.png)
The 'Pause
The menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn’t see coming, and the hilarious moments midlife can bring. You've got questions and we've got the experts to answer them.
The 'Pause
Hormone Testing: Beyond Blood Work
We dive deep into why standard hormone tests often miss the full picture of what's happening during perimenopause and explore comprehensive testing options that provide better answers.
• Dr. Erica Armstrong with Root Functional Medicine explains why conventional blood tests only capture a moment in time, missing the hormone fluctuations of perimenopause
• Standard testing ranges are broad, meaning you can be "within normal" yet still experience significant symptoms
• Functional testing options include Dutch test (urine), saliva cortisol testing, and gut microbiome analysis
• Tracking your symptoms is crucial alongside testing to identify patterns and triggers
• Comprehensive testing reveals how your body metabolizes hormones, not just hormone levels
• Many perimenopause symptoms can be addressed naturally by targeting the root cause
• DHEA and adrenal function are often overlooked but crucial during the perimenopause transition
• Autoimmune conditions like Hashimoto's commonly emerge during perimenopause and should be screened for
• Cortisol spikes can trigger hot flashes independent of estrogen levels
• Request FSH, LH, progesterone, estradiol, DHEA, insulin, inflammation markers, glucose, thyroid panel, and vitamin D from your doctor
Join our private Facebook group, the Pause Diaries, for real conversations about midlife symptoms, solutions, and sisterhood. It's a safe space to ask questions, share your story, and find support from other women going through the same journey.
Loved this conversation? Let’s keep it going.
Join our private Facebook group, The Pause Diaries, where we dive deeper into all things perimenopause and menopause—without judgment, just real talk.
If this episode inspired you, share it with a friend or colleague. And don’t forget to subscribe, rate, and review The Pause Podcast—your support helps us bring more expert voices to the table.
Got a story, symptom, or question? Send it my way at by posting it our Facebook Group The Pause Diaries that supports the podcast.
I just might feature it in an upcoming episode!
Until next time, stay curious, stay empowered, and never hit pause on your wellbeing.
Welcome to the Pause, the menopause podcast, with unfiltered conversations about the symptoms you hate, the changes you didn't see coming and the hilarious moments midlife can bring. I'm your host, val Leggo, and I've been a dedicated health reporter for 25 years and I wanted to normalize something that every woman goes through menopause. So together we're going to talk about it the Perry, the Menno and the Post. Welcome to the Pause. Hi friends, welcome back to the Pause. I'm Val Legle, your host. I started this podcast because I wanted to talk more about perimenopause and menopause. I have been in the health, wellness and lifestyle industry as an accredited health reporter for nearly 25 years and I feel like it's really time to just start talking about perimenopause and menopause. Women want answers and I hope this podcast helps to give you some of this. So I was thinking the other day. Let me ask you have you ever had one of those weeks where your mood is literally all over the place, your energy gone, your sleep non-existent, you're bloated, you're irritated, you're craving potato chips and you're thinking maybe I'm just having a rough week? Or maybe you're thinking, is it my hormones? Because that can definitely be an issue. So here's the deal During perimenopause, our hormone levels are just fluctuating wildly. Think back to, like your teenage years, like when I entered perimenopause. I cried a lot about nothing. I would cry at TV commercials, I couldn't watch Disney films. It was crazy, and I also was like that as a teenager, where I would just cry at everything. So think back to that and what you went through, and it might be mirroring what you're going through in perimenopause, because it's like a hormone rollercoaster and you're never getting off that ride. So let's try to understand what's going on. And really what it starts with is your estrogen levels and what they're doing. Here's a little bit of a twist, though. I'm not talking about like going to your doctor and asking for that blood test. We all want a blood test to tell us what's going on, and a lot of women I know do go and get that blood test and say, ok, the doctor says you're within range and that range could be within 400 points. But here's the thing that's only a moment in time. That day you're in the office, that's the only day you're probably going to have that hormone level. So we are going to talk about natural ways to monitor your estrogen. I'm talking about natural, functional ways to actually measure what your body is saying and to help us break it down.
