Hormone Testing in Perimenopause

Today we answer the most common questions about hormone testing, and the questions you need to get answered but might not know to ask. 

We talk about: 

• Where in your cycle testing will be most reliable, and what to do when you don't have a regular cycle. 
• Why there is value in getting tested before starting any hormone therapy, even when you don't have a period. 
• The importance of working with a hormone literate doctor that can order and interpret the labs from a perspective of optimal vs optimal, rather than disease vs within normal limits. 
• Whether liver function, blood sugar, cholesterol, and other markers should be monitored more closely or frequently as hormones that impact them start to change. 
• Testing that isn't standard that should be to help take clear and correct preventative action for things like osteoporosis and heart disease. 
• The uses and value of blood vs. saliva vs. urine testing for hormones. 

Chapters

00:00 Understanding Hormones and Testing Basics
05:14 Navigating Perimenopause and Hormonal Changes
10:33 The Importance of Comprehensive Testing
15:58 Evaluating Hormone Testing Methods
26:31 Addressing Hormonal Imbalances and Treatment Options

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Transcript

SPEAKER_02 0:01

Real women.

SPEAKER_01 0:02

Real talk.

SPEAKER_02 0:04

Real messy.

SPEAKER_01 0:06

This is Messy Midlife. Hi, everybody, and welcome back to Messy Midlife. Hi, ladies. Hello. Hello, everyone. So our last conversation was all about hormones and going over some of the basics for what hormones do in our bodies, the ways that hormones fluctuate when we're having our period, and the ways things get a little bit chaotic during perimenopause. And one of the things that comes up so frequently and that we've been asked to talk about is testing. And testing is one of those things that is so important that we know when and how to test and where it's important and where it really doesn't actually matter when we're looking at getting supports for any of the things that come up during perimenopause. So, Aliza, you do this all day, every day. And I'm just gonna look at you to lead the show today, if you are okay with it, to talk all about when we so let's start with pre-perimenopause. So like normal, fertile, menstruating regularly. When should people be getting tested to have accurate reflections of where their hormones should be to know if they actually are need support?

SPEAKER_00 1:12

Well, the first thing I'm gonna say is I'm I I hate air quotes, normal, like normal is different for everyone. In a 20 to 30 day cycle, I always say day one. Your cycle, day one is the day you start bleeding. So that's where we count everything from is day one is the day you you get your period. Um, in a cycle where you have, you know, 28, 29, 30 days between your day ones, you want to test a little bit in the later half of your cycle. So you want to test after you have that mid-cycle velation peak. Well, general rule of thumb is day 19 to 21 of a 28 to 30 day cycle. And look, the things that that can make that um a little sticky is like your day 19 on a Saturday and the lab's not open or a Sunday, right? So we have to be able to have a little bit of wiggle room. Nothing is totally set in stone. We want to make sure that we are testing after ovulation, but we want at least seven days before we're getting your period.

SPEAKER_01 2:12

And this is for all hormones that should be tested at this or primarily if the focus is on progesterone.

SPEAKER_00 2:17

No, this is for all of your hormones because you're basically wanting to see that estrogen progesterone ratio later in the cycle when estrogen is not the more dominant hormone, right? If we are looking at something like PCOS, like a polycystic ovarian syndrome, right? If we wanted to look at something like that for a specific health concern, we would actually do that earlier in the cycle. We would do that like day three of your cycle because that's where we would want to see your FSH and LH ratio.

SPEAKER_01 2:45

But follicle stimulating hormone and hormone.

SPEAKER_00 2:49

So it can vary depending on what we are wanting to look at. But if we're wanting to get kind of a general idea of estrogen versus progesterone, do we have more dominant estrogen versus not? Um, that's where we would do like a day 19 to 21. But we are doctors, we are not your doctors for anyone listening. So that needs to be discussed with your doctor. And I think it's really important to find a very hormone literate doctor to work with, right? Because anybody can put in a lab requisition or a lab order, but not everybody can interpret that, right? It's I I say this all the time. I can test for mold. I can I can tell you what test to take. It might not be the right test, like it might not be the best test. But when then what am I gonna do with those results? So just because we can test for something doesn't mean we should.

