Hormone Testing in Perimenopause: What Labs Can’t Tell You (and What Matters More)

Feb 8
4 min read

A lot of women come to me with the same request:

“Dr. T, I need ALL my hormones tested.”

And I get it. When you’re tired, moody, not sleeping well, and your body feels… off… you want answers. You want data. You want something that proves what you’re experiencing is real.

But here’s the truth I wish more women heard early:

Hormone labs often don’t diagnose perimenopause—and they can actually send you down the wrong path.

Not because your symptoms aren’t real.

But because your body is more complex than a single blood draw.

In this episode of Midlife Revival, I break down what perimenopause and menopause actually mean, why hormone testing is frequently misleading, and why hormone therapy—while powerful—should never be treated like a one-size-fits-all fix.

What perimenopause and menopause actually mean

Menopause is defined as 12 months with no menstrual bleeding. In the U.S., the median age is about 51 (and often earlier for Black women).

Perimenopause is the transition leading up to menopause. On average, it lasts about four years, and it typically becomes clearer in the late phase, when periods start skipping for 60+ days at a time.

Early perimenopause is trickier. Symptoms can include:

sleep disruption
mood changes (often cyclical)
shifts in libido
subtle cycle changes (shorter or longer cycles)
mild hot flashes/night sweats

And here’s the sticky part: those same symptoms can also come from stress, life circumstances, medications, depression/anxiety, thyroid issues, vitamin deficiencies, sleep apnea—so many things.

That’s why a “hormone panel” can feel reassuring… but not always helpful.

✨ Top 3 takeaways on hormone testing in perimenopause

1) Hormone levels change throughout the month—so one test can be misleading

Your hormones aren’t static. You are a cyclical being.

Estradiol, progesterone, and testosterone naturally rise and fall depending on where you are in your cycle. So if you test on a random day, your results may look:

“normal” (but not normal for you)
“low” (because you tested before progesterone is even supposed to rise)
“high” (because you caught a peak)

A classic example: someone tests early in their cycle and gets told, “Your progesterone is low.”Yes. It’s supposed to be. Progesterone rises after ovulation.

Bottom line: labs without cycle context can create confusion, fear, and unnecessary treatment.

2) Symptoms + cycle patterns are usually more useful than labs

If the goal is to figure out, “Am I in perimenopause?” — most of the time, your story tells us more than your lab results.

The questions that often matter more:

What are your cycles doing? (shorter? longer? skipped?)
Are symptoms cyclical or constant?
What changed recently in stress, sleep, meds, or health?
What are your goals (sleep, mood, energy, libido, hot flashes, weight)?

This is why the major professional societies generally don’t recommend routine hormone labs for diagnosing perimenopause in the typical patient—because they often don’t change what we do next.

(There are exceptions—like suspected primary ovarian insufficiency or very early menopause—where labs do matter.)

3) Hormone therapy is part of the toolkit—not the entire toolbox

I’m a big believer in hormone therapy when it’s appropriate. I use it myself. It can be life-changing.

But I need you to hear this clearly:

Hormone therapy doesn’t “fix everything,” and it doesn’t replace a full evaluation.

If someone has fatigue and poor sleep, we also need to consider:

thyroid disease
vitamin D deficiency
anemia or nutrient issues
medication side effects
depression/anxiety
obstructive sleep apnea (especially with certain risk factors)

Two things can be true:

Hormones might help.
Something else might also be driving the symptoms.

When clinicians skip the full picture and push hormones as the whole answer, that’s not “cutting-edge.” That’s lazy medicine.

What I see in real life (and why this matters)

I’m seeing a pendulum swing.

For decades, women were dismissed and shamed around menopause symptoms. Now, finally, the conversation is louder—and that part is beautiful.

But the pendulum is swinging toward:“If you just get on hormones, everything will be fine.”

And when women don’t feel better, they assume:

“Something is wrong with me.”
“Hormones didn’t work for me.”
“I’m broken.”

No, sis.

Sometimes hormones weren’t the right answer in isolation. Sometimes we need:

hormone therapy plus targeted mood support
hormone therapy plus sleep evaluation and treatment
hormone therapy plus chronic disease optimization
hormone therapy plus stress/rituals/rest and lifestyle interventions

That’s whole-person care. And that’s the standard I’m building at Revival Women's Health.

One gentle experiment to try this week

Before you order a pricey hormone panel, try this:

For the next 30 days, track two things:

Your cycle (start date, length, skipped days)
Your symptoms (sleep, mood, hot flashes, energy) and whether they feel cyclical

Bring that information to your clinician.

That data—your lived experience—often gives us a clearer roadmap than a one-time lab snapshot.

Hormone testing in perimenopause: FAQ

Can hormone tests confirm perimenopause?

Usually, no. Because hormone levels fluctuate day to day and across the menstrual cycle, a single test often doesn’t diagnose perimenopause.

When are hormone labs actually useful?

They can matter if you’re under 40 with skipped periods (concern for primary ovarian insufficiency), or in other specific clinical scenarios where labs would change management.

Why did my progesterone come back “low”?

If you tested early in your cycle, progesterone is expected to be low. Progesterone rises after ovulation.

If my labs are “normal,” why do I feel awful?“

Normal” ranges are broad. You may still have symptoms due to hormonal fluctuations, stress, sleep issues, thyroid disease, vitamin deficiencies, mood disorders, or sleep apnea—sometimes in combination.

Will hormone therapy prevent heart disease or dementia?

Hormone therapy may benefit some symptoms and may have favorable effects in certain contexts, but it is not a universal prevention strategy—especially when other risk factors (like diabetes, hypertension, high cholesterol) are present and need direct treatment.

If you’re feeling dismissed, confused, or like you need a more comprehensive approach, you deserve care that treats you like a whole human—not just a hormone panel.

That’s the mission behind Revival.

And if this post hit home, listen to the full podcast episode and consider bringing these questions to your next visit:

What are my goals?
What else could be driving these symptoms?
What’s the safest, most effective toolkit for me?

You’re not broken. You’re in transition—and you deserve real support.