Perimenopause, also referred to as the menopause transition, is a time period in a woman's life that may be characterized by irregular menstrual cycles and declining hormone production in the years leading up to menopause. Symptoms related to this phase can impact the quality of life and are quite prevalent, with roughly 90% of women seeking professional help for their symptoms in perimenopause and menopause. 

The menopausal transition can be a time of major shifts for women when it comes to their health and lifestyle, and an integrative approach that uses laboratory assessments to guide treatment options can be extremely helpful in improving symptoms and quality of life.  

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What is Perimenopause?

Perimenopause is a hormone transitional time leading up to menopause. During perimenopause, the overall levels of estrogen and progesterone start to decrease due to declining ovarian function. Fluctuations in estrogen can lead to symptoms like irregular periods, hot flashes, sleep changes, and other symptoms. The perimenopause experience varies greatly, though the average duration is three-four years. Some women may start to experience perimenopause in their mid-30s, while others may not start the transition until their early 50s.

What is The Difference Between Perimenopause and Menopause?

While perimenopause is a hormone transitional period that can vary greatly in duration, menopause is defined as having had no menstrual periods for 12 months and, as such, is more of a benchmark separating perimenopause from post-menopause.

Women can start perimenopause at different ages - for some, it may begin in their mid-to late-thirties, while for other women, it may just be the 3-4 years leading up to menopause closer to age 50. During perimenopause, the ovaries begin to go into failure, leading to significant decreases in estrogen production as a woman's fertile years come to an end. While hormones are declining overall during perimenopause, women still have menstrual cycles and may be ovulating during the transition, whereas menopause marks a full year of not having a menstrual period at all.  

Symptoms of Perimenopause

As many as 70% of women experience various symptoms during perimenopause and leading up to menopause. The symptoms of perimenopause vary from woman to woman and may include the following:

• Irregular periods
• Hot flashes
• Sleep problems
• Mood changes, including depression, mood swings, irritability, and rage
• Vaginal dryness
• Bladder problems
• Decreased fertility
• Decrease in bone density
• Changes in cognitive function, including brain fog and difficulty concentrating
• Weight gain
• Changes in cholesterol levels
• Decreased sex drive

The Importance Of Laboratory Testing In Assessing Perimenopause Patients

The diagnosis of perimenopause does not require a specific lab test and is often based on a given patient's age and history.

Laboratory testing can be a helpful tool in assessing the needs of perimenopause patients, helping to customize an integrative approach to address symptoms of changing hormones and improve quality of life. Evaluating sex hormones as well as other relevant physiology (such as gut testing, cortisol evaluation, and blood glucose markers, for example, can help correlate hormone status with clinical symptoms.

Top Labs to Run Bi-Annually on Your Perimenopause Patients

While each individual patient case may require different lab tests to get the full clinical picture, some of the top labs to consider running bi-annually on perimenopausal women can be found below.

Comprehensive Female Hormone Panel

A comprehensive evaluation of female hormones is an important starting step for perimenopausal women. During perimenopause, sex hormones start to decline, though this decline often occurs unevenly rather than being a smooth, continuous decrease - making for often-frustrating symptoms. The DUTCH Complete looks at sex hormones (estrogen, progesterone, testosterone) as well as adrenal hormones (cortisol), melatonin, and organic acids, which can provide insight into nutritional and neurotransmitter deficiencies that may also be impacting common perimenopause symptoms such as poor sleep.  

Blood testing that evaluates FSH (follicle stimulating hormone) may also be performed as part of a comprehensive serum hormone test, as rising FSH is closely associated with symptoms of the perimenopausal-menopause transition and can be related to symptoms like weight gain around the midsection and a decrease in cognitive function. 

Getting more information about hormone levels in perimenopause can help guide an integrative approach towards treatment, including options such as monitoring hormone replacement therapy, supporting stress management and reduction strategies, and implementing nutrition and lifestyle habits to help strategically support fluctuating hormones - all of which can help women feel more energetic and vibrant.

Comprehensive Thyroid Function Tests

A comprehensive thyroid panel is another important lab test to consider, as thyroid dysfunction symptoms often resemble symptoms of perimenopause. For example, the fatigue and poorer cognitive function often seen in perimenopause can resemble hypothyroidism symptoms, while hot flashes, anxiety, and sleep disturbances overlap with hyperthyroidism symptoms.  

In perimenopause, there can be a decline in various thyroid biomarkers, while others (such as reverse T3) can increase. Assessing a complete thyroid panel - not just TSH - can be helpful in getting the full picture of a perimenopausal woman's thyroid function. Additionally, the menopausal transition may affect the expression of autoimmune thyroid conditions, so monitoring thyroid levels can be particularly important for perimenopausal women who have these conditions.  

