SPEAKER_00 0:14

You can buy a test for pregnancy. You can test your blood sugar, your cholesterol, your thyroid. These days you can order all sorts of health tests online without ever having to leave your house. So surely there's got to be a test that can simply tell you whether you're pre-menopause, perimenopause, menopause, postmenopause? Well, yes, there is, and no, because although menopause testing kits do exist, your doctor can also run hormone tests. We can do functional testing for you if you want. But sometimes those tests might not actually give you the definitive answer you're expecting. And that's what most people expect to get when they do a test. They want a definitive answer. And in some cases, if you test at the wrong time or you rely too heavily on one hormone result or just one biomarker, that can actually make things more confusing. So we thought that in this episode we'd dig into a question that we get asked a lot. But before we delve into that, welcome back to Empower Your Menopause, the podcast all about health, happiness, and hormones for women 40 and beyond. I'm Coach James Ellis.

SPEAKER_01 1:18

And I'm Coach Julie Medacy, and today we're going to answer a question that thousands of women are typing into Google these days. Can you test for menopause? And also closely behind that, are menopause testing kits actually accurate? Because when your cycles are changing, you're suddenly not sleeping, your joints are aching, your brain has apparently left the building along with Elvis, and you're wondering why you're standing in the kitchen holding your phone while simultaneously looking for your phone. I won't admit to that ever having happened. It would be really nice to have a test that just simply said, hello, this is menopause. But unfortunately, human bodies are a little less accurate than that. So today we're going to look at what do these tests actually measure? When can testing be useful? Why it often isn't needed, and probably more importantly, how you can have a better conversation with your healthcare provider when something really doesn't feel right. So, James, can we test for menopause?

SPEAKER_00 2:25

So, unfortunately, it's a yes and no answer because you can test hormones, certainly. Uh, but that's not quite the same thing as having a definitive menopause test. So, when it comes to looking at what's going on in uh a woman's life as she approaches midlife, most testing revolves around hormone levels in some way, shape, or form, and particularly doctors tend to look at something called follicle stimulating hormones or FSH. So FSH helps stimulate the ovaries, and what happens is as ovarian function declines, FSH generally tends to rise. Why does it do that? Well, because your body is seeing that estrogen is low, but your body wants to stimulate more follicles naturally, so it starts increasing FSH in an effort to try and get some follicles stimulated and some potential pregnancy going on. So that makes it sound wonderfully simple. You know, if you've got high FSH, surely you're in menopause. Except well, not necessarily at all. During perimenopause, hormone levels can fluctuate considerably. So a blood or urine test is going to give you information about what your hormones are doing at that particular point in time. So it might be showing FSH is really high, it might be showing it's low, it might be showing estrogen's high, it might be showing estrogen's low. But that doesn't necessarily tell you where you are in the overall menopause transition. It's one of the reasons that here in the UK and in many other countries where we have a nationalised health service rather than a privatised one, there's an organization called NICE, it's the National Institute for Health and Care Excellence, and their guidance is that if you're an otherwise healthy woman age 45 plus with typical menopause associated symptoms, perimenopause and menopause should usually be identified without laboratory testing. So the key thing is there, the thing that really changes is if you're under 45 and you have quite severe menopausal symptoms, they might test to look as at whether you're in premature menopause, so you're entering the menopause transition maybe earlier than you should. To explain, you know, the menopause transition or perimenopause usually starts 40-ish, early 40s. And so if you're less than 40, that's when a doctor might look at testing. So, Julie, why don't you tell us why home tests aren't giving you that answer that you think they are?

SPEAKER_01 5:17

Well, you know, this is where the clever marketers really make things sound more definitive than your biology actually is, right? We're complicated organisms. There's a lot going on in our bodies. And a lot of home tests are measuring FSH, right? They might accurately detect your FSH levels in urine, but there's a big difference between accurately measuring something or whether that measurement actually tells you the answer that you need. And like James said, everything is all over the place when you're in paramenopause. So those things are really not the same question. And that's what we need to look at. Um, there are a lot of different biomarkers that are important to consider here. So measuring one thing, especially hormones during paramenopause, isn't going to give you that answer because you're, you know, it's it's kind of like weight loss. We think that there's going to be this nice line, nice even, straight line as we progress. And going through paramenopause and into the postmenopause, we think there's going to be just this nice steady decline, but it's not. It looks like you were on one of those machines that shakes you and you had a pen in your hand and you're trying to draw something on a piece of paper. It just fluctuates, it's all over the place. And that's why you can get really different results depending on when you take those tests. So it isn't that the test itself isn't inaccurate. It's what what we can actually conclude from the test result. Because remember, we're not laboratory animals, right? We don't live in a laboratory environment. So there isn't ever just one thing happening. So the the question then, of course, is if we aren't testing, then how do we know?

