What Every Active Woman Needs to Know About Hormone Testing in Menopause (and Why Most Labs Miss the Mark)

Blood, Saliva, and DUTCH Testing: What’s the Difference?

Hormone testing is often touted as the key to understanding midlife changes in energy, performance, mood, and motivation. But if you've ever been told your hormones are "normal"—while feeling completely off—you're not alone. For many active women in perimenopause, menopause, or surgical menopause, standard hormone tests miss the mark.

Some doctors dismiss hormone testing altogether because "hormones fluctuate too much to be useful." But let’s be honest—so do most things we track and use as data points: heart rate, resting heart rate, blood pressure, weight, and lipids all fluctuate day to day. That doesn’t stop us from looking for patterns, trends, and deeper causes when something feels off. Hormones deserve the same attention.

When combined with symptoms, training context, and even basic lifestyle tracking, hormone testing can become part of a powerful hybrid approach to help you move the needle and get answers that reflect your lived experience.

This guide breaks down the types of hormone tests, how to prepare for accurate results, and the overlooked details that can help you and your provider make better, more informed decisions.

Hormone levels impact everything from your motivation and recovery to sleep, strength, and bone health. But not all tests are created equal. Athletes, especially those navigating midlife, need testing that reflects their unique physiology, training demands, and recovery needs.

Another layer that often gets missed? Hormone receptor sensitivity. Even if your labs say your levels are "normal," your body might not be responding to those hormones as expected. That sensitivity is influenced by age, inflammation, nutrient deficiencies, and chronic stress. It’s not just about the number—it’s about whether your body can actually use what’s there.

And if we zoom out even further, we have to acknowledge the role of the gut. Hormones are metabolized in the liver and excreted through the gut, so if your digestion is off—constipation, bloating, irregularity—it can create hormonal feedback issues. Estrogen dominance, anyone? Yep, that can happen even if your estrogen looks low on paper.

And let’s talk reference ranges. Most labs are calibrated to catch disease, not optimize performance. So if you’re hovering at the low end of “normal” and still feeling like a shadow of yourself, that matters. Athletes and active midlife women often feel best when their numbers sit at the upper end of the range, or even slightly above—especially with testosterone, DHEA, and progesterone.

So yes, testing matters—but interpreting those tests in context matters even more.

Testing is helpful, but it’s not always the first step. If you’re barely eating enough, not sleeping, training hard with zero recovery, or just starting to stabilize post-surgery or illness, start there.

Sometimes your body isn’t ready to give you clear signals until you restore the basics. A few weeks of consistent fuel, protein, hydration, and sleep can make test results actually useful—instead of just confusing or inconclusive.

For athletes in perimenopause or irregular cycles, hormone levels change week to week. Tracking symptoms, sleep, libido, mood, and energy for a month or two before testing helps you and your provider time labs more effectively.

Even in the chaos of perimenopause, that tracking gives you a sense of what your body is trying to do—and where the signals are breaking down.

1. Blood (Serum) Testing
Most commonly used in conventional medicine, blood testing measures circulating hormone levels at a single moment. It’s best for FSH, LH, estradiol (E2), TSH, and total testosterone.

But it doesn’t show bioavailable hormone, doesn’t reflect daily fluctuations, and can be easily skewed by stress, food, or training.

2. Saliva Testing
Saliva testing shows free, active hormone levels that can actually bind to receptors. This method can be helpful for tracking cortisol rhythm, progesterone, and estrogen.

Some providers dismiss it due to sensitivity or contamination risk, but it can offer valuable insight if done correctly.

3. DUTCH Testing
The Dried Urine Test for Comprehensive Hormones tracks hormone metabolites—basically how your body is processing and clearing hormones like estrogen, cortisol, and androgens.

It’s incredibly detailed, but also expensive and not always necessary. Use it strategically, not reflexively.

Most people never get told when to test or how to prepare. But:

• Hormones like cortisol and testosterone follow a diurnal rhythm

• Training, especially high-intensity or long sessions, can suppress or spike hormone levels

• Food, caffeine, and supplements can skew blood sugar, cholesterol, and cortisol

Best Practices for Accurate Testing:

• Test fasted, ideally before 9am

• Avoid caffeine, alcohol, and supplements the night before

• Schedule on a rest day or light recovery day

• Hydrate, but avoid food and beverages before saliva or blood draws

One personal example: drinking a latte before labs once caused cholesterol levels to appear dangerously high. Testing fasted is key.

Surgical menopause means a sudden drop-off in estrogen, testosterone, and progesterone. Your baseline is zero without HRT. Standard lab ranges often assume you're producing hormones naturally, which you're not.

That’s why it’s important to test estradiol, estrone, progesterone, DHEA, testosterone, and your Pg/E2 ratio—and look at how these values are trending alongside your symptoms.

You also need to know if your HRT is metabolizing well, especially if you're still struggling despite using it. That’s where metabolite testing (like DUTCH) can sometimes offer insight.

Mood, libido, motivation, sleep, muscle recovery—all of these are clues. Track them. They matter just as much as the numbers.

Hormones don’t function alone. Your nutrient status determines how well your body uses hormones.

Make sure your doctor checks:

• Ferritin and iron panel (runners, this is huge)

• Vitamin D (critical for hormone receptors to function)

• B12 and folate (for brain, energy, and methylation)

• Magnesium and zinc (for recovery, mood, and balance)

• Thyroid panel (not just TSH—get free T3, free T4, reverse T3, and antibodies)

It’s not a magic bullet. But it’s not useless either.

DUTCH testing can be helpful after you've addressed the basics. If you’re doing “everything right” and still not improving, or you need deeper insight into cortisol rhythm, estrogen clearance, or testosterone metabolism, it can be worth exploring.

Use it with someone trained to interpret it—because misreading DUTCH results can lead you down rabbit holes you don’t need to be in.

1. Can we test both total and free hormone levels (like estradiol, progesterone, testosterone)?

2. Will you test my cortisol rhythm, or just a single snapshot?

3. Can we include nutrient markers like vitamin D, B12, ferritin, and magnesium?

4. How will you account for my training schedule when interpreting these labs?

5. Are we testing at the right time of day and in the right conditions (fasted, before exercise)?

6. Can you explain what my Pg/E2 ratio means and how it might impact my symptoms?

7. Will you test estrone and estriol in addition to estradiol?

8. How often should I re-test while using HRT or making lifestyle changes?

9. What can we learn from trends in my labs over time—not just single results?

10. If you don’t feel testing is helpful, can you explain your reasoning and offer alternatives?

If your doctor refuses testing or dismisses your concerns:

• Ask if they’ll document that refusal in your chart and explain why

• Bring symptom logs and training history to show your patterns

• Request a referral to a hormone specialist, functional provider, or sports endocrinologist

• Consider paying out of pocket for select labs if it’s within your means—data can help you advocate later

• Remember: your symptoms are valid. If you’re not being heard, it’s okay to seek a second opinion

• Test fasted and on a rest day to get true baseline readings

• Use blood or saliva testing strategically based on your symptoms and goals

• Hormone levels are only one part of the picture—receptor sensitivity, nutrient status, and metabolism matter

• Look beyond estrogen: progesterone, testosterone, cortisol, DHEA, and nutrient markers all matter

• Work with someone who understands the athletic context—training impacts labs

Being told your hormones are "normal" doesn't help if you're still struggling to run, lift, sleep, or recover. If you're in menopause or post-surgical menopause and your labs don’t match how you feel, it's time to go deeper.