SPEAKER_02 3:39

And again, the difference between optimal and not diseased, very, very different. Yeah. So to your point, very important that someone be able to differentiate between those two.

SPEAKER_01 3:52

And it might be that you are getting a test done by your primary care doctor with the intention that if anything shows up that's atypical or that they just don't understand that what the plan is is to get a referral. So just understand that perhaps this is just a preemptive step to know where to send you or if you need to be sent to something else too. So that could be the case for some people in a more managed care system.

SPEAKER_02 4:15

And even if those tests come back within normal limits and you don't feel well, follow that because you may be able to find connect with someone who can run a different test or interpret them in a different way.

SPEAKER_00 4:29

Or look at other things that need to be looked at beside this. I think we were talking about this before. Just because we think everything is hormones doesn't mean that it is.

SPEAKER_01 4:42

Right. Yep. Yep, right. When you're women of a certain age, everything gets blamed on your hormones when it could actually be something completely different. I mean, I think when you're just a woman in general, everything gets blamed on your hormones.

SPEAKER_00 4:55

You know, when and when periods stop, it look, I think there are there's some trains of thought that say, you know, what's the point of testing? You don't need to do it, you don't have period hormones are gonna be undetectable. I still like to test just to see because our bodies surprise us. We never know. It's not like it's this extraordinary cost to run hormone levels, right? Insurance covers it usually, and it's also very inexpensive. So yeah, it's something that that definitely should, I think, just look at, just so you have a baseline. It doesn't mean you always have to keep testing hormones, but it's nice to know where you're at starting out because sometimes you see surprising values, right? So I had a patient who had had you know, wasn't on testosterone, had taken in the past and stopped it. It's like, oh, I just I feel like I'm so low testosterone again. Well, I write her a prescription for testosterone. We do a baseline test before she starts her prescription. It's crazy high. You would have never thought it would be that high with her not taking it, right? Then she has a prescription she's not using. But anyway, my point is just um expect the unexpected and have the data and go from there.

SPEAKER_01 6:03

So you mentioned what it's when we should test when we're menstruating to get ideal values that are useful. And then you talked about when our period is stopped. But what about that messy in between where your period is unreliable, inconsistent, all over the place? And as we described last episode, that the hormones are like 17 roller coasters all trying to run at the same time and intersecting with each other, and it's just absolute chaos. So when should somebody get testing to actually give relevant information?

SPEAKER_00 6:33

Or I think it doesn't really matter. I think you can you can try to guess, you can look at I always have my patients track, even if they're super wonky, track your cycle so at least we can see what that loose pattern is, right? And if there comes a point where we need to test, we just test and we see what things look like and we go from there. Like this isn't something where it's this crisis if the number is not this certain way. We're just trying to get an idea of what's happening, and part of that is just gathering information. So rather than looking at testing as like a definitive answer, I look at it as we are gathering information. Some of that information can be helpful, some cannot, some can roll things in, some can roll things out, but we're just gathering data.

SPEAKER_01 7:18

So I'm curious if you think that it would be useful at all or just not even useful to start having female sex hormones or just sex hormones in general as part of standard testing once women get to like their mid-30s. Is that useful or not useful? I mean, I think it is, but I I run those on my patients.

SPEAKER_00 7:36

So standard. Oh yes, yes, useful. But I but I think look, I think in order for it to be standard testing, it has to be with a doctor who understands that there are fluctuations and that something being a little bit strange on a lab one time does not mean it's a huge problem, right? So I tell my patients all the time, in general, like I don't freak out about one number being off one time. If I see a pattern of something that isn't looking right, then yes, we want to do further investigation, but one thing one time is not the end of the world or cause for a meltdown, right? So it's like we have to take it all with a grain of salt. And I think that also goes for when when we're taking, when we're taking hormones and we're testing, right? We're oftentimes checking to make sure that things are not reading too high. We're not checking with these, with this bioidentical hormone replacement, your hormones are at perfect levels. No, because if you take a progesterone pill at night, even a slow release progesterone pill, right, and you test the next morning, it's out of your body. A regular progesterone is out within four hours, a slow release is out within 10 hours. So unless you're gonna have you take that progesterone in the morning, which will then make you sleepy, right? There's no way that we're going to do that. And when I have people check their hormones, no, you're not applying your testosterone or your estrogen cream right before you go in for your blood draw. Well, how about abnormaling like falsely high number? So it's not that we our levels have to be at a certain place. It's that we can see, okay, we're not, we're this isn't making too much, right? We're not giving you too much. That's really what that's what I use it for.

