Your body produces more than 50 hormones, chemical messengers that regulate everything from sleep to metabolism. Some hormone changes are natural, while others may signal medical issues. Low insulin levels can indicate diabetes, while high cortisol, the stress hormone, can contribute to obesity.
Other hormones, like melatonin, naturally fluctuate throughout the day. Women also experience predictable changes in estrogen and progesterone before menopause.
Hormones have recently gained public attention. On Nov. 10, the Food and Drug Administration removed the black box warning from hormone replacement therapy (HRT) for menopause. The FDA stated the long-term benefits, such as improved bone health and cognitive function, outweigh the listed risks like breast cancer.
The announcement has sparked renewed interest in HRT. Dr. Mary Jane Minkin, a Yale School of Medicine professor, said her patients have been “going wild” over the news.
But with the rise of over-the-counter hormone tests and supplements claiming to correct “imbalances,” it can be hard to know what testing is actually necessary.
Dr. Jan Shifren of Massachusetts General Hospital warns that women in perimenopause—the years before menopause—are often targeted by misleading marketing she calls “meno-profiteering” or “meno-washing.” These campaigns promote expensive tests and products with little scientific backing.
“I never use the term ‘hormone imbalance’ with my patients,” Shifren said. “Many of these large panels of hormone tests tell us essentially nothing.”
The U.S. endocrine testing market has grown rapidly, reaching $4.1 billion in 2022, and is expected to grow 7.7% annually through 2030. Commercial labs and telehealth companies offer tests ranging from $49 for a single hormone to nearly $1,600 for comprehensive panels.
Shifren and Minkin both caution that most perimenopausal women do not need hormone testing. “Hormones fluctuate all over the place during perimenopause,” Minkin said. Even healthy premenopausal women have wide hormonal swings throughout their cycles.
Follow Symptoms, Not Test Results
Perimenopause typically begins between ages 45 and 55 and can last up to a decade. Menopause is defined as 12 months after a woman’s final period, followed by postmenopause for the rest of life. Over 1 million U.S. women reach menopause annually, averaging age 52.
Symptoms can include hot flashes, night sweats, brain fog, mood swings, weight gain, painful sex, insomnia, vaginal dryness, and irregular periods. For women experiencing these symptoms, treatment is often possible without testing.
“If a 53-year-old hasn’t had a period for three months, is sweating at night, and feels unwell, I can tell she’s perimenopausal without any tests,” Minkin said.
Sex hormone tests are rarely useful in postmenopausal women. “There’s no reason to check estradiol or progesterone in a postmenopausal woman,” Shifren said.
Who Should Consider Hormone Testing
Hormone testing may be helpful for women experiencing early menopause (ages 40–45) or premature menopause (before 40). These conditions carry higher risks of heart disease and osteoporosis. Doctors use hormone testing to distinguish between normal perimenopause and other endocrine problems.
For women of typical perimenopausal age, the focus should be on symptoms and shared decision-making with a healthcare provider. Medications like birth control or breastfeeding can also affect hormone levels, making testing inaccurate if not timed properly.
Risks of Unnecessary Testing
While curiosity about hormone levels is natural, unnecessary tests can be costly and misleading. Over-the-counter tests may provide inaccurate results, and self-treating perceived imbalances with supplements can be unsafe. The global menopause supplement market was nearly $18 billion last year, with many products unregulated by the FDA.
Some home remedies, such as evening primrose oil, may help with symptoms and are generally safe. Doctors advise discussing any supplement use with a healthcare professional to avoid toxicity or interactions with other medications.
Minkin celebrates the growing attention on menopause, calling it an “estrogen festival,” but warns against companies exploiting midlife women for profit. “For 20 years, menopause was taboo. Now some companies label everything perimenopause to sell products,” she said.
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