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Have had no period in two years, have hot flashes every hour

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have had no period in two years, have hot flashes every hour on the hour but have had blood test and they came back as hormone level is normal, how can I be in menapause as my doctor suggested and have a normal hormone level?


Please read this helpful information below. I believe it is possible to have "normal" hormone levels and be in menopause. I would self check yourself monthly. You can buy self home menopause kits to check your own hormone levels. Thank you for your question!

-- Because hormone levels can and do fluctuate, many doctors advise getting tested more than once -- about a month apart. This is particularly important if you are still getting your period and/or have few symptoms, as there is a slim chance you're experiencing what is sometimes called "temporary menopause" -- a condition sometimes brought on by traumatic stress among other things. It's also important if your hormone levels come back normal, but you are experiencing definite symptoms, since you may indeed be beginning menopause, but your hormone levels didn't show it at that particular time.

-- Different labs may use different ranges in their testing. So if and when you do get tested, be sure to ask your doctor not only for your specific results, but also for the range used by the lab.

Here, then, are the specific tests you may want to consider asking for:

FSH Blood Level Measurement
This is the key test to determine whether or not you are in menopause. A sample of your blood is taken to measure the levels of FSH -- follicle stimulating hormone -- in your blood. Because your FSH levels rise when your ovaries stop producing enough estrogen, high FSH levels can signal that your body is entering menopause.

  • Normal FSH day 3 value is 3-20 mlU/ml
  • FSH levels above 10 to 12 mlu/ml indicate that your ovaries are starting to fail. In other words, this means that you are in perimenopause -- the beginning stages of menopause when you notice physical symptoms, but before you have stopped having a period for a year, or have "diminished ovarian reserve"
  • Higher FSH levels -- levels about 30 to 40 or above -- are usually taken to signal menopause or ovarian failure. You may even be getting periods with your FSH levels this high, but it still is a sign that your body isn't producing enough estrogen to maintain regular ovarian function.
  • Keep in mind that you may end up with FSH levels that are well in the post-menopausal range, but still be getting a period. This is one of the things that differentiates premature menopause or premature ovarian failure from "regular" menopause (i.e. menopause that occurs to older women after a full year without a period). Yet again, this hammers home the unfortunate fact that you may indeed be in premature menopause even if you're having periods. Once your FSH levels have reached a certain height for a period of time, it's highly unlikely that they'll drop back to premenopausal levels. In my case, even after my FSH was tested at over 150, I had apparently normal periods for eight months. Then when I was retested -- hoping that somehow my body had snapped back to normal, I learned that my FSH level had dropped. . . . but only to 126. Since my FSH levels had been well above 35 for over a year, I finally accepted that my ovaries had failed.
  • As mentioned above, because hormone levels can and do fluctuate, remember that the FSH is far from foolproof. Some women can test with a high FSH, then revert to normal levels the next month...and so on. Again, it's generally wise to get tested more than once.


Normal Menstruating

Follicular Phase

2.5 to 10.2

Midcycle Peak

3.4 to 33.4

Luteal Phase

1.5 to 9.1


23.0 to >116.3

((Note: Lab levels -- or "assay levels" -- do vary from lab to lab, so you may notice different levels listed on your lab report)

Estrogen (Estradiol) Levels
Estradiol is the primary human estrogen -- and when your ovaries begin to fail, your circulating estradiol levels drop. This is why doctors often give you a serum estradiol concentration test to measure the amount of estradiol in your blood. In this case, the doctor is looking to see if your estrogen levels are lower than normal -- again, a signal of ovarian failure, or, in other words, early menopause.

  • Normal estradiol Day 3 value -- 25-75 pg/ml

  • In spite of the above number, generally, estradiol levels about 30 or below -- in conjunction with a high FSH level (high in this case, meaning in the post-menopausal range, i.e. 30-40 or higher) -- is considered menopausal. (Important note: If your FSH hasn't reached post-menopausal levels and your estradiol is on the low side, you are not considered POF or EM. There can be other reasons for low estradiol, including excessive exercise, low body fat, and diminished ovarian reserve.) This is because estradiol levels tend to drop over time. During the first 2 to 5 years following menopause or ovarian failure, blood levels of estradiol drop to an average range of about 25 to 35 pg/ml. Women not on HRT generally will see this number drop even more over time; after about five years, it's common for menopausal women who aren't on HRT to have estradiol levels below 25.

