Thanks to Oprah, Suzanne Sommers, Dr. Christiane Northrup and many physician-authors before them (like Dr. John Lee), mid-life women now are far more knowledgeable about hormone therapy options that can help alleviate the most life-disrupting symptoms of menopause. What they (and their doctors) might not know so much about are the many kinds of tests that can be used to determine the best combination and doses of HRT products and supplements for optimal hormone balancing. To shed some light on this, I contacted Genova Diagnostics, and asked its Chief Medical Officer, Dr. Patrick Hanaway, to describe the different tests that a woman, complaining of menopausal symptoms, should request from their physician. (All lab tests require an ordering physician and cannot be obtained directly by consumers.)
Wendy: What kind of tests can help doctors pinpoint exactly what’s going on with a woman’s hormones?
Dr. Hanaway: A woman’s total hormones can be done with a serum (blood) test. A saliva test will measure reactive hormones. Urine will measure how your body uses the hormone. It’s important to find a doctor who is comfortable with one of these tests.
Wendy: Will you explain what the 24-hour urine test is and why it’s superior to a simple urine or blood test?
Dr. Hanaway: The 24-hour and First Morning Void (FMV) urine hormone tests are useful for measuring how the body uses hormones inside the cell. We get a picture of the levels of the “parent hormones” (progesterone, testosterone and estradiol) from urinary testing. We also begin to understand how these hormones are broken down or metabolized. Metabolites tell us about levels of stress, nutritional status and they can highlight risk of disease such breast cancer and osteoporosis.
Estrogen metabolites, in particular, are very useful to better understand modifiable risks of breast cancer. Of the two types of urine hormone testing, 24 hour urine testing is recommended for women using bio-identical hormone replacement therapy.
Wendy: There is much debate about whether saliva testing is a reliable way to measure a woman’s hormone levels. What is your opinion about saliva testing?
Dr. Hanaway: Salivary testing has been used for measuring hormones for the past 30 years. While many endocrinologists and OB-GYNs don’t have experience with this testing, they do reliably measure the free hormones in women (and men). However, it’s important to note that salivary hormone measurements in women taking trans-dermal hormone creams may not be reliable. Those tests should be run by a laboratory that has a demonstrated track record of reliability and reproducibility.
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P.S. from Wendy: Not all doctors have the experience with or see the need for the kind of specialized testing that Dr. Hanaway describes. If yours won’t, add a “specialist” to your health and wellness team who specializes in hormone balancing. This can be a naturopathic doctor, or an M.D. who practices integrative, holistic medicine. My earlier blog post on “finding an integrative medicine doctor” can help as can the websites of the American Association of Naturopathic Physicians and Genova Diagnostics, which will provide a list of physicians in your area that use their lab tests. Of course, personal referrals are always helpful, so if you’ve been working with a medical professional who has been espeically helpful for you, tell us about your experience in the comment box below and be sure to indicate where you live.
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Although I live in NC, I travel to see Dr. John Carr in Rancho Mirage, CA—he is well versed in BHRT therapy and is one of the kindest, most knowlegeable and patient centered physicians I have ever dealt with. His practice fees ($600 per year for unlimited office visits, phone consults, etc.) is far more reasonable than most because he is passionate that bioidentical hormone therapy should be available to women of modest means. His office number is 760-779-5511, his assitant’s name is Audrey.
Andrea – Thanks for the recommendation. He must be good for you to travel across the country to see him. BTW, Rancho Mirage is about 2 hours from Los Angeles and San Diego, near Palm Springs.
As we age, and especially by the time we hit menopause, it isn’t just the sex hormones that have a tendency to be crawling on the ground. Dr. Jerry Mixon of the Longevity Medical Clinic in Seattle tests the levels of ALL the hormones on every patient and never settles just for “within normal limits”. Optimal levels of the thyroid, adrenal, sex, and growth hormones work in concert with one another, and if one is off it can throw off the others. Pregnenolone is another important hormone that made me feel I was alive again once I began taking it!
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