• Dr. Saru Bala

Are your hormones all over the place? Here are the hormone labs your doctor needs to be checking


The most common question I hear is:

"What tests should I ask my doctor to run?"

This question is tricky because, as with everything, it depends. It depends on what symptoms you're experiencing, it depends on what your family history looks like, what your personal medical history looks like, what your day to day life looks like, how your nutrition, your sleep habits, your exercise habits, etc look like. All of these factors matter when considering what labs to test.


That being said, I do like to do some baseline work up to get an idea of the root cause of your hormonal issues.


Irregular periods


If you're having irregular periods, this means you're not ovulating. Your menstrual cycle centers around ovulation, and when your period is irregular, ovulation is not occurring regularly.


Thyroid

This could happen for various reasons. The most common reason is thyroid issues. Your thyroid is your master controller in your endocrine (hormonal) system. It controls everything from your body temperature, to metabolism, to heart rate, to digestion, all the way to brain development. In short, it does a lot. So if your thyroid is off, then you can bet your periods are going to be off.


The most important piece I always like to check for is subclinical thyroid autoimmunity. About 90% of people with hypothyroidism actually have Hashimoto's (autoimmune hypothyroidism). Testing antibodies is the only way to check for this.


Many providers say they only check for antibodies if TSH comes back abnormal. The issue with that is, you may have a subclinical Hashimoto's picture- meaning your antibodies are elevated but it hasn't gotten to the point of affecting your other thyroid markers... yet. If you let it get to the point of waiting for it to be out of hand, the damage has gotten pretty extensive. It's always good to rule out and prevent an autoimmune picture before it gets to the point of causing an underfunctioning thyroid.


On top of thyroid antibodies (anti-TG and anti-TPO), a full thyroid panel is always good to check in on. This includes:

  1. TSH

  2. Free T3 and T4

  3. Total T3 and T4

  4. Reverse T3

PCOS

The second most common reason is PCOS (Polycystic Ovarian Syndrome). This condition can happen for a number of reasons and there are various types of PCOS which can be stemming from different causes. Read more about PCOS and the different types here.


To assess for PCOS, you need to see elevated androgens, either clinically (facial hair growth, hair loss, or acne) or on labs, along with either anovulatory cycles (irregular periods), or polycystic ovaries.


On top of testing for androgens, assessing blood sugar and ovulatory hormones like FSH and LH are important as well. Generally in those with PCOS the LH:FSH ratio is higher than normal, as your brain is trying to send out signals to tell your body to ovulate and your ovaries are non responsive due to higher levels of androgens interfering with ovulation.


Lab testing for this should include:

  1. Free and total testosterone

  2. DHEA-s

  3. Sex hormone binding globulin

  4. Fasting insulin (not just HgA1c and glucose)

  5. LH & FSH (high LH:FSH ratio can be seen in PCOS)

Functional Hypothalamic Amenorrhea

This is another top cause of irregular or absent periods. This is usually caused by improper/inadequate nutrition generally due to disordered eating, high stress, and/or over exercising. This triad is also known as the "female athlete's triad" since many female athletes exercise heavily and don't get adequate sleep/recovery, and aren't eating enough calories to support their physical demands.


This results in low levels of estrogen that shut down the body's menstrual cycle. This happens up in the brain- where signals that go from your brain to your ovaries are no long communicating as they should and result in impaired feedback mechanisms.


To assess for this, you need to be looking at the signals from the brain and your overall estrogen status:

  1. LH & FSH (typically this ratio is low, unlike in PCOS)

  2. Estradiol

Heavy or Painful Periods


If you're having heavy and/or painful periods, this can be due to a number of factors as well. Blood testing for this doesn't always reveal much information, but it can sometimes provide some insight.


Heavy periods can often be associated with higher levels of estrogen, though blood testing for this may not always show this. This is why I like to do DUTCH complete testing. This testing helps to get a further and more functional understanding of what's going on with your hormones. It not only looks at total estrogen levels, but it also looks at progesterone levels (and comparison of estrogen to progesterone), along with both phase 1 and phase 2 of liver metabolism of estrogen to understand where the pain/heaviness may be stemming from.

