Should Middle-Aged Women Get Their Hormones Checked?

As women approach middle age, questions about hormonal health become increasingly common. Social media often advocates for hormone testing to understand menopause-related symptoms or to guide treatment decisions. However, current medical evidence indicates that routine hormonal blood tests during perimenopause or menopause are generally unnecessary and may not provide meaningful information. This is because hormone levels such as estrogen and progesterone fluctuate significantly during perimenopause, making single tests unreliable indicators of hormonal status.

During the menstrual cycle, key hormones like estrogens (estradiol and estrone), progesterone, and testosterone are produced by the ovaries, with their levels varying throughout the cycle. For example, estradiol levels double around ovulation, and testosterone levels increase slightly. Understanding these patterns helps clarify that sending blood at a random time doesn't yield conclusive results.

Menopause marks the permanent end of menstruation, characterized by a significant decline in ovarian hormone production. Perimenopause, the transition period leading up to menopause, involves irregular periods and fluctuating hormone levels, along with symptoms like hot flashes, night sweats, mood swings, vaginal dryness, urinary issues, and cognitive changes such as brain fog. These symptoms are primarily driven by hormonal fluctuations rather than static hormone levels.

Blood tests are not effective tools for diagnosing perimenopause, as hormone levels are highly variable. Instead, diagnosis relies on clinical symptoms—especially vasomotor symptoms like hot flashes—and changes in menstrual patterns. Routine hormone testing during perimenopause does not guide treatment decisions effectively. Management focuses on alleviating symptoms and addressing issues like heavy bleeding, rather than adjusting hormone doses based on blood results.

Hormone therapy, such as estrogen or progestogens, should be prescribed based on symptoms rather than blood test results. Blood estradiol levels cannot determine the suitability or dosage of hormone therapy because individual responses vary due to factors like hormone receptor sensitivity and metabolism. The same applies to testosterone and other hormones.

In summary, women in midlife should focus on symptom management rather than ordering hormone blood tests, which are not reliable or necessary for guiding treatment. Comprehensive care involves addressing specific symptoms, managing bleeding, and considering individual health profiles. It's important to consult healthcare professionals to develop personalized management plans for menopausal and perimenopausal health.

Source: https://medicalxpress.com/news/2025-08-middle-aged-women-hormones.html