Perimenopause, Menopause & Thyroid

• TSH and Free T4: how well your thyroid is working.
• TPO and thyroglobulin antibodies: markers of thyroid autoimmunity.
• FSH: the pituitary signal to the ovaries. It tends to rise as ovarian function declines, and can swing widely during perimenopause.
• Estradiol: the main form of estrogen before menopause.
• Total and free testosterone: androgen levels, which decline gradually with age.
• Lipid panel: total, LDL, HDL and non-HDL cholesterol, plus triglycerides.
• Hemoglobin A1c: your average blood sugar over about 3 months.
• Vitamin D, 25-hydroxy: the standard measure of your vitamin D status.

This panel suits women in perimenopause or menopause who have a thyroid condition, and women with midlife symptoms that could have either cause.

It does not include progesterone, which only reads correctly on a timed draw and is unreliable when cycles are irregular.

Consider testing when new symptoms appear or your cycle starts to change. In women over 45 with typical symptoms, perimenopause and menopause are generally identified from symptoms and cycle history, not from a hormone test. Hormone results can be more useful if you are under 45 or your cycle history is hard to read, such as after a hysterectomy.

If you still have periods, a draw in the first days of your cycle makes results easier to compare over time.

No fasting is needed.

• Thyroid medication: if you take levothyroxine or another thyroid medication, have your blood drawn before that day's dose and bring the dose with you. Keep taking your medication as prescribed otherwise.
• Biotin: high-dose biotin, common in hair, skin and nail supplements, can distort many of these lab results. Stop it at least 2 to 3 days before your draw.
• Hormone therapy and birth control: tell your clinician if you use either, because they change how FSH, estradiol and testosterone should be read.

Your report shows Quest's reference range next to each result.

• FSH and estradiol: these can change from month to month during perimenopause, so a normal result does not rule it out, and one high FSH does not confirm it. Read them with your symptoms and cycle history.
• Testosterone: use female reference ranges. Oral estrogen can lower free testosterone.
• TSH and Free T4: TSH usually moves in the opposite direction from thyroid hormone. If you start oral estrogen and take levothyroxine, your dose needs may rise, so ask your clinician when to recheck.
• A1c: 5.7% to 6.4% falls in the prediabetes range, and 6.5% or higher in the diabetes range, which is normally confirmed with a repeat test. Anemia and iron deficiency can skew A1c.
• Lipids: cholesterol often rises around menopause. Your clinician reads these results with your overall cardiovascular risk.