predispose your baby to health complications, according to Smotrich.
- Estradiol Test (See above for details.)
- Anti-Mullerian Hormone (AMH) TestA blood test that estimates the number of the eggs in the ovaries.
If the ticking of your biological clock has become deafening and time is running out, medical interventions can help women older than 35 conceive. During in vitro fertilization, for instance, eggs are harvested from your ovaries, frozen unfertilized, and stored for later use. Your eggs can then be thawed, combined with sperm in a lab, and implanted in your uterus. In women ages 35 and younger who undergo up to six cycles of in vitro fertilization therapy, the live-birth rate ranges from 65 to 86 percent. Women ages 40 and older have half the chance of giving birth from in vitro therapy, with their rate ranging from 23 to 42 percent, according to an analysis of more than 6,000 patients published in The New England Journal of Medicine.
During perimenopause, it is possible to conceive a healthy baby, while at the same transitioning to menopause, he says. However, since the risk of chromosomal complications increases with the mother’s age, Smotrich recommends women older than age 35 talk to their doctor about having their developing baby monitored for chromosomal conditions including Down syndrome. Tests include a nuchal scan, a type of ultrasound, and amniocentesis, also referred to as an amniotic fluid test or AFT, in which a small amount of amniotic fluid, which contains fetal tissues, is sampled.
BTW, no matter what kind of medical tests you are having, always ask for a copy of the lab results and keep them in a notebook or electronic folder.
Do not be shy about asking for the tests you need. You’re worth it! Your test results, together with an evaluation of how you feel and a discussion of your medical history will enable your specialist to successfully help you find hormone happiness and regain your quality of life back.
My Motto: Suffering in silence is OUT! Reaching out is IN!