Speaker 1:I'm so excited for this next guest, dr Erica Armstrong. She's the founder of Root Functional Medicine. She is a rock star in the world of personalized hormone care. She's joining us now. Hi, erica, hi, thanks for having me. Oh, I'm so excited to talk about this. I've had so many women wanting to know about how to measure their hormones, so many who have gone to the doctor and said my doctor says I'm fine. Have you heard that before? Absolutely yes, probably more times than you can count, and you know. Then it just it leaves women feeling confused because their doctor's not wrong if their hormone levels or when they get the blood test are in the right range, but it doesn't necessarily mean that they're right either.
Speaker 2:Yes, there's a chance that there is something going on that's being missed if it's not appropriately evaluated. So what?
Speaker 1:what would be the biggest signs for you if you're seeing someone and their estrogen levels are too high or too low?
Speaker 2:Yeah, so in perimenopause, as you likely know, it's a roller coaster Estrogen could be really high one day and low the next day, and it's that constant fluctuation that often causes the symptoms. But estrogen plays a key role in mood and metabolism and memory and sleep and menstrual cycles, and so you could have this constellation of symptoms that could be vague or confusing, and so actually knowing what's going on is very helpful.
Speaker 1:And we like to tell women to track their symptoms, because that part of the equation is really important as well. If you're noticing something that's going on, if you suddenly have joint pain which I had, terrible hip pain, if you're, you know, all of a sudden you've got dry eye. I mean, there's so many strange symptoms to perimenopause out there. So I do feel like that's a really important thing for women to do, but it's not, it's not the end, all be all to really help you dial in where that estrogen is in. So I want to talk a little bit about, like, when you do go to the OBGYN, why and you get that blood test, why, if you can expand, why that's not going to give you the full picture of what's going on.
Speaker 2:Yeah, and so at Root we still do use conventional blood tests like the estrogen estradiol level in the blood, but we tend to do a much larger panel of them than what is typically ordered, and we try to time them appropriately if we can. So traditional labs will measure estrogen at one single point in time, but often without the context of where you are in your cycle or how your body is metabolizing hormones, and so that snapshot can miss the broader story, especially in perimenopause when hormones shift daily. We have a lot of different ways that we can look at this. Functional labs help us see patterns and ratios and the way things are metabolized and pathways that basic tasks overlook. And then, as far as conventional labs, when we do our perimenopause panel at root, we include more labs. For example, often a lab test that is missed that can be drawn conventionally is a DHEA, and this is a hormone that's produced by the adrenal glands and that is converted to testosterone. So the adrenal hormones are actually really important in perimenopause as they're doing a lot of the work, especially towards the near menopause, and so it's also very common to have HPA access dysfunction. That means hypothalamus, pituitary adrenal or the signal from your brain to your adrenals to produce hormones like cortisol and DHEA. So, as you know, it's a very hectic time of life often too, and so the HTA access dysfunction is very common, and that can also be a confounding part of the picture.
Speaker 2:So, and you can also have identical symptoms from opposite hormone imbalances For example, low progesterone, could also lead to hot flashes, and so this guessing can lead to frustration and more trial and error and not testing. Things also opens up the potential to overlook key areas of health during these years, like inflammation, insulin resistance, a full thyroid hormone panel, since all of these things are actually also affected by hormones. So, as you said, there's a lot going on and the symptoms can be confusing. They get even things like joint pains and brain fog, as you mentioned, bloating, sugar cravings. They might be a part of something bigger that you don't want to miss. You know, for example, autoimmune diseases is more prevalent in perimenopause. So, at Root, we can use the testing to personalize a more holistic care plan and looking at all the different aspects of your health in perimenopause, not just hormones, although hormones are a big part of it. We would be missing a lot if we didn't evaluate the other areas I just mentioned.
Speaker 1:Yes, no, I totally agree, and probably a topic for another podcast because it's a large one. But I have a lot of friends who realized that they had autoimmune diseases as they were two or three years into perimenopause, and so it's interesting how those correlate a lot with each other. So I'm glad you mentioned that, because that is also something that I think women should be looking out for when they're looking at symptoms. I'm not realizing that maybe they even have one.
