Written by Dr. Erin Fix, ND

Let’s talk more about hormone testing. Women come to me all the time asking about hormone testing. From blood tests to the Dutch test, while each has their time and place, it’s not the first place I start.

We’ve mentioned this before, but it’s crucial to know that hormones fluctuate dramatically during your 40s and 50s. This makes testing one single point in time a little tricky to interpret because your hormones are changing day to day. As a Naturopathic doctor, I start by asking a series of questions to my patients to determine what’s going on with their hormones. I always start here, and only test hormone levels for cases that are tricky or not responding to treatment as I’d expect them to.

So how can you be your own hormone detective to figure out where you are at?

Let me walk you through what typically happens with your hormones during your 40s and 50s.

During the menstrual cycle, there are 2 main hormones produced—estrogen and progesterone. Estrogen dominates the first half of the cycle, and progesterone dominates the 2^nd. Estrogen is the signal for the uterus to build up a lining and prepare for an egg to implant. Progesterone is a hormone that helps strengthen and maintain that lining. Progesterone is only produced after ovulation (the release of an egg). So if you don’t ovulate or ovulation is weak, progesterone will be low during the 2^nd half of the menstrual cycle.

This low progesterone in the 2^nd half of the menstrual cycle is the first change that happens in perimenopause, usually in your early to mid 40s.

Low progesterone causes some specific symptoms, often worse during the week leading up to your period.

A few signs of low progesterone you can look for include:

• Anxiety and/or irritability
• Mood swings (sometimes to the point where they can be very disorienting)
• Crying easily
• Trouble sleeping
• Brain fog

When progesterone is low but estrogen is still doing its thing, your menstrual cycles will still be fairly regular. They may be getting slightly longer or shorter, and your bleeding may start to change as well, but you will still be having regular cycles.

When you start to notice your cycles become irregular, or when you start having symptoms like hot flashes or night sweats, this indicates estrogen is starting to fluctuate.  

So let’s talk estrogen. The next hormone change that occurs is estrogen starts to become more volatile. It rises and falls at irregular intervals causing irregular periods.

Some things to look for with low estrogen and increased volatility include:

• Hot Flashes
• Night Sweats
• Brain Fog

Once periods stop altogether, it is safe to assume estrogen and progesterone levels are both low. With time, you will also notice hot flashes and night sweats subside, and this is a good indication estrogen and progesterone have stabilized.

While these are generalizations, here are the hormonal patterns I see and you can look out for as your own hormone detective

LOW PROGESTERONE, NORMAL ESTROGEN

1.     If you are in your 40s, chances are you are starting to feel the effects of lower progesterone levels –your PMS may be worse, your more anxious and/or irritable, you cry easily sometimes for no apparent reason, your mood swings feel disorienting, and you may be having a harder time sleeping

LOW PROGESTERONE, FLUCTUATING ESTROGEN

2.     If you’re still having periods, you’re still making estrogen. You need estrogen in order for the uterus to build up and lining. If your periods are still fairly regular, then the production of estrogen is happening is a consistent fashion. If they are not, then your estrogen production is starting to become irregular.

LOW PROGESTERONE, VERY VOLATILE ESTROGEN

3.     If you are experiencing hot flashes and night sweats, your estrogen levels are on a roller coaster. As periods become more irregular during the transition through menopause, estrogen levels rise and fall randomly.

LOW PROGESTERONE, LOW ESTROGEN, OCCASIONAL ESTROGEN FLUCTUATIONS

4.     If you are no longer having a period at all, your estrogen levels are low

LOW PROGESTERONE, LOW ESTROGEN, STABILIZED

5.     If you are no longer having a period and your hot flashes and night sweats have stopped, your estrogen and progesterone are low and have stabilized 

You can become your own hormone detective by being aware of the signs that come with low progesterone and low estrogen. Knowing your hormone profile can be a great first step in finding care to support the hormonal changes you are experiencing.