Hormone Testing & Symptoms: What Every Woman Should Know Before Starting BHRT
Why Hormone Testing Matters for Women in Midlife
Hormone therapy can be life-changing for women in perimenopause and post-menopause. Relief from hot flashes, better sleep, stronger bones, and improved mood are just a few of the benefits. But here’s the truth: hormone therapy isn’t one-size-fits-all.
That’s where hormone testing comes in. Think of it as your GPS. Testing shows what your body actually needs, how it’s responding to bioidentical hormone replacement therapy (BHRT), and whether your body is metabolizing hormones safely. The right tests can help reduce side effects, guide dosing, and ensure you get the results you want.
BHRT in a Nutshell 🌿
- What it is: Bioidentical hormones that match what your body naturally makes
- Purpose: Eases menopause or post-menopause symptoms like hot flashes, mood swings, low libido, and sleep issues
- Why it works: Mimics natural hormones for better recognition by your body
- Personalized: Dosing and delivery methods (cream, patch, pellet) are tailored just for you
Essential Hormone Tests Before Starting BHRT
Before jumping into therapy, it’s important to establish a baseline. These are the key labs to request:
- Hormone blood levels: estradiol, progesterone, testosterone, SHBG, DHEA. It is important to note that there are “normal” results and “optimal” results. Your provider should aim for optimal levels—not just what’s “normal” on a lab report. Standard lab ranges show what’s “common” in the population, but that doesn’t always equal “healthy.” Functional medicine focuses on optimal hormone levels—the ranges where women feel their best. My recommendations would be:
- Estradiol: >80 pg/mL for bone health, 100–150+ pg/mL for full benefit
- Progesterone: 5–10+ ng/mL or 10–15+ mg/mL (100–150+ ng/dL with LC/MS testing)
- Total Testosterone: 50–60 ng/dL
- Free Testosterone: ~5 pg/mL
- DHEA-S: 200–430 ug/dL
- FSH: <25 mIU/mL if on BHRT
Understanding the difference between “normal” and “optimal” helps explain why many women are told their labs are “fine” while still struggling with symptoms.
- Hormone metabolism: The DUTCH test (Dried Urine Test for Comprehensive Hormones) is a functional hormone test that goes beyond traditional bloodwork. It measures not only hormone levels—such as estrogen, progesterone, testosterone, DHEA, and cortisol—but also how your body metabolizes and clears these hormones. This provides a detailed picture of hormone balance, detoxification pathways, and potential imbalances that can impact mood, energy, sleep, and overall health. For women on or considering BHRT, the DUTCH test can guide personalized dosing and help ensure therapy is both safe and effective.
Other important foundational testing, before getting started:
- Gut health: stool testing to check absorption, microbiome balance, and inflammation
- Thyroid function: since thyroid hormones and sex hormones are closely linked, this is an important baseline to cover.
These tests help create the right foundation for therapy by improving absorption, lowering inflammation, and supporting a balanced hormone environment. Testing isn’t just a starting point—it’s an ongoing part of safe, effective hormone therapy. Once you begin BHRT, you’ll want to track changes regularly:
- Bloodwork: every 3–6 months at first, then annually
- DUTCH urine testing: every 6–12 months to monitor hormone detox
- Stool testing: every 2 years or as needed
- Adjustments: made based on both your symptoms and lab results
This ongoing feedback loop ensures you’re not just taking hormones, but actually benefiting from them.
Common Symptoms When Starting BHRT
Beginning hormone therapy often brings relief, but it can also trigger transitional symptoms. These don’t always mean something is wrong—sometimes they’re just part of your body adjusting.
Estrogen-Related
- Breast tenderness
- Bloating or fluid retention
- Headaches or migraines
- Mood swings or irritability
- Uterine cramping or spotting
Progesterone-Related
- Drowsiness (especially at night)
- Brain fog or dizziness
- Abdominal bloating
- Mood shifts or anxiety
Testosterone-Related
- Acne or oily skin
- Increased facial hair
- Scalp hair thinning
- Libido changes (often increased)
📝 Tip: Oral progesterone can be sedating, and estrogen sensitivity varies widely—symptoms often calm down once dosing is balanced.
Perimenopause vs. Post-Menopause: Why the Response Is Different
- Perimenopausal women still have fluctuating hormones, so symptoms like breakthrough bleeding or heightened progesterone sensitivity are more likely.
- Post-menopausal women may be more sensitive to small hormone doses at first, but often stabilize once the right balance is found.
When to Reevaluate Your Hormone Therapy
Some symptoms suggest it’s time for a closer look at your labs or dosing:
- Persistent mood changes
- Ongoing bleeding post-menopause
- Severe breast tenderness
- Worsening acne or hair thinning
- No symptom improvement after 2–3 months
These may indicate a dosing imbalance, poor metabolism, or clearance issues.
The Bottom Line: Safe, Smarter Hormone Therapy
Mild, short-term symptoms are common during the adjustment phase, but with the right monitoring and support, BHRT can be a safe, effective way to restore balance and vitality.
Guiding principles for success:
✅ Start low and go slow
✅ Match delivery method to your needs
✅ Support your liver and gut for healthy hormone detox
With the right hormone testing strategy, you’ll not only feel better but also know that your therapy is working with your body, not against it. Book your call to learn more about testing!
Frequently Asked Questions About Hormone Testing & BHRT
- Is hormone testing necessary before starting BHRT? Yes. Testing provides a baseline that helps your provider tailor your therapy to your specific needs. It reveals where your hormones are, how your body metabolizes them, and which support systems (such as thyroid or gut health) require attention. Skipping testing is like driving without GPS—you might get there, but you’ll hit a lot more detours.
- How often should I test my hormones once I start therapy? In the first year, bloodwork is usually recommended every 3–6 months. After things stabilize, annual testing is common. DUTCH urine testing is often repeated every 6–12 months to track hormone detox pathways, and stool testing every 2 years or as needed.
- What’s the difference between “normal” and “optimal” hormone levels? “Normal” lab ranges reflect the average population—including people who don’t feel well. “Optimal” ranges are where women actually feel their best and experience protection for bones, brain, heart, and mood. That’s why you may still feel symptoms even when your doctor says your labs look “normal.”
- What symptoms are common when starting BHRT? Mild and short-term changes are common. You might notice bloating, breast tenderness, mood swings, or drowsiness. These often reflect your body adjusting and usually improve as your therapy is fine-tuned.
- How do perimenopausal and postmenopausal women respond differently to BHRT? Perimenopausal women still have fluctuating hormone levels, so they may experience breakthrough bleeding or cycling symptoms even with BHRT. Postmenopausal women, who have been estrogen-deficient longer, may be more sensitive to small doses but often stabilize once dosing is optimized.
- 6. When should I call my provider about BHRT side effects? If you have persistent mood changes, ongoing bleeding after menopause, severe breast tenderness, worsening acne or hair loss, or no symptom relief after 2–3 months, it’s time to reevaluate your therapy.
