January 15, 2017 Liza Colimon, MD It never fails... More than often I have the suspicious patient who feels I have overlooked something major because I haven't been regularly checking their hormones. Ladies! If you're over 35 and feeling fatigued or "out of whack" this doesn't automatically imply you are entering premature menopause. So take a deep breath. Make sure you are considering other possibilities that could be derailing you from your typical energetic day such as work schedules, children, stress, relationship demands, lack of sleep, lack of exercise, poor eating habits and diet, and other illnesses both acute and chronic to name a few. Disappointed ladies would present themselves in the masses exclaiming... "Doctor, I think I need my hormones checked," typically after The Oprah Winfrey Show hosted guests such as Dr. Phil's wife, Robin McGraw who openly suggested that if your gynecologist hasn't been checking your hormones then you should find another gynecologist. Other talk show guests such as Suzanne Somers, who launched the Bioidentical hormone debate, has also made my office visits more animated and given me more opportunities to teach. The bottom line is that if and when you need hormone supplements, there are many varieties and types depending on the therapy goals. However the real question remains... When should we be checking vs. not? Here are the top five reasons you should consider having your hormones evaluated by your gynecologist or internist. 1. You are Having Irregular Periods. If you are suddenly starting to skip your period, have missed a period, have prolonged periods, or bleeding in between periods a blood test is warranted to ensure you are not perimenopausal. The average age of menopause is around 51-52. But first, your doctor should perform a urine pregnancy test. You are officially Menopausal when you have not had a period for one year. However, most women don't wake up one day in Menopause. If only life could be that simple! Perimenopause is defined as the time around or before menopause. Typically 2-4 years prior one may start to have irregular periods. Some studies suggest perimenopausal symptoms can start even 8 years prior. You are risk of having earlier menopause if you smoke cigarettes or have a history of smoking, have had an ovary removed, have participated in assisted reproductive therapies such as Invitro Vertilization (IVF), or if you suffer from certain autoimmune conditions such as Lupus, Graves Disease or Hashimotos Thyroiditis. You may also be at risk if you've ever received chemotherapy or radiation therapy. "Checking Hormones" is rarely helpful during this time period as your hormones will fluctuate during your menstrual cycle. However an elevated Follicular Stimulating Hormone (FSH), which is made by your pituitary gland, will confirm you are Menopausal or close to it. Your Thyroid Stimulating Hormone (TSH) should also be evaluated as an abnormal thyroid gland can cause menstrual irregularities. 2. You Are Suffering from Fatigue and Weight Changes If you have noticed gradual or sudden changes in your weight, in combination with fatigue, you may be suffering from Hypothyroidism. This condition can cause irregular menstrual cycles as well. Hyperthyroidism can also cause menstrual irregularities. You doctor should check your TSH to ensure your Thyroid Gland is functioning properly. Likewise, ladies if you have known thyroid disease and choose not to be treated with recommended therapies, then prepare yourselves to welcome all types of visitors such as lethargy, weight gain or loss, energy level disturbances and menstrual problems. Again, there are many causes of fatigue and weight disturbances. A skilled physician will know when to check for hormonal causes. Exercise caution if you are seen at Med Spas or physician offices that want to check hormone levels monthly at a cost. This should not be necessary. 3. You Notice Discharge or Milk coming from Your Breasts Hyperprolactinemia is a condition where abnormally high levels of prolactin are found in bloodstream. Prolactin is produced in the brain by the Pituitary Gland. High levels of this hormone can cause nipple discharge that can be clear or look like milk. If the gland itself becomes enlarged it may also cause headaches or vision changes. High levels of prolactin will also cause you to skip your period altogether and can cause infertility. 4. Unwelcomed Hair Growth If you notice hair growing on your chin, chest, or in other areas where it is uncommon for women to have noticeable hair, talk to you doctor. Some women naturally have thicker hair or more noticeable hair growing on their upper lip, chin or chest. However elevated testosterone levels can contribute. There are very rare tumors that can release testosterone that can be diagnosed by ultrasound or other imaging. Also obesity can elevate other types of hormones in your body that can cause hair growth and darkening skin changes. Often times, these complaints will be accompanied by irregular periods. 5. Loss of Libido I hate to disappoint you, but as the character Benjamin Button so eloquently stated in one of my favorite movies, "Nothing Ever Lasts." So let me keep it real ... as time changes as we transition through the decades of life, so will our libido. Our estrogen and testosterone levels start to decrease with each decade. This may contribute to your desire to have sex and how aroused you become when you either fantasize about having sex (if you fantasize at all) or are about to be intimate with your favorite beau. Checking your hormones to confirm what we already know to be true after decades of medical research became En Vogue as celebrities continue to be given major platforms on television. We can replace hormones and even use testosterone creams, which would require your blood levels to be checked regularly. I often use estrogen creams to treat vaginal atrophy and changes that may cause pain with intercourse around and after menopause, as pain will push anyone's sex drive out the door. But often times I like to start with a detailed history to see what other factors may be contributing to a dip in your desire. This is a topic that deserves center stage so be sure to schedule an appointment to discuss ways to enhance your libido.