Yes, you Can Test your hormones in Perimenopause

Perimenopause is the topic of conversation everywhere I look these days. And I know I am not the only one - so many of my friends and patients want to know if they are in perimenopause. And many have been given the message by their providers- our hormones fluctuate so much in perimenopause that it’s no use in testing them. 

The truth is, we can test hormones in perimenopause and it can be quite helpful in piecing out what is causing symptoms and what to do about them. But while estrogen and progesterone steal the headlines, I am far more interested in what influences these hormones - thyroid, nutrients and metabolic health. Here are the top 5 lab markers in the blood that I find essential—but are routinely missed—during perimenopause.

#1 Fasting Insulin

Fasting insulin, along with hemoglobin A1c and fasting glucose, can help us understand if insulin resistance or a blood sugar imbalance is influencing the hormonal landscape. Insulin impacts our immune system, brain and heart health. It’s good to look at cholesterol and liver enzymes if fasting insulin is high. Symptoms of high insulin are:

• Weight gain around the middle

• Stubborn weight loss

• Fatigue after meals

• Craving sweets

• Overall exhaustion

#2 Complete Thyroid

Thyroid stimulating hormone (TSH) is often run as part of a general lab panel, but there are several other important thyroid markers. Thyroid hormones influence cycle length and ovulation, and also support the production of progesterone. Symptoms of an underactive thyroid are: 

• Exhaustion

• Feeling cold

• Weight gain

• Depression

• Brain fog

• Hair loss

#3 Iron and Ferritin

Iron status is about both circulating iron and stored iron (ferritin). Heavy, long or frequent periods can deplete both. Low iron and ferritin can look like: 

• Exhaustion

• Pale skin

• Heart palpitations

• Hair loss

• Poor concentration

• Anxiety

#4 Vitamin D

Vitamin D is an essential nutrient and hormone. It’s famous for protecting our bones but it also supports immune, brain and possibly even heart health. Low vitamin D is often asymptomatic, but some might feel:

• Tired

• Brain fog

• Muscle cramps or weakness

• Depression

• Hair loss

#5 Vitamin B12

Vitamin B12 is a nutrient that supports several systems in the body, and absorption typically goes down as we age. The symptoms of low B12 overlap with many other causes, which is why it is so helpful to test. B12 deficiency may show up as: 

• Fatigue

• Brain fog or memory loss

• Anxiety

• Depression

• Tingling in hands or feet

• Weakness

Thyroid and blood sugar imbalance and nutrient deficiencies are common drivers of hormonal symptoms. When people ask about hormone testing, what they’re usually asking is why they don’t feel like themselves—and this is where we often find the most clarity.

While these tests may be available through a primary care provider, insurance can make access challenging. For those who need an alternative, I offer a cash-based comprehensive lab panel for $150 that includes over 60 markers—covering all of the labs discussed above, plus many more.

Can we test estrogen and progesterone in perimenopause?

Yes. Once we’ve assessed thyroid function, metabolic health, and nutrient status, we can look more directly at sex hormones. Keep in mind that there is no single blood test that can diagnose perimenopause or predict exactly when menopause will occur. And decisions about hormone replacement therapy (HRT) are typically guided by symptoms rather than lab values alone.

With serum (blood) testing, estrogen is usually measured on cycle day 2 or 3 along with FSH and LH, and progesterone is tested 5–7 days after ovulation. To add more nuance, we may also use urine-based testing.

The Mira Monitor is an at-home urine test that tracks estrogen and progesterone (along with FSH and LH) in real time across the cycle. This can be especially helpful when symptoms fluctuate throughout the month, or for those who’ve had a hysterectomy but still have their ovaries.

The DUTCH test is a comprehensive urine test collected at home during the second half of the cycle. In addition to estrogen and progesterone, it evaluates testosterone, DHEA, melatonin, and cortisol. This deeper look can be invaluable when standard approaches aren’t providing enough answers or relief. 

Beyond Testing - Perimenopause and Our Golden Opportunity

Perimenopause is an enormous transition. During our reproductive years, our ovaries go from producing enough estrogen and progesterone to nourish both ourselves and the possibility of new life, even if we don’t have children. We have enough resources for ourselves and to give away - to raise a family, take care of aging parents or to grow our careers. In perimenopause, ovarian hormone production begins to slow, and eventually these two powerhouse hormones decline significantly. 

As the ovaries retire, our adrenal glands take on production of estrogen and progesterone in modest amounts, and our fat cells become a source of estrogen as well. Estrogen receptors in some areas, like the brain, increase in order to make the most of the reduced levels of estrogen - fascinating!

We are, in many ways, built for this transition, even if it doesn’t always feel this way. By the time we enter into perimenopause our resources are often tapped. Years of stress, disrupted sleep, nutrient depletion, and “pushing through” can leave the body without the capacity to smoothly adapt to rapidly changing hormone levels.

In Chinese medicine, this season of life is viewed as a Golden Opportunity. Without enough resources to give away anymore, we are invited to slow down, realign with nature, and attune to our changing needs. Ancient wisdom tells us that this is a time to restore qi and blood, to nourish what has been spent, and to reassess how we live and care for ourselves. Modern neuroscience is beginning to echo this perspective. We now understand that the brain is actively rewiring during this transition, pruning less-needed connections and creating space for new ones.

Working Together

Acupuncture can be a powerful way to reconnect with yourself during this transition. Treatments can help regulate cycles, improve sleep, and reduce hot flashes—but they also offer a chance to pause, decompress, and reset. Care can be symptom-focused as needs arise, or more comprehensive, incorporating lab testing and functional medicine approaches such as liver support and gut healing. While I don’t prescribe hormone replacement therapy (HRT), I can help you determine whether it might be a good fit for you and can connect you with prescribing clinicians.

No matter what brings you in, this is a space to exhale—to be fully yourself. Nothing is too much, and you don’t have to figure it all out on your own!