Comprehensive Stool Testing

Evaluating the health of the gut microbiome is an important component of any plan to support optimal hormone health during perimenopause. The sex hormones and the gut microbiome influence each other, so a period of hormonal changes is likely to impact the makeup of the gut microbiota, which can, in turn, influence other hormone systems, digestive function, and other physiological roles.

The gut microbiome plays an important role in estrogen detoxification, and a segment of the microbiome called the estrobolome is composed of bacteria that are responsible for eliminating inactive estrogen metabolites. If enough beneficial gut bacteria are not present due to a dysbiotic gut environment, an enzyme called beta-glucuronidase is produced and converts inactive estrogen back to its active form, which is reabsorbed by the body and can often contribute to frustrating hormonal symptoms. As estrogen levels can fluctuate quite a bit in perimenopause, the relationship between estrogen and the gut microbiome can be an important lab assessment to help with patient results.  

A comprehensive digestive stool analysis can assess for aforementioned biomarkers such as beta-glucuronidase, evaluate for dysbiosis, and can help identify if gut support is needed for optimal digestion and immune function.  

Micronutrient Testing

During perimenopause, a woman's nutrient needs change as her physiology changes. Micronutrients such as vitamin D, calcium, B vitamins, zinc, magnesium, and iron are essential for the hormone fluctuations and accompanying shifts in insulin sensitivity that are happening at this time. Vitamin C may be helpful for improving symptoms of cognitive decline that can occur with perimenopause.  

Calcium and vitamin D are important to support bone health, an important issue as bone density starts to decrease with declining estrogen levels. Vitamin K, selenium, and beta-carotene have also been linked with better bone mineral density in postmenopausal women, so optimizing intake of these nutrients, as guided by testing, can be part of a proactive plan during perimenopause.  

Using micronutrient testing can help identify vitamin or mineral deficiencies that may be exacerbating symptoms of hormone decline and can help guide personalized nutritional and supplement interventions to improve the quality of life for perimenopausal women.  

Lipid Profile

Estrogen production is known to exert protective effects on lipid metabolism and on vascular health. As estrogen declines in perimenopause, there's a loss of those protective effects, leading to a higher risk of cardiovascular disease, as well as lipid profile changes, including a rise in LDL-cholesterol and triglycerides with a concomitant decrease in HDL levels. Apolipoprotein B (ApoB), the main protein found in LDL cholesterol, tends to increase in the menopausal transition and can be included as part of a comprehensive lipid panel to assess cardiovascular risk as accurately as possible.  

A comprehensive lipid profile can help with the early detection of any unfavorable changes in cardiometabolic biomarkers so that early nutritional and therapeutic interventions can be planned.

Blood Glucose and Insulin Levels

Perimenopause is associated with the appearance of many features of metabolic syndrome, including increased abdominal fat and increased fasting insulin and blood glucose levels. This association may be due to ovarian failure, or it may be a more indirect result of the redistribution of body fat to more central adiposity that can occur as estrogen levels decline.  

Fasting insulin and blood glucose levels are important markers of metabolic health, alongside lipid levels, triglycerides, blood pressure, and waist circumference. The menopausal transition may bring with it a higher risk of developing poor metabolic health, but regularly monitoring blood glucose and insulin levels can help perimenopausal women finetune their nutrition and lifestyle habits to support healthy fasting biomarkers - which will help decrease the risk of chronic health issues that accompanies poor metabolic health, and allow for early detection of any signs of insulin resistance or diabetes risk.  

Anemia Panel

While anemia is often associated with menstruating women due to the blood loss from having a regular period, iron-deficiency anemia can still occur in perimenopausal women, particularly in those who restrict their nutrition in an attempt to offset perimenopause symptoms such as weight gain. An anemia panel can provide information on iron levels and storage pools and can help a patient understand if they need to adjust their dietary intake accordingly. Iron levels tend to increase as women get closer to menopause and in the post-menopause time frame, as that monthly blood loss is no longer occurring.  

However, women using hormone replacement therapy to address perimenopause symptoms may experience lower iron levels, making monitoring anemia panels an important piece of data in an integrative approach to supporting perimenopausal women. Adequate iron stores are important for maintaining good energy levels and a sense of vitality, as iron plays physiological roles in oxygen transport as well as energy production in the mitochondria. 

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Summary

Perimenopause is a hormonal transition phase that doesn't have one definitive test or age range to identify when it's occurring. Utilizing lab testing can help women to be proactive about supporting their shifting hormones and other areas of metabolism and physiology that are impacted by the decline in sex hormones that characterizes perimenopause.