We caught up with Ann L. Steiner, MD, clinical professor of obstetrics and gynecology, who specializes in caring for menopausal women and practices at Penn Health for Women Radnor.
Penn Medicine for Women: When should you have your hormones checked?
Dr. Steiner: First of all, we don't routinely check hormone levels in women. Some women think that because they might be going into menopause, they need to have their hormones checked. It’s not appropriate to do this, because we don't treat hormone levels.
The emphasis here is that in menopause, we treat symptoms. And therefore, there's no reason to check sex hormone levels routinely for women who are in the menopause.
Taking a history and hearing someone's story, especially if they have issues related to menopause, is much more important in guiding management than hormone level results. Really, it's the story and history that gives us guidance in joint decision making of care.
For instance, during menopause, a women’s estrogen level is dropping and other hormones go up in response. We know what's going on. We treat her symptoms.
You might have one woman who's going into menopause, and she has absolutely no symptoms, she has no hot flashes, she feels great. And if we were to check her hormones, they would be reflective of menopause. We might have another woman who's the exact same age who is not sleeping well, and has terrible hot flashes, and her mood's off, and we check her hormones, and they're exactly the same as the woman who has no symptoms.
PM: Are there other times in a woman’s life when it would be appropriate to check hormone levels?
Dr. Steiner: Yes. There are other times when we need to check hormone levels.
For instance, if a woman stops getting her period prior to menopause, or has menstrual irregularity, we would check hormone levels to diagnose what is causing the problem, then treat her.
We commonly check thyroid stimulating hormone (TSH), a hormone that regulates metabolism, for women who are having hot flashes, symptoms of having too much thyroid, or not enough thyroid, fatigue, sleep issues or unexplained weight change. Abnormal thyroid levels can be associated with these symptoms, as well as abnormal menstrual changes.
PM: Are women who have reached perimenopause or menopause generally more concerned with hormone levels than those of reproductive age, or does it run the gamut?
Dr. Steiner: That's a tough question, because it's pretty subjective. My practice involves mostly women who are around the age of menopause, but I would just say over the years looking back, I've had women of all ages ask to have their hormones checked when they feel that something is not right or that there are changes.
For instance, if they experience mood changes, weight change, or fatigue, they often will ask to have their hormone levels checked, whether it's an appropriate thing to do or not.
It is not an uncommon request from women approaching menopause or with issues related to menopause. The best approach is to take the time to use this as an opportunity to educate patients about the appropriate use of tests.