Written by the PureMuze team and published October 7, 2026. This article is general information, not medical advice, and is not a substitute for a consultation with a licensed clinician.
“Just test my hormones” is the most natural request in perimenopause, and the one most likely to disappoint. The levels move day to day, the gold-standard diagnosis is clinical, and some of the most useful numbers are not hormones at all. Here is what the panel said is worth measuring, and what each result can and cannot tell you.
Why a single hormone test can mislead
In perimenopause estrogen is erratic by definition. “One day your estradiol may be elevated, and you may check it the next day and it may be critically low,” Dr. Sarah Bonza said. That is why guidelines tell physicians not to diagnose perimenopause from hormone levels, and why a normal-looking result does not mean nothing is happening.
Blood, not urine or saliva
Asked about the DUTCH test, which measures hormone metabolites in dried urine, Dr. Bonza was clear about her own practice: she prefers serum (blood) testing. It is more sensitive, and the research literature is built on serum levels, not urine or saliva, so results can be compared to something. In the US, she said, serum testing is usually covered by insurance when ordered with the right diagnostic codes.
What she tests
- FSH, the signal from the brain telling the ovaries to make estrogen. It rises as the transition progresses, so a high value supports the picture, though a single normal one rules nothing out.
- Estradiol, progesterone and testosterone, read as a pattern over time rather than a verdict.
- Insulin. Insulin resistance climbs early in perimenopause as estrogen falls, and a fasting insulin shows that long before glucose does. Dr. Bonza tests it so women can see how their hormones are affecting their metabolic health.
- Ferritin, the iron store, which heavy perimenopausal periods drain; low ferritin mimics most of the symptoms. See the ferritin article.
- A broad panel when symptoms warrant it: cholesterol, HbA1c, vitamin D, thyroid, and in her experience surprising deficiencies, including undetectable copper.
The diagnosis is clinical
The gold standard is a clinician taking a proper history and scoring symptoms, not a lab value. The most validated tool is the Greene Climacteric Scale, a short questionnaire covering mood, sleep, physical symptoms and vasomotor symptoms; Dr. Bonza offers a free version on her own site. If you want to walk into an appointment prepared, a symptom score and a few months of notes on sleep, cycle and mood are worth more than a one-off hormone result.
The numbers you can collect yourself
Angela Foster works alongside the medical picture with measurements that show whether changes are working. Body composition (muscle mass, body fat, and visceral fat around the organs) from a DEXA or InBody scan where available, or a home smart scale used consistently: same time of day, fasted, hydrated, before caffeine. Sleep data from a wearable: resting heart rate, respiratory rate (a faster rate at night suggests a stressed nervous system) and heart rate variability as a read on resilience. And simple strength tests, so that progress is visible. Her point is that these are not diagnostics; they are the feedback loop that keeps you going once the medical questions are answered.
What to ask for
Ask your clinician for serum hormones read as a trend, a fasting insulin, a ferritin level, and a symptom score, and ask what they consider optimal rather than merely normal. A clinician who recognises perimenopause will know why you are asking. Whether and how to treat what the tests show, including hormone therapy, is a decision made with that clinician and depends on your history.
The session, and this article, are general health education, not medical advice. Neither the panelists nor PureMuze are your clinicians, and nothing here is a diagnosis or a treatment recommendation for you. If something applies to you, take it to your own clinician.