SPEAKER_02 9:09

And quality of life reporting in conjunction with that is the sweet spot.

SPEAKER_01 9:15

Exactly. Do we also need to be testing for things like any of the the other proteins and enzymes that we haven't talked about yet on in our conversations that influence the hormones converting to each other? Is that something that is regularly tested or should be regularly tested? What do you mean, like hormone? When you mean enzymes, what are like sex hormone binding globulin or other any of the things, the like DHT?

SPEAKER_00 9:41

Yeah. Sorry, yeah. So for me, yeah, that's part of, sorry, I just didn't process it because for me, that's part of the panel. Right. When we look at what our hormones convert to, when we think about it very generally, right? We have our cholesterol and our cholesterol, we make pregnetolone, and pregnenolone turns into progesterone, and pregnolone turns into DHEA. And then DHEA turns into testosterone, testosterone turns into estrogen, or testosterone can convert to DHT, dihydrotestosterone. So there's this whole hormone pathway. So for me, I'm always checking the entire pathway. I'm never just checking one or two numbers. So yes, I think that is really important. And then sex hormone binding globulin, which does what it sounds like, it helps those hormones move through their detox pathways. So yeah, I think it's important to look at all of those. And again, I don't think it's so individual. I don't think it needs to be all of those things every time, right? But I do test those frequently, like, you know, a few times a year in my patients.

SPEAKER_01 10:41

And I only reason I bring this up is as somebody who has gotten hormone testing through my primary care doctor, those are not things that are tested. So for you guys, they're automatic, but for many of our listeners, they're not being done automatically. And so they should be aware that these things exist that might be useful additional pieces of information. If somebody has their testosterone isn't where they expect it to be, is it possibly that they have too much estrogen and or that it's converting into a different form that we're not really looking for, that kind of thing? Right. Or that they have pathways are important.

SPEAKER_02 11:12

Or that they have a a lot of a hormone, but it's all in storage with sex hormone binding globulin, which some people tend to have a lot of and it's easy to remedy if you do if you know that that's where that hormone is. Yeah.

SPEAKER_01 11:25

So one of the other questions that I think should at least be discussed, you know, we we said should this be part of the standard for you guys, it is, and maybe someday it will be for all doctors that are whether they're a naturopathic doctor with specialist training, or if they're just a primary care doctor, that we recognize women need to be checked for these things to see where they're at. And we also understand, need to understand the timing and the value of the information that we're being given. We already look for things on an annual screening panel that check for cholesterol, that check for liver function, that check for blood sugar. And these are all things that are impacted by the changes in our hormones, as we shared last episode. So estrogen in particular is the primary driver of all of those things that I just mentioned. And so I'm curious if you think that those things should be monitored more frequently or differently once we get into perimenopause and if they need to be addressed differently.

SPEAKER_00 12:19

I think it depends if we find that they are being impacted, right? So not everybody in perimenopause has cholesterol that goes up. Mine didn't. Mine went lower. Not what you would think, right? But I do think that checking blood sugar lipids, your cholesterol, thyroid, iron and ferritin, like there are the standards for us that I think need to be checked. And again, if you have a totally normal in the naturopathic world, normal is different, right? If you have optimal or you have a thyroid function test that looks really good, do you need to check that three months later? Not necessarily. Maybe you check it six or eight months later. But I do think they are things that need to be checked. I check most of my patients at minimum, like twice a year, just because you don't want things to become a problem and then check it and say, oh gosh, when did that become a problem? Right. We want to see it as it's happening. So I do think those are important things to check. I think as we stop menstruating, we're not losing blood, right? Which means our iron and our ferritin, our stored iron, those levels can actually go up because sometimes they can be kind of normal and optimal when we're losing blood, but some people can store more. So I do think it's important to look at all of those things. I think once we get a little bit older, um, again, barring any other medical issues or conditions that would result in decreased bone density, we should be doing DEXTA scans too.

