Measuring hormone levels in the blood may be useful for some women to help doctors choose the most effective and appropriate dose of TRH. Hormone levels in the blood can be very misleading if they are normal, since it only means that the levels were normal at the time of the blood test and do not reflect how hormone levels change at other times of the day or throughout the month. Urinalysis helps identify these imbalances and help the doctor design an appropriate treatment plan to treat specific hormonal deficiencies or excesses. In the United Kingdom, NICE guidelines for the diagnosis and treatment of menopause state that, in women aged 45 and over, there is no need for blood tests to detect hormones such as follicle stimulating hormone (FSH), estradiol and progesterone in healthy women who have menopausal symptoms or whose periods have changed.
It is important to have adequate levels of estrogen in the blood to improve symptoms and also reduce the risk of diseases in the future. Physicians who engage in bioidentical hormone replacement therapy (BHRT) require comprehensive tests, including urinalysis, to evaluate the hormonal status of their patients and determine the most appropriate course of treatment. However, a blood test with normal-range hormones does not rule out that symptoms are due to perimenopause, especially if there is no other explanation for the symptoms that occur. These blood tests may include hormone tests and, usually, a test to detect other causes of similar symptoms, for example, to check for thyroid problems, anemia, vitamin B12 or folic acid deficiency or type 2 diabetes.
Testosterone and SHBG levels are monitored at the same time and a proportion of them is calculated (and multiplied by 100) to obtain the Free Androgen Index (FAI) score, which is expressed as a percentage. In women younger than 45, hormone blood tests can sometimes be useful if menstrual periods have changed or to rule out other possible causes of similar symptoms. Physicians can also do blood tests and evaluate a patient's medical history, symptoms and general health to make informed decisions about bioidentical hormone replacement therapy. However, it's important to note that a “normal” hormonal blood test doesn't mean that a trial of hormone therapy isn't useful if a more serious cause has not been found to explain the symptoms.
According to the North American Menopause Society, determining doses of menopausal hormone therapy based on blood tests or salivary hormones doesn't make sense for middle-aged people because these levels vary from day to day and even from hour to hour. It's important to note that urine tests are only one aspect of a comprehensive evaluation when considering BHRT. Extensive urinalysis can provide valuable information about a patient's unique hormonal patterns, allowing for more personalized and specific treatment approaches.
