Which Lab Tests Are Most Helpful for Women in Perimenopause?
- Dr. Teresa True
- Oct 22
- 6 min read
Updated: Nov 10
Perimenopause can sneak up on you. One month everything feels normal, and the next your sleep, mood, or cycles start to shift for no clear reason. These changes aren’t random. They reflect the way your hormones are fluctuating as your body begins the transition toward menopause.
The problem is that most routine lab testing for perimenopause doesn’t show the full picture. If you’ve ever been told your “hormones are normal” while you feel far from it, you already know how frustrating that can be. To really understand what’s happening in perimenopause, you need the right type of hormone testing, the kind that actually measures what’s active in your system, not just what’s floating around bound to proteins and unavailable for use.
You need testing that actually measures what’s active in your system, not just what’s floating around bound to proteins and unavailable for use.
Why Standard Lab Tests Often Miss the Mark for Perimenopause
Traditional blood testing measures total hormone levels. That means it looks at how much hormone is circulating in your bloodstream, but not how much your body can actually use.
In perimenopause, this distinction matters. When estrogen and progesterone start to fluctuate, your free or “bioavailable” hormone levels can change dramatically even if your total blood levels don’t. Blood testing also has another major blind spot: it primarily only measures estradiol (E2), the dominant estrogen during your reproductive years. It ignores estrone (E1) and estriol (E3), which become more relevant as you move toward menopause. Without those, you’re missing critical information about how your body is metabolizing and balancing estrogen overall.
Why Saliva Hormone Testing Is More Accurate for Perimenopause
Saliva hormone panels measure free, unbound hormone levels
Saliva hormone panels measure free, unbound hormone levels, the hormones actually available to your cells. That’s why they’re far more reflective of what your body is feeling than what’s on a standard blood panel.
Saliva testing also has another advantage: it’s reliable even if you’re using topical hormones such as creams, gels, or patches. Those forms often don’t show up accurately in bloodwork because they don’t circulate evenly through the bloodstream. Saliva reflects the hormone activity in tissues, where it actually matters.
Most saliva panels also include E1, E2, and E3, along with progesterone, testosterone, DHEA, and cortisol. This gives a complete view of both ovarian and adrenal contributions, which become closely linked in this stage of life.
You can order a Saliva Hormone Panel directly through our Functional Labs page. The process is simple: order online, collect at home, and ship it back to the lab. You’ll get detailed results and the option for an interpretation session if you’d like professional guidance.
The comprehensive PLUS includes E1, and E3 in addition to E2 and is ideal for women. The regular Comprehensive Hormone Profile tests just E2, and is better suited for men.
The Role of Adrenal Function in Perimenopause
As ovarian hormone production slows down, the adrenal glands begin to pick up some of the slack. They produce smaller amounts of estrogen and progesterone from precursor hormones like DHEA.
If your adrenals are already depleted from chronic stress, poor sleep, or nutrient deficiencies, this transition can feel like hitting a wall. Hot flashes, mood swings, low libido, and insomnia become much more pronounced when your adrenal reserve is running on empty.
That’s why adrenal testing is so important during perimenopause. A good hormone panel will include cortisol measurements taken throughout the day. Generally at least 4 separate measurements of cortisol at waking, mid-day, evening and bedtime help us understand and evaluate the normal cortisol rhythm. This helps identify whether your adrenals are overactive, underactive, or simply worn down.
If your cortisol pattern is flat or erratic, that’s often a sign your stress response system needs support before hormone balance will improve.
DUTCH Testing: A Deeper Look at Hormone Metabolism
The DUTCH (Dried Urine Test for Comprehensive Hormones) offers an even deeper look at how your body is processing and clearing hormones. It measures not only hormone levels but also metabolites that reveal how your liver and detox pathways are handling estrogen.
For women dealing with stubborn symptoms or a history of estrogen dominance, this test can be invaluable. It also assesses cortisol and cortisone rhythms, giving insight into both adrenal function and stress resilience.
You can order a DUTCH Complete through our Functional Labs page. Each test includes clear, actionable data and can be reviewed with a licensed naturopathic physician for personalized recommendations.
When to Consider Hormone Testing
You don’t need to wait until your periods stop to test your hormones. Some of the best insight comes early, when changes are just beginning. Testing is worth considering if you’re noticing:
Irregular cycles or skipped periods
Weight gain that feels different from before
Mood swings or anxiety
Night sweats or hot flashes
Trouble sleeping or waking too early
Low libido or vaginal dryness
These are all signs your hormones are shifting and your adrenals may be under strain.
The Bottom Line
Perimenopause doesn’t have to feel like a guessing game. The right lab testing can clarify where your hormones actually are, how your adrenals are coping, and what kind of support will make the transition smoother.
If you’ve been told your labs look “normal” but you know something is off, it’s time for a more functional look at your hormones.
Order a Saliva Hormone Panel or DUTCH Test to get the information you actually need. Results are delivered securely, with the option for professional interpretation and next-step guidance.
Looking for the full overview of lab options and when to use them? Read Functional Lab Tests Explained.
Frequently Asked Questions
When should I test my hormones during perimenopause?
You don’t have to wait until your periods stop. Saliva or DUTCH testing can be done at any point in the cycle, ideally during a time you’re experiencing symptoms. Tracking your cycle days helps with interpretation but isn’t required. Often we recommend testing during the luteal phase of the cycle so we determine if ovulation occurred and better assess progesterone levels but this isn't necessary.
Why is saliva hormone testing better than blood testing?
Saliva reflects the free, bioavailable hormones that your tissues can actually use. Blood testing mostly measures bound hormones that aren’t active, which often leads to “normal” results that don’t match how you feel.
Can I do hormone testing if I’m using a topical cream or patch?
Yes. In fact, saliva testing is the best option if you use topical hormones. Topical hormones don’t circulate evenly in the bloodstream, so blood levels often appear low or normal even when tissue levels are elevated.
What’s the difference between saliva testing and DUTCH testing?
Saliva testing gives a snapshot of your current free hormone levels and adrenal function. DUTCH testing goes deeper, showing how your body is metabolizing and clearing those hormones through liver and detox pathways.
Do I need to see a doctor to order these tests?
You can order either test directly through our Functional Labs page. Results are delivered securely, and you can schedule an optional interpretation session for professional guidance.
References
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