SPEAKER_00 7:05

And I suppose again the answer is, well, we don't know accurately, but the kind of guidance that a GP or doctor, as a reminder, we're health coaches, we're neutral health coaches, we're nutritionists, we're functional medicine specialists. We aren't medical professionals in the traditional sense of a doctor. And it would be your doctor or your you know, your gynecologist who would actually be looking at this thing to decide if you're in menopause or not. So they'll be looking at the clinical picture and they'd be looking at a number of different things. So, first of all, they're gonna look at your age. Yeah, they know you're over 45, they're thinking, yeah, this woman, likely if she's following the norms, she is potentially at that time of life. They'd be looking for changes in your menstrual cycle. Are you still regular? Are you heavy? Are you noticing a different type of blood flow? Is it light one month and then heavier the next month? All those kind of things. They'd be looking at some of those traditional symptoms that people talk about all the time. You know, the key ones hot flushes, night sweats, sleep changes, mood changes, brain fog, you know, as Julie said, you know, looking for your mobile phone while you've still got your mobile phone in your hand, yeah, um, kind of joint muscle aches, uh, different changes in your urine system as uh systems, what's going on when it comes to sort of like your sexual health, um, and so then they look at the overall pattern of all those kind of things. So we have a document, it's called uh 17 signs, you're in perimenopause. If you want, we can send that to you. We can send you a link to download that. But then we're looking there at the main 17 symptoms that there are. I can't remember, I've lost count of where we are. But the last time I saw a list of potential symptoms for menopause, we're looking at sort of like 50 and above. Um so that is trying to look at perimenopause, then. For women who are not on some kind of hormonal contraception, uh, menopause itself, so you know, when you consider you are have have hit that one day of the menopause transition, that's after 12 months and a day without a period. So obviously, perimenopause is much trickier because you're trying to identify a transition while it's actually in place. And as we'll see down the line, there are other things that can mimic that as well. So some of those symptoms may come from other things, you know. If you've got dizziness, that doesn't just mean that you're perimenopausal because it could be an issue with your blood sugar balance or lots of other things that could be going on as well. Um so doctors will be looking more at the pattern, uh patterns over time. They may ask you to um track your habits over time and your symptoms over time and your cycle over time and see how things are going. But having said all that, there are times, of course, when testing is appropriate. So, Julie, why don't you talk about that? Because the last thing we want people to do is walk away and think, you know, hormone testing is pointless, because it's not always right.

SPEAKER_01 10:15

No, it it really isn't. I mean, testing can be clinic clinically useful. As James said, it depends on your age and your symptoms and your circumstances. And, you know, going back to NICE, this uh this organization about excellence and health and care, um they recommend considering FSH testing to confirm menopause, especially in people who are aged like 40 to 45, which is in that early stage of paramenopause, because if you've got some more severe menopause-associated simple symptoms and major cycle changes, then that's a good time to do it, or especially if you're under 40 and menopause is suspected, because that does happen sometimes. There's a lot of different factors at play. Um, when you're under 40, they might be they might suspect premature ovarian insufficiency, and that requires a very different approach, right? Like repeated measurements of that FSH, because one result isn't going to give you a definitive answer in any case. Yeah. So, you know, sometimes your healthcare provider might want tests for an altogether different reason depending on what's going on. So, you know, and that's that's something really important to remember because not everything that happens, not all of your symptoms, not everything you experience with your health in your 40s and 50s is necessarily menopause.