SPEAKER_02 13:40

Yes.

SPEAKER_00 13:41

Um, and doing a baseline for that. Like in our early 60s, if well, again, if there's no other medical conditions, if there aren't medications that have been taken that cause it, if there isn't a strong family history. But for the general population, yeah, get a baseline, see what things are looking like, right? Like early intervention does make a big difference. And I think it also knowing what's happening in our bodies is very empowering. And it lets us sit in the driver's seat with our doctors and make those decisions that are going to be really impactful for long-term care and long-term health. So yeah, I am a believer in checking. I would probably more often than um than not in a conventional world. Yeah. Two, three times a year.

SPEAKER_02 14:22

The DEXA scam piece is so important. I am consistently the provider that is advocating for this in women who are postmenopausal. How is that happening? We know that postmenopausal women have to have bone density preventative measures and screenings. And it's not happening. So I I really appreciate that you mentioned that because this is a wonderful opportunity for us to spread the word that and earlier is better because if you get a baseline of your bone density before you stop menstruating, before your hormones have completely left the building, then you have a sense of what changes are happening versus, oh, actually, my bone density was in a questionable state state even before my hormones decreased.

SPEAKER_00 15:14

And conversely, don't tell patients to take calcium without doing a bone density. I think that's the other thing is that people are given advice from a lot of conventional doctors, oh, start taking calcium. Well, no, that's a really bad idea if your bones don't need calcium, right? Because calcium is not something that just flushes out of our body if we have excess. It deposits in places that we don't want it, like the walls of our arteries, like our breast tissue, right? So calcium isn't like, oh, if you don't need it, it just gets flushed out. It goes places where we don't want it. So I think that's also really important. It's like we can't just expect that this is an issue and that you need to take this. We can't just expect that it's not an issue and you don't need this. Like we we live in an advanced society where we have that medical technology easily available. So why are we not using it, right? ADAXASCAN is not an expensive test. Cash pay, it's maybe$150 to$200.

SPEAKER_02 16:04

And then some insurance coverage will incorporate that under their preventative umbrella. Yeah. So it might not even cost you anything. I have seen that be the case as well.

SPEAKER_03 16:16

Yeah.

SPEAKER_00 16:16

And I think looking at other things, Jen, like you mentioned, like a coronary artery calcium score, right? Your CACS, like those are important too. Again, insurance doesn't cover them typically, but they are not pricey tests. So we can having that information, I think is how we empower ourselves and our patients to know where things need to be checked more frequently, to know where interventions need to be put in, and to know what's actually looking great. And I think that's part of sort of the piece that gets missed is we still have to focus on what is like what's going well. Like we still have to focus on all of the good things. There might be a couple of numbers in our labs that aren't ideal, but let's focus on all the things that are as well. I don't want us to ever be in a place where we're looking at, okay, well, now let's figure out what's wrong. What's the next thing that's wrong? Like that's not a way to approach medicine or your health either, right?

SPEAKER_01 17:09

So I will I know we'll talk more about HRT and its uses and all of that in probably the next episode. And then I know we're also planning to talk at some point because we've had questions about it. Non-HRT options for support for people who HRT just isn't really the right option for them for one of very much various reasons. I want to just see if this is a quick answer or if we need an entire episode on this topic too, which is if you're starting to see some of these other labs, if you're starting to see insulin sensitivity um decreasing. So we're seeing like an increase in insulin numbers, or we're seeing um, you know, fasting insulin, or we're seeing an ever-increasing blood sugar, fasting blood sugar, if we're seeing changes in cholesterol, and if we're seeing changes in liver function, is that something that addressing the hormone can address multiple things? Or is that really this is just gonna happen. We need to start looking at other interventions for all of these multiple things that are happening just because your body's going through a normal transition. Depends on the person. Always depends on the person.

