I absolutely agree that hormones are variable and that a blood test might not be useful around this time. In my practice I experience many women who are struggling with night sweats, weight gain, fatigue and mood changes around the menopausal transition. There is some evidence that high cortisol levels might be connected with hot flushes although the research in this area is conflicted. High levels of cortisol have also been connected with weight gain and depression. There is also evidence that rats who have had their ovaries removed ( I'm really not in favour of this type of research on animals) experience an improvement in all of the metabolic parameters associated with weight gain, once treated with melatonin.
Research on progesterone shows that this hormone can reduce the symptoms of hot flushes http://www.ncbi.nlm.nih.gov/pubmed/21651797 and that it might be a breast friendly hormone with regard to possible cancer risks, although this is a complicated issue.
I have found that, despite the acknowledged fluctuation in hormone levels, using salivary assays to get some sort of baseline handle on hormone status especially with regard to nighttime melatonin and cortisol levels, where blood tests are of no help and are in fact impractical and inappropriate, can be a useful starting off point for assessing necessary hormone treatments.
At time of consultation assessing nutritional status can also be very helpful.
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