While blood tests are not necessary to diagnose the perimenopause and menopause for most women, we may measure hormone levels in your blood to guide treatment, in conjunction with discussing your symptoms. These blood tests may be performed before starting HRT or testosterone and/or when you are already using hormones. In addition, other blood tests may be beneficial as part of a general ‘well woman’ check or to target specific systems. They can be useful way to check for other conditions that can mimic or worsen the symptoms of menopause and can help us advise you on optimising your future health.
Below are details of the seven different blood test packages we offer at Newson Health. If you’d like to arrange a blood test, please contact our team on 01789 595004, or ask your clinician at your next consultation.
You can request a blood test with us by filling out the form here.
Tests included: Full blood count, kidney function, liver function, lipids, ferritin, thyroid function (TSH, T4 and T3), HbA1c, oestradiol, testosterone, sex hormone binding globulin (SHBG), vitamin B12, folate, Vitamin D
This comprehensive profile helps us assess your current health and risk of future diseases as well as measuring levels of some important vitamins and hormones. This profile includes:
Full blood count
This test checks the types and numbers of red and white cells in your blood and can help give an indication of your general health, as well as providing important clues about certain health problems you may have, such as anaemia.
Kidney function (eGFR, creatinine, sodium, potassium, urea)
Your kidneys are important for filtering your blood and clearing waste products from your body as well as regulating levels of important chemicals such as sodium and potassium. Many conditions, medications and some aspects of your diet can affect kidney function. This test gives an indication of how well your kidneys are working.
Liver function (ALT, ALP, AST, GGT, bilirubin, albumin)
Your liver has many functions including clearing waste products, making proteins, maintaining hormone balance, storing vitamins and producing chemicals to help digest fats. Nutrition, lifestyle, medications and various medical conditions can all affect liver function. These tests help build up a picture of how well your liver is working.
Lipids
Lipids, which include cholesterol and triglycerides, are fat-like substances found in your blood and body tissues. Your body needs these lipids to work effectively, but the types and proportions of these lipids are important.
Cholesterol is used to build cells and certain hormones – all your sex hormones (oestrogen, progesterone and testosterone) are derived from cholesterol. Cholesterol is carried in your blood by proteins and these combinations are called lipoproteins. Various lipoproteins affect your health in different ways:
Triglycerides are another form of lipid that are needed to store unused calories and provide your body with energy when needed. However, having high levels of triglycerides can also contribute to narrowed arteries. Having excess weight, drinking too much alcohol or eating a lot of fatty and sugary foods or can cause high levels of triglycerides. You can have normal levels of cholesterol but still have a high triglyceride level so it is important to check these too.
RELATED: Menopause and cholesterol: what you need to know
Ferritin
Ferritin is a measure of the iron stored in your body. Having too little ferritin levels can lead to anaemia and may also contribute to fatigue, poor sleep, restless legs, and hair and nail changes. Having too much ferritin can indicate certain underlying diseases.
Thyroid function (TSH, T4 and T3)
Your thyroid is a small gland in the front of your neck which produces thyroid hormones that affect numerous processes in your body. Having too many or too few of these hormones can cause unpleasant symptoms but also potentially serious health problems.
Many of the symptoms of thyroid disease can mimic menopause which is why it is often important to check that your thyroid is working normally. Thyroid function tests comprise several different hormones:
HbA1c
This is a marker of your average blood glucose level over the past few months. It is used to diagnose diabetes and also prediabetes (a condition that is an early warning of possible diabetes developing in future). This result can help guide diet and lifestyle to reduce your risk. Taking HRT can also reduce the risk of developing type 2 diabetes.
RELATED: Navigating your diabetes and the menopause
Oestradiol
This is the most potent form of oestrogen and is important not only for symptom control in perimenopause and menopause but also for bone, heart and brain health as well as for reducing your risk of many chronic diseases. During perimenopause, your own oestradiol levels will often fluctuate significantly throughout the month whereas in menopause they will usually be consistently low if you do not take HRT.
If you are taking oestrogen through your skin by way of patch, spray or gel, we often measure your oestradiol level as an indicator of how well you are absorbing the hormone. If your oestradiol level is low then we may advise you to change the dose or type of HRT. Measuring oestradiol levels if you are taking oestrogen orally is not accurate as this the oestrogen is metabolised and processed by your body in a different way.
Testosterone
Testosterone is a female hormone produced by your ovaries and adrenal glands. It can work to improve libido and it can also help to improve mood, energy and concentration, as well as bone and muscle strength. Testosterone is at its highest around the age of 20 years, and levels fall gradually with time. At the age of 40, testosterone levels are approximately half what they were 20 years before. Measuring testosterone, in conjunction with SHBG (below), can help guide treatment with testosterone replacement.