SPEAKER_00 18:11

I know that, but in general. So I don't think there's a general, but I think yes, there there can be instances where working with bioidentical hormone replacement therapy can help bring down cholesterol. Absolutely. There are situations where, yes, that plus maybe another supplement that helps with that as well. But no, it's not like, oh, you're in menopause, you need to start a statin. Absolutely not. There's so many things that we can that we can look at that can influence that whole pathway. So, no, it's not like cows out of the bar and there's nothing you can do, not at all. Those things can be reversed. Right.

SPEAKER_01 18:45

And being being somebody who has been, as I've shared multiple times, in chemical menopause right now, as I'm waiting my surgical menopause that I'm gonna have in about a month, that we have seen my lab values change just because of this forceful reduction of estrogen. No change, specifically my LDL changed. And there's no change in anything in my lifestyle, in my diet, in my exercise, anything like that that would have warranted that change or explained that change. And then we did a pause in my medication, and lo and behold, everything got normalized. So it was 100% related to this medication that was causing a forceful like cliff drop in my estrogen projection.

SPEAKER_00 19:28

Decreases in estrogen can increase LDL by 10 to 15%. Like that alone, just that decrease in estrogen can increase that LDL.

SPEAKER_01 19:36

All right. So my last question that I really want to ask you guys, because this comes up in conferences all over the place. And so people have probably heard about it, whether they've heard about it from their doctors, from wellness influencers, just their own research, whatever. There's different ways that you can do testing. And so there are blood tests, which is the pretty standard conventional approach. There's urine tests that are promoted in lots of different places, and some of these that you can order by yourself now. And there's also saliva testing. Can you guys give me your feedback on these different testing approaches and if they're equally valid, not valid, useful in different ways? What do we make of all this?

SPEAKER_00 20:14

I mean, I think a big part of it is if we are checking things and wanting to check things on a more consistent basis, what's realistic, right? Can you pay hundreds of dollars out of pocket every time you need to check labs? Not necessarily. So I do think that there is a lot of value in looking at blood levels. I think that can be at times supplemented with like some saliva tests, which are more of those kind of free, unbound, active forms. But I think we still have pretty good idea and pretty good testing from a blood sample. Again, I'm always trying to think about like how this can be done effectively, but how it's not something that patients are having to like take out a second mortgage to afford, because I think that is a lot of what happens in the kind of like health, wellness, influencer space is it's a thousand dollars for this test. It does not need to be that. That being said, I know there there can be a lot of controversy, you know, versus kind of health and wellness and conventional with like the Dutch test, which is a really common urine test that's done. Dutch stands for dried urine test for cortisol and hormones. So I do like the Dutch test. Again, I don't use it all on its own. But what I like about the Dutch test is that it is showing your different hormone metabolism pathways. So it is actually showing, we talked about our three types of estrogen, right? It is showing percentage breakdowns with conversion into those three different types because you have testosterone that can convert to estradiol. You have androsinodion, which is a testosterone precursor that can convert to estrone, and then you have estrone and estradiol that can change, and then you have estradiol that can convert to estriol, right? Like it's this whole complex pathway, and it can tell you what. Those conversions are looking like and what those pathways are looking like. But it also speaks to the detoxification pathways because it's one thing to make hormones, but then what does our body do with them? And so our body has different ways in which we detox estrogen and different pathways. And some can be a very beneficial, easy, nice flow pathway to move that estrogen out. And some can be more carcinogenic and have more, more risk for DNA damage, right? So we we typically think of there's two hydroxy, four hydroxy, and 16 hydroxy estrogen pathways. That's what I really like about the Dutch test, is it shows that pathway, all those pathways and the preference for those different pathways. It also shows pathway preference for moving out testosterone, right? Do we go through this alpha pathway, which is more androgenic, or a five beta pathway, which is less? And so I think it gives us valuable information. And again, even if you can order a test yourself, what are you going to do with that information? You have to be working with a hormone literate doctor that knows what to do with that information, right?