Speaker 2:Especially Hashimoto's. That's the most common autoimmune condition. That is the thyroid dysfunction. And again, if your thyroid is not evaluated as part of your labs, several things could be missed there, including hypothyroidism. That could be contributing to waking, or it could be related to how your hormones, your estrogen, is working in the body Now you do something called the Dutch test when you're talking about this panel that you just described.
Speaker 1:is that the Dutch test? Is that including everything, or is that a little bit more?
Speaker 2:specific. We have multiple ways to test hormones, so blood tests are still great to get. That panel the FSH, lh, estrogel, progesterone, dhea that is a good baseline, especially if you're not sure. If you're close to menopause, fsh is a great blood test to get and it's super affordable compared to some of the other functional testing. For example, our perimenopause panel, if you're rude, is less than $100. And so that can be a great way to get a lot of key information from the blood.
Speaker 2:Dutch testing is urine testing, so pros and cons of this. Pro is you can do it at home. You have to collect urine on a card at several points throughout the day for 24 hours so we can see a good 24-hour picture. It's very comprehensive. It shows hormone levels, how your body is actually metabolizing and detoxifying estrogen. It includes 35 different hormones. Did you know there are different types of progesterone and different types of progesterone and different types of estrogen do different things in the body, and so it also includes an organic acid test to look at vitamin levels and even melatonin. And you can do this all at home. It's actually actually just mail in the cards, so super easy to collect and send in, but it is a very comprehensive test, so it is more expensive, and so the last way to test hormones is saliva.
Speaker 2:The way that we test hormones in saliva is for cortisol, and we want to do this again at four points during the day because we want to see what happens morning, mid-afternoon, evening and before bed, because people will spike cortisol at different points and it might be correlating with your symptoms and we can target in the treatment plan when we know what's happening for you and we can actually point out. Sometimes it's like, oh, it's spiking, you know, right after dinner Maybe there's some blood sugar indents going on. So, yeah, so yeah, so it can help put that together. One last thing just because I'm a functional medicine doctor, I have to mention this is gut health testing. So if you, especially if you have any gut health concerns, a stool microbiome test can be really helpful. So the gut is involved in hormone metabolism, especially beta-glucuronidase, which is an enzyme produced by a bacteria in your gut, and it can cause estrogen to be reabsorbed, and so this is part of estrogen balance. A big part of it is how it's microbiome.
Speaker 1:Yeah, the microbiome. I've been reading so much about it and how much it truly impacts your health and all of the things that are going on in your body, let alone when you're going through it in perimenopause and menopause. That is fantastic that you're able to test that as well and really get people set on the right path with that. Do you have women that you've helped that have been in the perimenopause space, that have had these tests, that are saying like, wow, I'm so glad I did this?
Speaker 2:Well, absolutely yes, and some things get better right away Just knowing, like certain nutrient deficiencies, or knowing your thyroid's been malfunctioning. Other things like gut health. We can devise a three to six month gut healing protocol and you'll continue to improve over this next several months.
Speaker 1:So let's say you have a patient and they've gone through all of the testing that you've asked them to do and it seems like they might need maybe some estrogen supplementation. But they're a little bit worried about HRT, and I just want to be transparent here. I've said this on many other podcasts. I am on HRT, it works for me and I am very happy with it. However, it's not for me and I'm very happy with it. However, it's not for everyone, and this podcast is about inclusivity and making sure that women get the information that they want, and I know that there are a lot of women out there that want to do things in a natural way. So what would be your next steps with a woman who maybe is a little bit low on estrogen, doesn't want HRT, but wants to feel a lot better than she does right now?
Speaker 2:Yes, we definitely attract this clientele at Root as well, although we can prescribe HRT and we do when it's part of their goal, their treatment plan. But let me tell you one client success story that I'm thinking of in this picture. She did not want estrogen, but she was having hot flashes. She originally came in to see us for high blood pressure and as we improved that through diet and lifestyle, we were able to wean her blood pressure medication. That was her primary goal. Yes, and she noticed oh, by the way, my hot flashes got better.