Sex hormone binding globulin (SHBG) and free androgen index (FAI)
SHBG is a protein which binds to sex hormones in your blood and controls the amount of these hormones that are actively working in your body. When the protein binds to sex hormones, your tissues cannot use those hormones effectively. So, we often use SHBG in conjunction with testosterone levels to calculate a ratio called the FAI to estimate how much testosterone is available in your body for use.
Vitamin B12 and folate
Vitamin B12 and folate are needed to make your red blood cells and keep your brain and nerve tissues healthy. Having low levels of either or both can lead to a wide range of symptoms and potentially serious problems. Sometimes levels of vitamin B12 and folate can be low due to poor or restrictive diets, or because of certain medications or other medical conditions.
Vitamin D
Vitamin D helps your body absorb and retain calcium and phosphorus which are both important for building bone. Vitamin D can also help control infections and reduce inflammation.
It is difficult to obtain adequate vitamin D from your diet: most is formed by your body when your skin is exposed to sunlight. So, in the UK, especially in the winter months, many people are a low in vitamin D. UK government advice is that everyone should consider taking a daily vitamin D supplement at least during the autumn and winter and for some individuals, year-round.
Tests included: Full blood count, kidney function, liver function, lipids, ferritin, HbA1c, oestradiol, testosterone, sex hormone binding globulin (SHBG), vitamin B12, folate, Vitamin D and full thyroid panel (TSH, T4, T3, TgAb, TPOAb)
This is the most detailed profile which includes everything in Newson Health 1a plus the full thyroid panel at a discounted reduced cost. This might be particularly useful if you want a general health check and if you are particularly concerned about your thyroid, have a family history of thyroid problems, or if you or your family have other auto immune conditions.
In addition to TSH, T4 and T3, this profile will also check anti-thyroglobulin and anti-peroxidase antibodies. Antibodies are proteins made by your body to protect you from various infections. However, sometimes the body mistakenly makes antibodies which can attack your own normal body tissues and cells. This can lead to an autoimmune disease and can affect your thyroid as well as other parts of the body. Checking for these antibodies in your blood can indicate if you have current thyroid disease, or if you are more likely to develop thyroid disease in the future.
Thyroid peroxidase antibodies (TPOAb)
Thyroid peroxidase is a substance that helps drive the process of making thyroid hormones. Antibodies to thyroid peroxidase may be present in people who have an underactive or overactive thyroid due to an autoimmune cause, such as Hashimoto’s thyroiditis or Graves’ disease. These antibodies affect your thyroid’s ability to function normally.
Thyroglobulin antibodies (Tg Ab)
Thyroglobulin is a protein that helps make thyroid hormones. Thyrogloblulin antibodies work against this process and can be present in certain thyroid conditions, including Hashimoto’s thyroiditis amongst other diseases.
In some people, these antibodies may be present without having thyroid disease. Depending on your symptoms and results, it may be necessary to refer you to an endocrinologist (a doctor who specialises in these types of hormones) or thyroid specialist to assess you further.
Tests included: Oestradiol, testosterone, SHBG
This profile is most useful before starting HRT or testosterone and/or when you are already using hormones.
Tests included: testosterone, SHBG
This profile is most useful before starting testosterone replacement and while monitoring testosterone levels once using testosterone, in conjunction with discussing your symptoms.
Tests included: oestradiol, testosterone, SHBG, thyroid function (TSH, T4 and T3)
It is important that sex hormones and thyroid hormones are all balanced correctly for good symptom control and also for your future health. These blood tests may be done before starting HRT or testosterone and/or when you are already using hormones. Many of the symptoms of thyroid disease can mimic menopause which is why it is often important to check that your thyroid is working normally.
Tests included: full thyroid panel including anti-thyroglobulin and anti-peroxidase antibodies (TSH, T4, T3, TgAb, TPOAb)
This profile is the most comprehensive check of your thyroid function offered at Newson Health.
Tests included: oestradiol, testosterone, SHBG, thyroid function (TSH, T4 and T3), vitamin D
This profile is useful to have both for checking or monitoring your sex hormone levels before starting or while on HRT, but also for ruling out other problems. Many of the symptoms of thyroid disease can mimic perimenopause or menopause. Similarly, symptoms of low vitamin D can overlap with some symptoms of perimenopause and menopause but also you may be deficient in vitamin D without any symptoms and this can impact your bones and overall health.
References
www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/
www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/
https://medlineplus.gov/lab-tests/tsh-thyroid-stimulating-hormone-test/
https://www.btf-thyroid.org/thyroid-antibodies-explained
https://medlineplus.gov/ency/article/003556.htm
https://www.btf-thyroid.org/thyroid-function-tests
https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/diagnosis/
