Should a 42-year-old woman with perimenopausal symptoms, including nocturnal hot flashes, undergo hormone level testing?

From the Guidelines

You should have your hormone levels checked if you're experiencing perimenopausal symptoms like night hot flashes at age 42. This is because hormone fluctuations, particularly declining estrogen levels, are responsible for hot flashes as they affect your body's temperature regulation system 1. To determine the cause of your symptoms, your healthcare provider will likely assess the likely cause for the menopausal symptoms, including likely causes for hot flashes, as outlined in the practical clinical guidelines for assessing and managing menopausal symptoms 1. Some key points to consider when evaluating your symptoms include:

• The majority of breast cancers are estrogen and/or progesterone receptor positive and will be treated with endocrine therapies, which may cause hot flashes 1
• Chemotherapy and endocrine therapy commonly induce temporary or permanent ovarian dysfunction and induce hot flashes 1
• In those managed with bilateral oophorectomy, >90% will experience hot flashes as well as other menopausal symptoms which may be particularly severe and long lasting 1 Make an appointment with your healthcare provider for a comprehensive evaluation, which typically includes blood tests to measure estrogen, follicle-stimulating hormone (FSH), and sometimes other hormones like thyroid hormones. These tests can help confirm if you're in perimenopause and rule out other conditions that might cause similar symptoms. Your doctor might recommend lifestyle changes, hormone therapy, or other treatments based on your test results and symptom severity.

From the Research

Menopausal Symptoms and Hormone Level Checks

• A 42-year-old woman experiencing perimenopausal symptoms, including hot flashes at night, may want to consider having her hormone levels checked to determine the best course of treatment 2, 3.
• Hormone therapy is often prescribed to alleviate menopausal symptoms such as hot flashes and vaginal atrophy, but it is essential to weigh the benefits and risks, particularly for women with a uterus, as combined estrogen/progestogen therapy may increase the risk of breast cancer 2, 4.
• Nonhormonal alternatives, such as low-dose paroxetine, venlafaxine, and gabapentin, are also effective in reducing hot flashes and may be considered for women who cannot tolerate hormone therapy or have contraindications 2, 3.

Hormone Therapy and Treatment Options

• The decision to use hormone therapy depends on clinical presentation, a thorough evaluation of the risks and benefits, and an informed discussion with the patient 2, 5.
• Systemic estrogen alone or combined with a progestogen can reduce the frequency of vasomotor symptoms by approximately 75%, while nonhormonal options like citalopram, desvenlafaxine, and gabapentin can reduce symptoms by 40% to 65% 3.
• Bioidentical estrogens and low-dose vaginal estrogen are also available options for treating menopausal symptoms, with the latter associated with subjective improvement in genitourinary syndrome of menopause symptoms by approximately 60% to 80% 3, 6.

Considerations for Hormone Level Checks

• The timing of hormone therapy initiation, type and route of administration, and patient-specific considerations should be taken into account when prescribing hormone therapy 4, 5.
• Women with a uterus should be prescribed combination therapy only to treat menopausal symptoms, using the smallest effective dosage for the shortest possible duration, and should also take a progestogen to reduce the risk of endometrial cancer 2, 6.