SPEAKER_02 23:03

I really like the Dutch test when there's a obviously for perimenopausal or any kind of hormone presentation that is just we're not getting the information that we need from blood. And when somebody has been tracking their symptoms, so let's say we're suspecting mast cell activation or mold or something else, and it's very closely tied to cycle flares. It's a great for exactly the same reasons that Elisa was just describing. The detox pathways help you to understand if you're having issues detoxing those specific hormones, you're probably having a lot of issues detoxing some other things that might be activating histamine responses or, you know, making it difficult to remove other environmental toxins from your body as well.

SPEAKER_01 23:48

Absolutely. That's such a good point, Karen. So it sounds like you guys would use the Dutch testing more when you're looking for complicated cases, not more of like the straightforward.

SPEAKER_00 23:58

Or it's, you know, wanting to know how is my body working. Yeah.

SPEAKER_02 24:02

Some people are really data-driven. Some people love to see the graphs and the numbers and and the psychology of healing. That is so important to meet people where they thrive. So if somebody comes in and says, you know, I don't have a lot of money, but I know that if I don't see these things specifically all laid out for me, I'm a lot less likely to take my supplements. Well, okay.

SPEAKER_01 24:28

Then that is a really good use of your resources. And you bring this up because the Dutch test is not currently covered by insurance. Is that correct?

SPEAKER_00 24:36

It's not.

SPEAKER_01 24:37

Yeah. No, it's a few hundred dollars. And it's how much? A few hundred dollars. And most people are also not going to see saliva tests covered by insurance. So insurance-based, especially more conventionally driven doctors, it's going to be blood tests, and that's it. And you're both sharing that there are just some limitations in what you can find from the blood tests.

SPEAKER_00 24:58

And a and a blood test, if insurance doesn't cover it, you know, cash pricing for a full hormone panel is usually just around$100 versus, you know, Dutch is I think about 300 now. Okay.

SPEAKER_02 25:10

So and a lot of information can come from just blood. I I actually don't use a ton of specialty hormone testing. I use it, I don't know, once a week or so. You know, I mean, it's not, it's not uncommon, but it's definitely every patient. Yeah. It's much more common for me to rely on blood data that for I would say a solid 60% of the people that I work with is sufficient.

SPEAKER_01 25:35

So it's really the people, I'm just trying to understand when you're gonna like order the tests for somebody that would be like this more detailed test. That's gonna be either when it's because of the way the person works that they're more likely to have success with it, or if there are extra complications that you're trying to figure out that it would give you an additional clue without reordering and reordering and reordering more things that to like do the discovery.

SPEAKER_00 26:03

Or like here's an easy example, I think. If I see a patient who definitely is making a lot of estrogen, right? And some people would call that their term is estrogen dominance. I don't know that we need to put a name to it, but they when we're checking their hormones, their blood work, their hormones day, you know, 19 to 21, we're seeing pretty high estrogen comparatively to progesterone, which is where we shouldn't see that. Then I would say, great, you know, DUSH can be really helpful because it's showing us that estrogen breakdown in metabolism. So if we've got all of this excess estrogen and we don't know necessarily like why we're making so much and how we're moving it out, then let's see what your like metabolism pathways look like. Because there are different phases of hormone metabolism as well, right? There's three phases. And if we're looking at how to treat that, if we have an issue with phase one estrogen metabolism, what we would implement there in terms of supplements would be very different than if we were seeing a phase two issue, right? Phase three is mostly in the gut. So it gives me more information to say, well, how am I going to help this patient manage that level that's not ideal? And not just say, I'm going to give them this one thing because I give if a patient has an issue in phase two, but I give them something that's going to help in phase one, it's not going to help them. So it's just more detailed.

SPEAKER_01 27:19

And are all of these things that you just mentioned, Elisa, are these all things that can come up and make perimetopause more challenging for people? Yes. Okay. So this would be potentially more useful in a difficult situation in perimetopause to figure out where you really are going to get the best bang for your buck for interventions.

