It’s not uncommon for our patients to report that their hormonal tests that they have had done previously have been reported as “normal” but that they are experiencing symptoms that are related to their hormones. There are a few reasons why this may happen, which illustrates why hormone testing is so difficult, and why you need an experienced practitioner to help you solve the mystery of your blood work and your symptoms.
- It matters WHEN you go for your test.
If you’ve gone for testing before, but no one told you when to go (i.e. which week of your menstrual cycle), then your blood work isn’t being interpreted as clearly as it should be. You see, each week of your menstrual cycle has different levels of “normal” hormones. There are weeks when they are supposed to be low, and there are weeks where they are supposed to be (sometimes 10x) higher. So if we don’t track when you went, then we have no context for whether the tests lines up with the way you are feeling. It also means that the reference range for each hormone can be thousands of points wide to accommodate for the various stages of the cycle.
If you are not menstruating, some of your hormone levels might come back as very low, while others may be normal. The challenge is that depending on where you are in your stage of life (peri-menopause or menopause) we may again find this number to be “normal”, but it might not be ideal for your health.
2. Some hormonal conditions can’t be checked with lab work.
The other difficulty with hormonal testing is that it often doesn’t reflect how you actually feel. PMS for example, doesn’t get reflected in your lab work. If we line up 1000 women’s lab work, we can’t predict who has PMS just by looking at their lab work. So again, you may have been told that your lab work is normal, and this may have made you feel that your symptoms were not real. This couldn’t be farther from the truth. PMS mood changes, breast tenderness, menstrual cramps, and other symptoms have nothing to do with your lab work. Lab work during perimenopause may not accurately connect with how unwell a woman feels, and lab work in menopause (especially in the first 12 months) may not line up with a true “menopause” diagnosis, leaving women feeling under supported because the messaging they receive is that they aren’t in menopause quite yet, even though they have many symptoms of menopause.
3. Your numbers have to be matched up with your case (and your case needs to be actually taken!)
Would it surprise you to know that a full thyroid panel has 5 tests? Or a full hormonal work-up for women can be as many as 10-12 tests? There are other hormones and markers that could be added to get a full picture and help us understand if your main hormones are normal or not. Lab tests like insulin, SHBG, 17-OH progesterone, DHEA, Vitamin D or pituitary hormones like prolactin can teach us why women are struggling with acne, mid-cycle spotting, or how to construct a weight loss plan.
A full hormone assessment also requires a long conversation about your hormonal health history. Did your period first come when you were 8 or 16? Did you have difficult to treat acne? What was your fertility experience like? Yes your symptoms now matter, but the root of your concerns have probably left clues in your history. A deep discussion about your hormonal health as an adult can help us construct a strategy built just for you, with recommendations that match your needs.
As a practice that focuses deeply on women’s health, we often see women who feel brushed off or confused about their symptoms when their lab work has come back normal. We give clarity to women seeking support for their hormonal symptoms by listening to their story, educating about the importance of the right testing and by creating a plan that addresses symptoms with a practical approach.
If you have been told your lab work is normal, we’d be happy to give you a second opinion in our free 15-minute discovery call for new patients. Call the office to learn more.