20 - Why estrogen has everything and nothing to do with your midlife health check
Women often approach me in midlife and tell me they are in perimenopause and think they should get their estrogen checked. What I explain is that estrogen has everything – and nothing – to do with their health. I believe strongly that it is super important in midlife to have a really thorough health check to see what the lay of the land is, but estrogen is not the main thing I am watching.
Perimenopause & menopause are not medical conditions
The reason is – perimenopause and menopause are not a medical condition – they are a normal rite of passage or transition. During perimenopause and midlife, we expect estrogen to be on a massive rollercoaster. At the moment of a blood test it may be through the roof, but within a few days it may have plummeted. So the level of estrogen in one moment of time is not in itself usually significant.
Where estrogen IS relevant, is that the fluctuations and eventual decline of estrogen lead us to other health changes. So a midlife health check is vital for seeing which markers that estrogen was buffering us from are now starting to shift.
Hormonal health
One of the key areas is hormonal health more broadly. When one hormone changes, there are often changes to others, so midlife is a key time to ensure hormonal balance is still there, particularly as symptoms of hormonal disruption may be disguised as perimenopause symptoms such as hot flushes and weight gain. This ideally will include
fasting blood sugar and insulin,
thyroid hormone panel including antibodies
saliva cortisol over 4-6 times of the day
and occasionally assessment of testosterone levels
Cardiometabolic health
Cardiometabolic health becomes increasingly important – before perimenopause women have a much lower rate of cardiometabolic issues than men, but this is largely as estrogen is protective, so from midlife it pays to pay attention. This include checking
blood pressure
cholesterol/ lipid panel
liver function test
homocysteine
CRP (an inflammatory marker)
Bone health
Estrogen also protects our bone health, so now is a good time to start keeping an eye on maintaining bone strength. The ALP marker on the liver function test can give us early warning of increased bone turnover, and we can also test
· parathyroid hormone- which increases when our calcium intake is insufficient, and instructs our body to breakdown bone to release calcium stores
· bone density scan
Breast health
Regularly self examination of breast tissue and mammograms are key components of self care.
Nutritional status
Whenever you have a thorough health check, it’s a great idea to check your nutritional status also. Not specific to midlife, but if any of the above markers are moving away from optimal it helps to know where your nutrients are at because these nutrients support the health of the other markers.
Some markers are not that accurate, such as magnesium, but the ones I find very helpful include
B12 & folate
B6
Zinc
Copper
Iron studies
Vitamin D
Random urinary iodine
Well, there you have it! Armed with this information you are in a good position to better target your efforts in supporting your health. And of course, if you need any help interpreting the results, send me an email to enquire about how naturopathy can support you.