SPEAKER_00 27:39

Well, yeah, what's what's going to make sense and what's going to be applicable. I think it's also interesting, you know, when I have a patient who has a prevalent family history with different breast and gynecological cancers, it's helpful to look at their estrogen metabolism and say, oh, is this going down a really nice two-hydroxy pathway? Is this going down a potentially more harmful four-hydroxy pathway? Right. So that we also know what to do, not going to say, oh, your mom had breast cancer. You should definitely have a prophylactic mastectomy. But I'm going to say, oh, your mom had breast cancer. Let's see what's happening with your hormorns and see what we can do to see if we need to shift that metabolism to a healthier way.

SPEAKER_02 28:19

And but and back to the psychological piece of healing. Specificity of treatment is really important for people who are at their wit's end. So if somebody comes in and is like, I have tried everything, everybody keeps telling me things are fine or it's not that bad. And I need to have an answer now, then a specialty test would be a really great option for them. And not messing around with, well, we could try this, like what Elisa was just saying, you know, we could try to support phase one or phase two, but that's going to take time for us to figure out what it is that is actually what you need versus doing the test and having an immediate response. Because when people do things that don't work, and this is something that can be an issue in um health programs, it's very broad. And I'm not saying that that doesn't have a place. There are people who can get a lot out of that when your picture isn't particularly complex. But if you have you follow that protocol and you start to feel hopeless, then you start to feel shame. There's no, you know, nothing's ever going to get better. And now we're dealing with secondary and tertiary issues range outside of the primary hormone imbalance, if that is what the issue is.

SPEAKER_00 29:37

I think what I would kind of close by saying is that we have the ability to gather the data we need. So there really isn't a place, like in this time of medicine. There isn't really a place for just guessing. There's no need for it. It wastes the patient's time, it wastes the patient's resources. Like it's not good medicine, it's not good doctoring to just guess, right? Like, Jen, you would never say, you're tired, here's a homeopathic-free, right? Like you think that the most detailed history to figure out like all the characteristics of that fatigue and what's behind it. It's the same thing, right? Like it's not this generalized one size fits all. Like, oh, you're you're 45, you might be in perimenopause, take dim. Like it just doesn't work that way.

SPEAKER_01 30:23

So or like my situation, your labs don't support that you're in perimenopause, but your symptoms sound like perimenopause. So let's go ahead and put you on HRT and then send you to the emergency room because you actually triggered the worst endometriosis flare ever, because it was always endometriosis. Yeah. Because there's so much overlap between endometriosis and perimenopause. Anyway, all right. Yes. Thank you, ladies, for sharing all of your expertise and letting me be the annoying patient with all the questions. It's not amazing. It's important. And I'm got more for you. I got a lot more for you in future conversations that we have about all of this. And I really I appreciate it because believe it or not, guys, this is the type of conversation we have sometimes. So even though we are doing these in a listener-requested situation, these are actually some of the conversations that we do have where we help each other sort through some of this stuff and remind each other of the things that we are better at than each other. So and as you know, I've got my forced, my surgical menopause coming up. And so I am really looking forward to our conversation about HRT because I need to make sure that I'm making good decisions about what I choose to do moving forward when it will be more available to me and should not cause a flare. Hopefully, knockwood, not guaranteed, but you know, all the things.

SPEAKER_00 31:45

Well, and there we're text to the podcast, right? We're gonna take all the things we text about, we're gonna bring it to the podcast. Yes, exactly. Exactly.

SPEAKER_01 31:53

So I will look forward to our next conversation where let's just plan on it so that we can talk about HRT. And then if we have time, the non-HRT options for support. And if we don't have time for it in the next one, then we'll do it in the one after that. Another one. All right, love you guys. Love you guys.

SPEAKER_03 32:11

Talk to you soon.

SPEAKER_01 32:12

Bye.

SPEAKER_02 32:14

If our messy is your kind of messy, we'd love for you to rate, review, and follow or subscribe wherever you get your podcasts.

SPEAKER_00 32:22

We'd also love to know what's on your mind. If you were to join us, what would we be talking about? Email us at messy midlife podcast at gmail.com or message us on Instagram or TikTok.