SPEAKER_00 11:42

100%, yeah. So this is where we need some nuance. And one of the things that sometimes makes me smile, and you know, there's not a lot to smile about when it comes to women having quite severe menopause symptoms, obviously. But it's almost like we've gone from flipping a switch, whereby four or five years ago, a woman would go to a doctor's and she would complain about certain things that were happening to her and certain symptoms that she had, and the doctors would may diagnose almost anything but menopause. You know, the first pot of call was often like an anti-anxiety medication or something like that. Now it seems as though women go to the doctors, and as soon as they say they've had one hot flush, it's boom, right. Here's some HRT. Let's get this get this sorted. So it's important to realise, I think, that it's a much more nuanced uh set of symptoms that can have can be affected by lots and lots of different things. So your symptoms can be really broad. So fatigue. How do you know if fatigue is menopause? Or have you just had a really bad week where you've not slept, you know, where the kids have been playing up, where you've had work, stress. Um, so fatigue obviously could lead to that poor sleep, brain fog, anxiety, palpitations, all those things could be blood sugar balance, there could be thyroid issues, there could be lots of other things. Weight or body composition changes, not necessarily just menopausal. Have your eating habits changed? Are you drinking more alcohol than you used to do? Yeah, so there are lots of things that we can ask ourselves as well: joint pain, changing your periods, low mood, hair and skin changes, tinnitus, they can all have other explanations. And so there are lots of other medical conditions that can produce uh overlapping symptoms. And so, what we don't want to do is just say, you know, I'm 48, therefore everything that my body does is menopause, because it could be, and it likely is, particularly if you're over 45, but it doesn't mean it necessarily is. So sometimes appropriate uh testing isn't just about proving menopause, it can be about investigating whether something else might be contributing to it. And as we know, you know, our bodies are very, very complicated. Things don't tend not to happen in silo, it tends not to just be one thing that's going on. There can be lots of other things to do. So testing can really help also look, as well as what else might be going on, but some of the supporting mechanisms that might be out of whack that might be making if you are menopausal, your menopause, your your perimenopausal or menopausal symptoms actually just that little bit more elevated or more spiky or more more troublesome for you. So it's a really good reason to have a decent conversation with your healthcare provider because it's really, really important to get a nuanced approach and an individualized approach as possible. So we're not here to trash doctors at all. Yeah, we we love our doctors, right? So Julie, why don't you talk a little bit about where healthcare gets complicated and why sometimes at first glance, you know, we we might not be getting this what we think is the support that we need.

SPEAKER_01 14:51

Yeah, and and again, we're not gonna try to say, you know, doctors are rubbish because we don't we don't agree with that, we don't believe that at all. They're not. Doctors have enormous amounts of information that they have to know and be able to apply to so many different situations. Um appointments are often quite short, and we're talking like eight to twelve minutes on average from the the different health systems that we're aware of. And historically, menopause just hasn't received coverage throughout medical school. Um, it's just historically hasn't been a hot topic, right? And research has identified some real gaps. We've talked about this before as far as menopause and women's health generally. So it can change the ability to recognize it and clinicians' confidence that they understand it well enough. And you know, there are a lot of women we in the research, there are a lot of women who report that they feel like their symptoms are being dismissed or not recognized. So, and as James said, menopause can be really difficult to identify because the woman, not only are there all of the these symptoms, you said 50, the last I saw was 67. Um, and you know, if you go into your doctor, yeah. Um, but if you go into your doctor, you're not going to go in and say, I'm experiencing parametopausal systems. You might just say, I can't sleep, my joints hurt, I'm having trouble concentrating, or I'm exhausted, or sometimes my heart races, I feel anxious and I don't know why, my periods all are over are all over the place. Taken individually, those symptoms could point in a lot of different directions. And when you combine that with age and your menstrual history and other changes, that might tell a very different story. But when you go into the doctor and you have that one or two complaints, as James said, they could be related to many, many other things. And your doctor isn't living in your body, right? So he can only, he or she can only look at the surface of what's being said and what's being discussed because they just don't have the time to dive in so much deeper. And that's why it's so important to learn how to advocate for yourself. And one of the things that we do in addition to coaching and functional testing and all the other things we do for our clients is education, because this is really important. You need to understand what's happening at this time of your life. So we aren't trying to pit you against your doctors, you need to learn to advocate.

SPEAKER_00 17:26

Yeah, yeah. So it's interesting that there are two ad words that tend to come up. Yeah, you don't want to be an adversary against your doctor, but you want to be able to advocate for yourself. So it's a really important difference. You know, your doctor's an expert in the medicine, but you're the expert in what's happening with your body. You know, your doctor doesn't live in it, you've only got 10-15 minutes together. So we'd always advocate, when you want to advocate with your doctor, taking the most useful information that you can take into the room. So the better chance then the both of you have of seeing the whole picture. So a couple of things that you might want to think about tracking, writing down for a few weeks, maybe before you go in, and have the conversation if you suspect you may be perimenopausalist. What are the symptoms you're experiencing, and maybe keep a record of those, score them if you want. When did they start? Are they changing? Do they happen a lot? Changing your menstrual cycle are really, really important. There's loads of apps out there these days that can do that for you. Sleep is really important. How's your sleep getting on? Are you having any of those conventional symptoms of hot flushes and night sweats, mood changes, you know, vaginal challenges, sexual symptoms, whatever they may be? Anything that seems to trigger or improve the symptoms, you can write all that kind of stuff down. And sort of any medications or supplements that you might be on as well. Um, and the key thing is, how is this affecting your quality of life? Because that is the one thing nobody wants. Nobody wants your quality of life to be less than what it is. So we're not saying, you know, walk in with a colour-coded 47-page menopause dossier, although many of the women that we we talk to are so um get get so wrapped up in when they want to do something and they want to talk about something and they get really uh involved with it, that many of them actually do produce that 47-page dossier. So you don't need to go into those levels of having every single page colour-coded and sectioned off and things like that. But if you consider two different statements, you know, walk into your doctor and say, I've felt awful lately, they don't have much to work with. But if you could walk in and say, you know, over the last six months, my periods have become irregular, my flows become irregular, I'm working several times a night, I've started having some night sweats, and I've noticed that at some points of the day I've got brain fog that's affecting my work. That gives a doctor a lot more information to look at and play with and investigate than if you're going in somewhere really with like an uh a limited statement, let's say. So hopefully, if you do that and you've got a good medical professional on your team, you should be heard. But what happens if you feel as though you're not being heard? And again, this is not painting you as an adversary, but Julie, why don't you tell people how they can advocate in that kind of uh situation?

