By Dr. Alicia Ware
Almost every day, a woman comes to my clinic asking to have her hormones checked. Sometimes it’s for typical menopausal symptoms, like hot flashes, night sweats or mood swings. Most often, it’s for fatigue, weight gain or decreased libido. Only sometimes is it necessary or appropriate to measure hormone levels.
Many times, we know what’s going on just by the symptoms. The average age of menopause onset is 52, so if a woman in her late 40s or early 50s is complaining of hot flashes or night sweats, it isn’t necessary to assess hormone levels in the blood. We know they will be low. Investigation might be warranted, however, for the same symptoms in a much younger woman.
It’s important to understand which hormones we can check and what those values mean. The brain makes FSH and LH to tell our ovaries what to do. If ovaries are failing, FSH will rise. Estrogen and progesterone are the hormones ovaries make. Symptoms of low estrogen are those of menopause: hot flashes, night sweats and vaginal dryness. Varying levels of estrogen and progesterone can be responsible for headaches, nausea, bloating, abdominal cramps, irregular bleeding, breast pain, depression or sleep disruption. Often, these symptoms may come and go at different times in the cycle because there is a vast change in the level of these hormones over the course of a normal cycle.
If some symptoms are magnified, we often use formulation of hormones like birth control pills to overcome what the ovaries are doing and provide a stable hormone level to see if this addresses the symptoms. Because levels of estrogen and progesterone change every day, sometimes dramatically, drawing these levels isn’t usually helpful.
The thyroid gland makes thyroid hormone, which is a major metabolic force. Symptoms of low thyroid include cold intolerance, weight gain, hair loss and fatigue. Symptoms of elevated thyroid levels can include heat intolerance, rapid heart rate, palpitations and weight loss. All these symptoms can occur very commonly. We check thyroid levels very often, but they are usually normal. So while thyroid disease should always be ruled out, don’t bet on hypothyroidism being the cause of your weight gain.
Many people read about cortisol levels and the symptoms that can come with elevated cortisol. Elevated cortisol without a tumor is often due to Cushing’s disease. This is a very uncommon disease and usually presents with very specific symptoms such as a moon face, a buffalo hump on the back of the neck, central obesity and stretch marks. It’s usually more than weight gain and fatigue. Testing for Cushing’s disease is more specialized and may require referral to an endocrinologist.
Decreased libido may or may not be due to low testosterone, but this is a very common cause. Sometimes small amounts of testosterone supplementation can be helpful. Though testing testosterone levels is possible, normal levels of free testosterone in women are not clearly established.
In summary, although we can measure hormones, establishing a diagnosis of “imbalance” is very difficult because the numbers aren’t very useful for some hormones; follow your doctor’s recommendation about which tests are useful. The best course of action is often to manipulate the hormone levels to see if symptoms resolve.
Dr. Alisha Ware is an obstetrics and gynecology specialist with The Woman’s Clinic PA. Reach her at (228) 822-6368.