Sample Report from DUTCH


With painful periods, prostaglandins are the main reason you feel pain. Prostaglandins can cause more inflammation and uterine contractions. The higher your prostaglandin level, the higher your pain. Prostaglandins could be elevated due to diet (fried foods, alcohol, low fiber, high processed food intake), poor sleep, and lack of exercise.


I don't do much blood testing to assess for either of these as the DUTCH testing provides more than enough information to adequately address heavy and/or painful periods. If you struggle with heavy or painful periods, check out my online course to help navigate you through how to address these issues integratively!


Hair Loss or Thinning Hair


Ah yes, everyone's biggest concern! This can be a scary issue when you don't why it's happening.


The main reason for hair loss is usually due to stress. It causes something called telogen effluvium. Your hair has different phases, and telogen is the last phase before your hair essentially dies and sheds naturally. Stress can speed up the rate at which it takes your hair to reach the telogen phase and cause excess shedding. So don't forget about daily stress management!


Another reason for hair loss could be iron deficiency or anemia. Assessing for this includes not only looking at a complete blood count (CBC) to evaluate the size and shape of your red blood cells, but also looking at full iron panel including:

  1. CBC

  2. Iron

  3. TIBC

  4. Ferritin

  5. Iron Saturation

Aside from anemia, thyroid conditions and PCOS may also contribute to hair loss. Check in with your provider to make sure you're checking for hormonal issues along with anemia to evaluate your hair loss.


Functional Testing


Along with lab testing, most of what integrative medicine looks at are the functional tests. DUTCH testing is one of these. Along with food intolerance testing, stools testing to get a closer look at your microbiome and flora, or micronutrient testing. Most of these labs won't be done by your conventional provider. You will likely need to be working with an integrative medicine provider to get these more eclectic lab testing done.


These tests gives us a further look into what's going on with your body as a whole. Your hormones don't act independently from the rest of your body. If something is off with your hormones, you better believe there's likely something going on with your gut health, diet, nutrition, stress, sleep, etc as well. So, assessing your body as a whole is important for figuring out the root cause of why you're having hormonal issues and then addressing those causes!


What if my doctor won't run these tests?


This happens, a lot. I've worked with several patients who have told me that their previous provider refused to run the tests they wanted to look at. And this can be for a number of reasons, but usually it comes down to this: if your provider is unaware on how to treat something, they won't test for it. And that is purely for legal reasons. If something comes up on a test and they don't address it, then they're liable for that.


Most providers are unaware of what to do when thyroid function testing comes back normal but antibodies are elevated. Most providers are unaware that gut health and liver metabolism play the biggest role in period pain and heavy periods. Most providers aren't trained in using supplements, nutrition, and botanical medicine in their treatment plans, so they can't explore those options with you.


This is why it's important that if you want integrative care, you have to work with a licensed integrative provider. Licensed naturopathic doctors are trained not only in conventional care, but we also get hundreds of hours of training in botanical medicine, nutrition, and lifestyle therapies to give you the most evidence-based integrative approach we can!


If you're finding that you're hitting a wall with your provider, opt for a more integrative approach to assess your hormonal issues from a root cause perspective!


REFERENCES:

  1. Armstrong M, Asuka E, Fingeret A. Physiology, Thyroid Function. [Updated 2020 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan

  2. Nussey S, Whitehead S. Endocrinology: An Integrated Approach. Oxford: BIOS Scientific Publishers; 2001. Chapter 3, The thyroid gland.

  3. Nussey S, Whitehead S. Endocrinology: An Integrated Approach. Oxford: BIOS Scientific Publishers; 2001. Chapter 3, The thyroid gland.

  4. Harris HR, Titus LJ, Cramer DW, Terry KL. Long and irregular menstrual cycles, polycystic ovary syndrome, and ovarian cancer risk in a population-based case-control study. Int J Cancer. 2017;140(2):285-291. doi:10.1002/ijc.30441

  5. Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581

  6. Ricciotti E, FitzGerald GA. Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol. 2011;31(5):986-1000. doi:10.1161/ATVBAHA.110.207449

  7. Malkud S. Telogen Effluvium: A Review. J Clin Diagn Res. 2015;9(9):WE01-WE3. doi:10.7860/JCDR/2015/15219.6492

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