SPEAKER_01 20:34

Yeah, absolutely, because there are times when your doctor or clinician might have a perfectly good medical reason for thinking about a different diagnosis first, because some of these symptoms, as you've hopefully seen by now, are genuinely ambiguous. But if you're at a point where something major has changed and you don't feel like your concerns are being properly explored or listened to, it's reasonable for you to keep asking questions. And this is where that self-advocacy comes in again. What else could be causing these symptoms? Could this be related to perimenopause? Is there anything we should rule out first? You know, ask if testing would be useful in your particular situation. Find out what your treatment options might be. And it's perfectly okay, because this is your health and your life we're talking about, to ask, you know, would it be appropriate for me to see somebody with more specialized menopause experience? That might even give your doctor a great sigh of relief because they're trying to help you. They don't have the expertise necessarily in that area. And there are others, other practitioners who do. So it's perfectly reasonable to ask that and help them help you. Because a lot of times, you know, and the research does show women encounter a lot of barriers to getting the support that they need. Of symptoms are being recognized, and some women feel dismissed. And I can say personally, I've had that experience. So we're not talking about walking into the surgery and just say, you know, I saw these reels on TikTok and now I've I'm sure that this is what I've got, right? We're talking about bringing good in bringing good information and being a participant in the decisions about your health rather than just handing things over and say, here, fix me, right? That's not what doctors are there for. It's it's your health and you have a role to play in that. So so, James, now that we've talked about all of those things, should you buy a menopause test?

SPEAKER_00 22:38

I think if you're 45 and you're experiencing the typical symptoms we've talked about, probably don't assume that you need to have one, excuse me, before you talk to somebody about what you're experiencing. So that could be your GP, it could be a health coach or a nutritionist or somebody who offers functional testing. Um and also a test result really doesn't override what you feel is happening to you personally, right? Your symptoms matter. Um lab tests only give you a snapshot of what's going on on that particular day that the test was done. So you can't just reduce the whole thing to the lab test results. You need to take a more holistic view. I'd argue that if you are gonna go for for for some kind of testing, it's probably worth looking at a functional testing option, which, as I said previously, will look into all the supporting bodily symptoms uh symptoms and systems and see if you know they're all working optimally so you can help with those support systems that might help with your symptoms overall. If you're much younger and your situation feels unusual, symptoms don't feel as though they're right for your time of life, um your mental pattern's changing a lot, then that's a different conversation, one you probably need to have with your GP or your doctor. So the important question isn't simply what does FSFSH say, and that that's the result you get from a home test, but what's happening to me, what might be contributing to it, and what support do I need. So, you know, here's something to really take away from today's episode. You don't need a test result to give you permission to take any changes that are happening in your body, whether they are menopause related or not, to take them seriously. Julie.

SPEAKER_01 24:39

Yeah, it's important again, pay attention to the patterns, track what's changing, because a lot of times once you can see it over time, you can see the patterns much more easily if you're keeping track rather than trying to remember. And learn enough to understand what questions to ask your doctor or your healthcare practitioner. So then you can take that information with you when you speak to them. Because again, good health care should be a conversation, it should be a partnership, because your doctor brings medical expertise and you bring expertise about your body, and you need both.

SPEAKER_00 25:18

Yeah, absolutely. So we'll wrap it up there then. But just to say, if you're struggling to make sense of what's happening in midlife, or you know what you'd like to change, but you can't work out where to start, that's exactly the kind of thing that Julia and I can help you with. We offer a free strategy call, it's 45 minutes long. We can have a proper conversation with you about what's going on, what you'd like to change, what might help, and if you're interested, how we might be able to help as well. There's no obligation, no hard sell. And we'll put the booking link in the show notes if you would like to take the offer of that free 45-minute call up.

SPEAKER_01 25:56

Awesome. Well, um, I guess that's it for this week. So thank you for joining us. It's been a pleasure, as always. We've been James and Julie from Fabulous Beyond 40. And we're here to remind you to stay strong and stay fabulous. And we'll see you next time.

SPEAKER_00 26:14

See you next time.