You have been on oral estrogen for menopausal symptoms, but you still don’t feel right.  Despite being on 1 or 2 mg of estradiol, you still have hot flashes, can’t sleep well, and feel anxious.  Or, what if you’ve been on hormones for a long time and are wondering how safe they are? Or, what if you are 40-something and you still have your periods but feel exhausted and emotional?  What is the best way to test your hormones in these cases?This is a snapshot of the typical patient in my office.  How do you test for hormones effectively?  There are 3 main ways to test hormones:

1. Serum (blood): they are inexpensive and easy to collect.  They have reference ranges that are easy to understand.  However, they have a wide reference range and many people fall in the normal range.
2. Saliva: a little more expensive but also easy to collect.  Once on hormone replacement, these tests will be less accurate and people will often look overdosed even though they feel good
3. Urine testing: expensive, and a bit inconvenient to collect.  However, this test can assess cancer risk by measuring the estrogen metabolites, is very comprehensive, and can help to monitor hormones once on hormone replacement.

If you suspect your hormones are out of balance, discuss hormone testing options with us.  I use serum testing for estrogen levels sometimes, and I find urine testing to be helpful for just about everything else.  Did you know that urine hormone testing can tell us:
– if the hormones you are ingesting are getting absorbed, or are just being metabolized to your liver and broken down quickly
– if the hormones are adequate
– if there is a good balance of E1 (estrone), E2 (estradiol), and E3 (estriol).  Since estriol (E3) is breast protective and E1 is pro-carcinogenic, these measurements are very helpful at assessing risk
– the ratio of 2 hydroxyestrone/16-alpha-hydroxyestrone: a low ratio is associated with increased risk of cervical and breast cancer; a ratio that is too high can increase the risk of osteopenia and osteoporosis
– if your poor energy is due to low estrogen, or low thyroid or adrenal function
– if your body is metabolizing your estrogen to protective metabolites, such as 2-methyoxyestrone or 2-methyoxiestradiol

The urine hormone test, serum test, and good history and physical exam can be used together to get your hormones balanced and get you feeling back to your best self again.  Contact us for more information.

Nari Pidutti, ND