Ellen is your advocate until you are strong enough to advocate for yourself. Ellen's book, Shmirshky: the pursuit of hormone happiness, guides you through the maze of options available to relieve symptoms, restore your sanity and improve your health.
Your journey through perimenopause and menopause (I call it PM&M) may be intimidating, but it doesn’t have to hold you back. When you think of menopause, you probably envision night sweats, insomnia, exhaustion, hot flashes, and weight gain. Let’s rethink the daunting menopause journey as an opportunity to function at 100%. If Dorothy was looking to go home and the Cowardly Lion was looking for courage, you are following the yellow brick road to hormone happiness, no matter what flying monkeys get in your way!
First, it’s helpful to understand that perimenopause is the symptom-laden 6-10 years before you reach menopause. You are in menopause when you have been without a period for 12 consecutive months. The average age of menopause is 51.
You might we be wondering, “How do I know if I am in perimenopause or menopause?”
I have put together a list of tests that I found helpful during my PM&M journey in Shmirshky: the pursuit of hormone happiness. In addition to your yearly Pap smear and mammogram, these will help you and your PM&M specialist (find one here) determine where you are on your PM&M trek, and most can be done with one blood draw. Always ask your doctor’s office for a copy of your lab results and keep them in a notebook or folder as you might need to refer back to them during the course of your journey. Everyone operates differently. It is important to understand that your test scores are only half of the story—the other half is how you feel. I put together a Daily Symptoms Chart on pages 168-9 to make it simple and convenient for you to track your symptoms. Be sure to take your filled-out chart with you to your doctor’s appointment. This will enable your doctor to successfully fine-tune your personalized path to “Emerald City.”
Hormone panel: If you’re still menstruating, have your hormone panel (blood test) done during the first three days of your period.
DHEAS: DHEA sulfate is a hormone that easily converts into other hormones, including estrogen and testosterone. This adrenal hormone triggers puberty and is of the highest concentration of the hormones in the body. DHEAS is the sulfated form of DHEA in the blood. While DHEA levels fluctuate throughout the day, DHEAS blood levels are steadier and more reliable.
Estradiol is the main type of estrogen produced in the body, secreted by the ovaries. Low levels can cause memory lapses resulting in sticky notes aplenty, anxiety, depression, uncontrollable bursts of anger, sleeplessness, night drenches and much more.
Free and Total Testosterone: Free testosterone is unbound and metabolically active, and total testosterone includes both free and bound testosterone. In women, the ovaries’ production of testosterone maintains a healthy libido, strong bones, muscle mass and mental stability.
FSH (follicle-stimulating hormone) is a pituitary hormone that stimulates the growth of the ovum (the egg and surrounding cells that produce ovarian hormones). This test can help indicate whether you’ve entered menopause. However, the suggested normal ranges need to be examined along with your Daily Symptoms Chart so that your doctor can properly evaluate the test results. There is no one-size-fits-all correct test result. What is normal for your best friend, sister or mother may not be normal for you.
Progesterone is a hormone that stimulates the uterus and prepares it for pregnancy. It also regulates the menstrual cycle, and low levels of progesterone can cause irritability. Results will vary depending on when the test is done.
Thyroid workups usually include checking your TSH (thyroid-stimulating hormone). If there is an irregularity with your TSH, you may need to get your Total T3 and Free T4 checked as well. (Free means it won’t be affected by your estrogen status, not free of charge!) Remember that the symptoms for PM&M and a thyroid disorder can be very similar.
Other important tests for women in PM&M:
Bone density is a measure of calcium and other materials in your bones. Also called a DEXA scan, the bone density test can determine whether you have or are susceptible to osteoporosis. When you enter PM&M, the decline in estrogen can trigger a rapid loss of bone mass, so it’s important to check. The test measures the strength of the hip and spine. It takes only minutes and exposes you to very little radiation.
CA-125 (cancer antigen 125) is a protein best known as a blood marker for ovarian cancer. It may be elevated with other malignant cancer, including those originating in the endometrium, fallopian tubes, lungs, breasts and gastrointestinal tract. Be sure to talk with your doctor about the pros and cons of this test, as the normal value range varies among laboratories and the CA-125 test can result in false positives.
Cholesterol is a waxy substance produced by the body. It makes hormones, skin cells, and digestive fluids. Cholesterol levels change in PM&M. Too much cholesterol can build up artery plaque, narrowing blood vessels and potentially causing a heart attack. A cholesterol panel usually includes checking your HDL (high-density lipoprotein or the good cholesterol), LDL (low-density lipoprotein or bad cholesterol) and Triglycerides (molecules of fatty acids), and gives you your total cholesterol/HDL ratio. You’ll need to fast for this test, so don’t eat or drink for 12 hours beforehand.
Vitamin D3 (Cholecalciferol) is the vitamin that helps maintain normal blood levels of calcium and phosphorus, keeping your bones nice and strong.
For a full list of suggested test ranges see pages 57-64 in Shmirshky: the pursuit of hormone happiness.
Knowing and understanding these levels in your body, in conjunction with tracking your symptoms on your chart, will help you and your doctor determine the right approach to finding hormone happiness. If you are suffering from sleeplessness, hot flashes, or an emotional roller coaster and your doctor looks at your blood tests and tells you, “You are fine. You are not in PM&M,” do not go home and suffer! Push the wicked witch aside (It may be time for a new PM&M specialist) and trust how you feel—you know your body better than anyone. Once you finally reach the end of the yellow brick road, you’ll find you had the courage, knowledge and love for yourself to get the help that you deserved all along!