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Laboratory testing in Surgical Menopause can be a useful tool in balancing your hormones.  However, it can be confusing and many doctors will try to avoid running lab tests stating, “ Hormones are best adjusted based on how you feel.”  While this is very true and you always want to adjust your HRT based on how it is making you feel, lab tests can give invaluable insight on which direction you might want to adjust your hormones as it can be easy to get stuck not knowing if you should decrease or increase your HRT.  


We will address some of the most common lab tests that can be useful during the HRT balancing process.  All suggested levels are based on USA lab values, and as we are not doctors we recommend you discuss all lab tests with your personal physician.  These are recommendations only, compiled from credible sources and only meant to help you gauge your process with HRT. Be aware that ranges for lab values can vary from lab to lab but the general range will be similar.


(FSH) Follicle Stimulating Hormone:


This is the main test to determine whether or not you have entered menopause.  You would think this would be a given when you have had a hysterectomy, however, sometimes the ovaries are left behind and go into shock during the post-op period and fail to come back online.  There are also rare instances where tiny bits of ovarian tissue are missed during surgery, causing Ovarian Remnant Syndrome, which can produce some levels of hormones despite having the majority of the ovarian tissue removed.  


FSH levels increase when your ovaries stop producing estrogen or have been removed.  This signals that your body is now in the menopausal stage.







Estradiol (E2):


Estradiol is one of the three main estrogens in your body.  It is the most potent and active estrogen in the pre-menopausal years and usually signals fertility.  When the ovaries are removed or are not functioning, estradiol levels will drop producing many of the symptoms that come with the menopause transition.  While the ranges for estradiol can be large, it is usually recommended that an estradiol level of at least 50 pg/ml is achieved to prevent bone loss. In our research and group we have noticed that most women in Surmeno tend to feel better when their estradiol levels reach 75-100 pg/ml. Younger women in Surmeno tend to need higher levels of estradiol to feel well.












Many women in Surmeno can benefit from the calming and opposing effect of Progesterone.  However, some do not respond well to Progesterone. The adrenals in menopause can still produce progesterone and it depends on each woman’s body and adrenal health how much will be available for systemic use. Progesterone is great at helping with insomnia and anxiety, as well helping regulate blood sugar, PCOS, maintaining the myelin sheath for nerves and supporting the adrenals.  Some patients with diagnoses like PMDD will find that Progesterone will exacerbate symptoms of PMDD again if it is added to their HRT regimen.


When researching levels for Progesterone, what we found was, it was less about the lab levels of progesterone but more about the BALANCE of Estrogen to Progesterone Ratio.  This is called the Pg/E2 ratio. This ratio is something physicians typically use when evaluating hormones that seem to be normal on labs, but symptoms of hormonal imbalance are still occuring.  When Progesterone is deficient or in excess compared to Estradiol, this can lead to a situation called “Estrogen Dominance.” Estrogen Dominance can easily occur when using Estrogen only HRT. The symptoms of Estrogen Dominance can be as follows:


*Mood Swings



*Migraines/ Sinus Pressure Type Headaches

*Hot Flashes

*Low Libido

*Hair Loss/ Thinning Eyebrows

*Frequent Waking

*Water Retention/ Bloating

*Breast Tenderness/ Fibrocystic Breasts


Our research has shown that a Progesterone/Estrogen ratio of 100-500 is ideal to help alleviate the stimulating effects of Estradiol.  There are some complicated math equations to help assist in figuring out your E2/P ratio, however, the easiest way to do this is to divide your Estradiol by 10.  That will give you the minimum level your Progesterone should be. Take that minimum level of Progesterone and multiply it by 5, and that should be the max Progesterone you should have for that Estrogen level.  For example, if your Estradiol is 50, then your Progesterone should be at least 5 and probably no more than 25. Beyond that, it’s really based on how you feel. If you are still having symptoms of Estrogen Dominance and Symptoms of Low Progesterone then slowly tweaking your Progesterone up a little at a time can help you find your optimal level.  













Free and Total Testosterone:


Testosterone is getting more and more notice in the Hormone Replacement arena. Studies and clinicians have recognized that in surgical menopause low levels of Testosterone can be an issue.  Testosterone is good at helping bump up the libido, increasing muscle mass, and just overall with energy. However, there are no FDA approved Testosterone only medications available for women at this time, and we often see Surmeno ladies being overdosed with Testosterone as they use prescriptions dosed for men.  So keeping tabs on your Testosterone levels can really help you regulate your dose appropriately and keep the masculine side effects at bay.


Usually a physician will order Free and Total Testosterone Labs.   Total Testosterone levels that are 25ng/dl or less will typically indicate a deficiency.  And free Testosterone levels of 1.5 pg/ml or less will also indicate that you might benefit from small amounts of added Testosterone.  However, if a woman is at, or just barely above these levels, yet has symptoms of Testosterone deficiency such as, no libido or extreme fatigue, then adding Testosterone in may help.







(DHEAS) Dehydroepiandrosterone Sulfate:


DHEA is an adrenal androgen, like Testosterone. But it is actually a precursor hormone to Estrogen and Testosterone.  DHEA supplementation can cause serious side effects and the studies show that it may have little to no effect on Osteoporosis or Vaginal Atrophy.  However, sometimes physicians will run DHEAS labs if a woman is exhibiting symptoms of low androgens (decreased libido, excessive fatigue) that have not been adequately eliminated by the addition of the three main hormones, Estradiol, Progesterone, and Testosterone.  DHEA typically decreases as we age, but for women under 50 with DHEAS levels less than 150 ug/dl are considered to have a deficiency.






(SHBG) Sex Hormone Binding Globulin:


The Sex Hormone Binding Globulin (SHBG) test doesn’t help much in balancing your HRT, except to let you know if your liver is reacting to an overload of hormones.  SHBG is a protein made by the liver that binds to Estrogen and Testosterone. It usually does this in response to an increase in either hormone that is beyond the body’s preference.  Mainly this happens with oral HRT, but on occasion studies have shown that SHBG will increase with transdermal HRT as well. When the liver gets flooded with an overabundance of hormones, it will kick in SHBG to help bind some of the excess up.  The bound hormones will be processed out of the body and the unbound hormones are free to relieve symptoms and provide health benefits. When you notice a SHBG lab that is too high, it is usually a good indicator that the dose of HRT you are taking is over and beyond what your body needs or wants.  The higher the level of SHBG the harder the body is working to inactive and bind up some of the excess. Reducing the dose will usually help SHBG to drop into a normal range.






UK/AUST Lab Values:


As of right now we don’t have enough information to give lab values for countries outside of the USA.  We would refer you to your physician and local OB/GYN groups for more information. We will continue to work on coming up with lab values for our Surmeno ladies across the pond.  


What we have discovered at this time is lab conversion calculator to change USA estradiol lab values to UK/AUST lab values.  When we entered the USA estradiol lab ranges for estradiol where most women feel well at (75-100 pg/ml) it converted it to UK levels that range from 275-367 pmol/L.  

You can access that calculator here





* Okeke et al. “Premature Menopause.” Ann Med Health Sci 2013



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