Hormone Testing – For and Against

Many menopause and pre-menopause related problems relate to an imbalance of the hormones oestrogen and progesterone. Hormones are usually measured in blood serum but they can also be measured in saliva. However, this second method has both advantages and drawbacks.

The great advantage of saliva testing is that it can be done easily at home and does not involve needles or visits to a laboratory. This is particularly useful when repeating the hormone level tests several times in a cycle, or on particular days of a cycle or if one wants to check the hormone levels for oneself.

The drawback is that not all doctors find that they are useful. This is based on two things: that saliva testing gives you only a picture of one moment in a day not an overview, and that results can be variable and not always as accurate as some doctors require.

Do saliva tests give the same results as blood tests?
Blood tests measure the hormone that is protein bound but water soluble, whereas saliva testing measures the hormone that is in a fat-soluble form. However, saliva tests and blood tests will provide the same information so long as the person interpreting the results realises these differences and does not expect the levels to be the same for blood as for saliva. Whatever results are obtained must be compared with the normal levels for that method of measurement.

What is the difference between protein bound water soluble hormones and fat soluble hormones?
The difference lies in the different levels of activity of the hormone. For a hormone to be biologically active it needs to be fat-soluble so that it can pass into the tissues. The hormone in the protein bound water-soluble form, and which is transported in solution in the serum, is the form in which it is produced by the endocrine gland. In its protein bound state only about 9% of the hormone is biologically active. Fat-soluble hormones that are transported on the fatty membranes of the red blood cells are 99% biologically active and pass readily and proportionately into the saliva where it can be measured. Saliva testing gives a more direct measurement of the amount of biologically available hormone than blood testing.

Is there any time when one test is more useful than the other?
The saliva tests can be more useful than blood tests if you need to check that you are absorbing a transdermal hormone. Transdermal means that the hormone is absorbed through the skin by the use of a hormone patch or cream for example. This is because the hormone, when absorbed through the skin into the fat, is in a fat-soluble form. It is then transported in this fat-soluble form on the red blood cells and filtered into the saliva. When transdermal hormones are being used, looking for increased hormone levels in the blood serum to confirm its absorption will often suggest that it is not being absorbed and saliva testing must be done.

Is saliva testing reliable?
This is an area of some disagreement and certainly saliva tests are only reliable if a reputable laboratory with considerable experience in this field does them. It is also important that the laboratory is given accurate information when the saliva is sent to them and that the instructions for taking, and keeping, the saliva are followed carefully.

How often is it necessary to do saliva testing of hormones?
It may not be necessary to do saliva testing of your hormones at all. If the practitioner treating you is experienced in the field of hormone imbalance they may well be able to assess your problem, and treat you from the clinical history you give them and their examination of you.

Saliva testing can be useful if you are trying to manage a hormone imbalance problem yourself, although this should always be a last resort. Your practitioner will advise you as to when and how often to repeat your saliva tests.

When might the practitioner advise hormone testing?
Saliva and serum testing of hormones is useful to confirm the levels of your hormones when you are not taking any hormones. It is important to remember that these tests will only give you the levels of your hormones on the day or days that they are measured. It does not follow that your hormone levels will be the same in your next cycle or that they were like that in the previous cycle.

Saliva testing of hormones can be useful when it is important to measure the changes in the levels of progesterone and oestrogen throughout a whole cycle. This is helpful when assessing infertility and early miscarriages.

Which hormones can be measured in saliva ?
The hormones most commonly measured in this way are Oestrogen, Progesterone, Testosterone and Cortisol.

How do I know which hormones, if any, to have measured?
Below you will find lists of problems arranged in groups. Go through these and tick any that you have. You may find that the same problems occur in different groups. You should tick them in all groups where they occur.

If you find that you have ticked off two or more in any group that indicates that you probably have a hormone imbalance. When you have completed all groups check the answers at the end.

Group 1
These problems indicate a lack of the hormone progesterone leading to a state known as oestrogen dominance. Measure your oestrogen and progesterone levels. A one-day test will suffice if you are postmenopausal or your problems only occur in one part of the cycle.
This imbalance can be remedied by changing your diet, checking on your nutritional supplements and eliminating synthetic hormones such as the contraceptive pill or Hormone Replacement Therapy (HRT). It may also help to supplement with natural progesterone.

Group 2
These problems indicate a deficiency of oestrogen. This is particularly likely to occur at the menopause in slim women. Measure your oestrogen and progesterone levels.
This imbalance can be remedied by changing your diet and checking on your nutritional and herbal supplements. It may be necessary to use some weak oestrogen that will need to be balanced by progesterone.

Group 3
These problems indicate an excess of oestrogen. This excess leads to a state known as oestrogen dominance. It is most common in women who are taking more oestrogen than their body needs. Measure your oestrogen and progesterone.
This imbalance can be remedied by reducing or eliminating the oestrogen. It is also important to check your diet and your nutritional and herbal supplements. If you need to continue to take oestrogen, and the problems continue even with reduced dosage, a better balance can often be achieved with natural hormones.

Group 4
These problems indicate an excess of androgens (male hormones). Measure your testosterone, oestrogen and progesterone with a one-day test.
These problems can be remedied by reducing sugar and simple carbohydrates in the diet and making sure you are taking the correct nutritional supplements. Severe problems may need medical treatment to suppress testosterone.

Group 5
These problems indicate a deficiency of Cortisol. This is caused by tired or exhausted adrenals. Adrenal tiredness is usually a result of excess stress. You should measure your cortisol levels.
These problems can often be remedied by alteration where possible in your life style and making sure that you are eating a proper diet and taking the correct nutritional supplement. Supplementation with cortisone should only be considered after extensive screening with an endocrinologist.

You should now have some indication as to which of your hormones are out of balance and which ones it would be helpful to test.

Saliva Tests are available for single day tests which can be used as a one day test or on several days in the same cycle. The test normally includes a short questionnaire and the results will be sent to you with an interpretation and guidelines for management.

If you have any further questions about testing for hormones, please consult with your own doctor for individual advice.