Why Women Over 40 Should Still Get Their Hormones Tested

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Hormone health is complicated. Sometimes it's hard to know what we should be doing about it and when! That's true at almost every stage of our lives but especially when we start to exit our reproductive years.

Hormones are messengers that are released from one gland to exert effects on another, varying in quantity and form depending on our age and sex. They are part of the endocrine system and include glands such as the thyroid, ovaries or testes, adrenals, pancreas, pituitary, pineal, hypothalamus, and thymus. Each of these glands has at least a few different messages for other organs listed here, as well as other organs in the body.

The communications between these glands can be altered by many things, including a less-than-optimal lifestyle; factors such as poor diet, health status, relationships, emotions, and sleep can snowball over a period of time, leading to dysfunction—which is why it's important to get hormone levels tested.

Should all women get their hormones tested?

Women over 40 not only still make hormones, but they are naturally less predictable in function. This means they are likely involved in many health concerns of women in this age group. We shouldn't make the mistake of assuming that a woman's hormones aren't a factor if she's already had children or is entering perimenopause or menopause.

The sex hormones estrogen, progesterone, and testosterone are each produced in different amounts in the ovaries. Estradiol (E2) is the predominant and most potent form of estrogen in premenopausal women and is synthesized primarily in the ovaries, while estrone (E1) is the weaker form of estrogen that is dominant in menopausal women. The shift to predominantly E1 may also prompt a body change in women in which their weight shifts more to their abdomen than their hips. The adrenal glands and fat cells also produce E1 and E2, which is why women can still have estrogen even after ceasing to menstruate (and why men have it too).

What are the symptoms of an age 40-plus hormonal imbalance?

When a woman's sex hormones are out of balance they can contribute to pathology in the reproductive organs such as uterine fibroids and ovarian cysts, as well as anxiety, depression, premenstrual syndrome (PMS), acne, sleep issues, food cravings, weight gain, gut issues, low libido, low energy, and heart disease. The majority of women around this time frame may experience new or worsened symptoms because hormones now are biologically scheduled to shift. It's just a matter of how, and to what degree they shift, as symptoms can be varied and unpredictable—or even absent.

Common issues include menses being closer together, fertility dropping, greater difficulty in handling stress, random flow of menses, insomnia, weight gain, mood issues, and structural concerns like endometriosis, ovarian cysts, and uterine polyps, all commonly associated with elevated estrogen. Progesterone, the hormone that's associated with keeping us relaxed (and can help us lose weight), plummets in comparison to estrogen's decline, leaving estrogen higher than usual, which is known as estrogen dominance. Further, extra estrogens over the past few decades from places like chemicals in our environment and beauty products, for example, also have a snowball effect in contributing to issues. Testosterone also drops a bit, as well as dehydroepiandrosterone (DHEA), a precursor to testosterone and our anti-aging hormone (declines naturally with age), which also influences weight changes as well as hormones involved in appetite control.

When hormones are out of balance, they can also affect the activity of other organs that are involved in making and metabolizing hormones. For example, elevated estrogen increases thyroid-binding globulin (TBG), which binds up active thyroid hormone. The thyroid is responsible for metabolism and how fast processes move throughout our body (why symptoms like constipation and low energy are present in an underactive thyroid). In another example, stress on the body—which releases the hormone cortisol—actually turns inactive thyroid hormone into another inactive version, instead of active.

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What hormone tests should we all be getting?

Tests allow for an in-depth quantitative look of how seemingly unrelated health concerns correlate, as well as address any other issues that could be hindering healing. Blood tests are great for analyzing thyroid markers, complete blood count (CBC), comprehensive metabolic panel (CMB), cholesterol, hemoglobin A1c, vitamin D (which is a precursor to hormones), iron, FSH, LH, DHEA-S, and sex-hormone binding globulin (SHBG), a protein that binds up estrogen and testosterone. Urine and saliva tests are also useful because these reflect free, active versions of hormones like progesterone, cortisol, estrogen, and testosterone versus blood tests that reflect free and bound (inactive versions). Further, urine and saliva tests collected over a period of time (especially correlated with a curve in cortisol, our stress hormone) provide information as an average versus just a snapshot in time. Urine can also provide information regarding metabolites of E1 and E2, which can also be helpful.

Women have at least four different hormones in fluctuation each month, and their whole body is affected. Factor in inherited conditions or genetic mutations that affect estrogen and metabolism of other hormones, and it quickly becomes a complicated puzzle. Birth control and hormone replacement options may be discussed as treatment modalities, but they address only a fraction of the full conversation.

Once they have an accurate picture of their hormone health—using testing and analysis of signs and symptoms—women need a treatment plan that addresses all the different organ systems to nudge their bodies back to homeostasis. This can often be done by re-establishing a good foundation for hormone health, which means proper nutrition, good sleep, stress management, and a healthful lifestyle. 

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