Speaker 2:Yes, and she noticed oh, by the way, my hot flashes got better. She had thought there was nothing else she could do because, you know, she was already beyond, you know, that window when doctors were ready to prescribe, you know, hrt or estrogen. Yes, and so she thought well, I guess this is a getting better one if there's anything else we can do. And so we actually did cortisol testing. It was the right test for her because it also could be related to some of her other symptoms and blood pressure, and we found that her cortisol was spiking after dinner. We started adaptogens at dinner and bedtime and, along with good sleep hygiene and making sure enough protein was consumed at dinner. After about a week of starting the adaptogens, she was no longer waking up in the night with hot flashes. They were coming from cortisol, which actually we see very, very commonly.
Speaker 1:I feel like estrogen gets all the press, but if you treat your cortisol, it will help your hot flashes as well and the fact that she felt a difference in a week because a lot of times they'll say, oh, give it a month and then we'll see where you're at. I mean, if you've been suffering long enough, a month month seems like an eternity the fact that she could see things turn around and this was for her. What I love about it is that you are individual. Every single woman that comes through your doors is different. Their body makeup is different. Your testing might be very much the same, but the results of those tests are going to be different, and that's where the key comes into the way that you prescribe. You know whatever it is that they need to do to be able to feel better.
Speaker 2:Yes, thank you.
Speaker 1:Yeah, I think that's really great. So how often should a woman test her estrogen levels? And I don't mean like just to be able to see like where she's at? If you've already done that course of seeing like where you're at and you know you've done the strips that you mail in After that, should you continue to test yearly, every six months, where? What? Should women continue to monitor that?
Speaker 2:Yeah, I think again, this is personalized. I think once a year is great. We recommend other testing once a year, but also when you feel like things may need to be adjusted and it might not just be your hormones, as we were saying. There might be other factors that you want to have tested if you're feeling like your hormones are off because the symptoms may be overlapping.
Speaker 1:So what should women be asking for when they go to their practitioner?
Speaker 2:Yes, if you're going to a conventional practitioner, you'll likely be getting a blood test, as typically Dutch testing or microbiome testing is not available. But a blood test can be a great start. So I would ask for an FSH, lh, progesterone, estradiol and DHEA. Ideally you would also get an insulin level, an HSCRP, a marker for inflammation, a glucose and a full thyroid panel and vitamin D. But keep in mind these are not covered as preventative, so they would have to be ordered tied to symptoms and you may end up with a bill. But if you prefer to skip all of that guesswork and surprise large insurance bills, you can actually order all this stuff on our website. I recommend starting with our root cause panel, which has a lot of those and more, and then the perimenopause hormone panel and that's drawn at Quest Labs, and you can download those results and take to your practitioner if that's easier for you.
Speaker 1:Erica, are there any final thoughts that you want to do to wrap up this conversation? It's already been great and insightful, but I want to make sure that we don't miss anything.
Speaker 2:Yeah, I think you know. My final thoughts are trust your symptoms. You're not going crazy. There's something off. Yes, love that. Confirm it with data. Yeah, confirm it with data. And if you can't get the testing from your doctor, there are lots of other ways to get that, including root. And then don't let anyone tell you.
Speaker 1:It's just aging. There is a root cause and a solution, and you don't have to feel like this for the rest of your life. That's what I thought, right, all right, thank you so much, dr Erica Armstrong from Root Functional Medicine. Your expertise has been invaluable and I know there are women listening that are truly going to be wanting to look into the ways that they can feel a lot better.
Speaker 1:Ladies, here's the bottom line If something feels off, you're not imagining it, you are not crazy and you're definitely not alone. There are natural, data-driven ways to figure out what your hormones are doing, and you don't need to settle for being dismissed or ignored. Also, before we go, I want to invite you to our private Facebook group, the Pause Diaries. This is where we have the real conversations about midlife symptoms, solutions, sisterhood. I love these ladies. We've got almost 700 in our group. It continues to grow. It is truly a safe space to ask questions, share your story, find support from other women. This is where I'm going to put some information on how you can get a hold of Dr Armstrong, because navigating perimenopause is hard enough. No one should have to do it alone. Remember, menopause is not the end of anything. It's the beginning of the rest of your life and we are going to talk about it.