  • If your estradiol levels are lower than 50 picograms per milliliter, you may still be having a period, but also may be experiencing symptoms of low estrogen -- including hot flashes, vaginal dryness, and sleep difficulties.


Follicular Phase


Luteal Phase






With HRT


(Note: Generally, it is recommended that you raise estradiol levels to a minimum of 40 to 50 pg/mL to prevent bone loss, but 60 pg/mL or higher is optimal -- with many specialists advocating levels of about 100 pg/mL for younger women.)

Other Ovarian Hormones
It's not necessary to determine whether you are definitely menopausal or not, but -- depending on your symptoms -- you or your doctor may also want to test your levels of the other major ovarian hormones: testosterone, progesterone, and luetinizing hormone (LH).

  • Testosterone: There has been more attention paid recently to testosterone -- and more doctors and studies have been concluding that low levels are often a problem for a woman with premature ovarian failure or early menopause (particularly women who've undergone surgical menopause).

    The general rule of thumb is that total testosterone levels that are 25 ng/dL or less is indicative of a deficiency, as are free testosterone levels of 1.5 pg/mL or less. (Women over age 50 are considered to have a deficiency at a lower level -- 1.0 pg/mL or less.) But if you're just a little bit above these levels -- and have symptoms of low testosterone such as a lagging libido or excessive fatigue -- then you may still benefit from testosterone supplementation. (Some doctors and labs also test bioavailable testosterone levels. Normal ranges for this are 0.6 - 5.0 ng/dl for premenopausal women and 0.22-4.3 ng/dl for postmenopausal women who aren't on HRT.)

  • Progesterone: Most labs and studies state that menopausal levels are about .03-.3 ng/ml. By way of comparison, premenopausal women will have progesterone levels at about 7-38 ng/ml during their luteal phase.

  • Leutinizing Hormone (LH): normal day 3 LH levels are 5-20 mlU/ml. If your LH levels are high in ratio to your FSH levels, this could indicate that you aren't in menopause or going through premature ovarian failure, but instead have polycystic ovarian syndrome (PCOS) which can cause some similar symptoms.

  • Finally, there's DHEA, another androgen. This often isn't tested unless you have been exhibiting symptoms of low androgens (as with testosterone, the symptoms include decrease in libido and energy levels). For women under 50, DHEA levels of less than 150 ng/dL are considered low.

Many doctors will also recommend that you have your thyroid tested when you suspect menopause. This makes sense for two reasons: First, many women in premature menopause also are at a higher risk for thyroid problems. Second, many symptoms of thyroid disease overlap with menopausal symptoms. In fact, thyroid diseases often interfere with menstruation. Testing your thyroid, then, will help determine whether you are in premature menopause -- or instead have thyroid disease. In this case, your doctor will probably check your thyroxine and thyrotrophin levels.

Salivary Hormone Tests
Some doctors recommend saliva testing to measure hormone levels. This isn't as widely used as blood testing, but advocates clam that it is quicker, less expensive and reliable. There is, however, debate in the medical community about saliva testing -- with some claiming that the blood levels are the better form of testing and others saying the same about the saliva tests.

With salivary testing, your doctor takes samples of your saliva to see the levels of hormones you are producing and to determine if you have any deficiencies. Unlike the blood tests, the saliva hormone tests will show the levels of "free" hormones in your body -- that is, the hormones that aren't bound to proteins but instead are able to move into cells. Because about 95% or more of your blood hormones are bound, the saliva tests measure only the remaining 1 to 5% -- so the results may be markedly lower than that which you see on your blood test results. In addition to getting saliva tests at your doctor's, you can also order kits to test your hormone levels at home. If you do choose to do this, though, be sure to go over any results with your doctor. There are several pharmacies on line that offer saliva testing, including Aeron Labs and Women's Health America.

In some cases, your doctor may perform high resolution ovarian ultrasound to view your ovaries. This will determine whether you still have any eggs and follicles. However, generally, this information doesn't help that much. According to a British study, up to two-thirds of women diagnosed with premature ovarian failure do indeed have remaining follicles. The problem is, even when eggs are detected, attempts to stimulate ovulation through hormones have been relatively unsuccessful. However, ultrasound may make sense if you are in the early stages of premature menopause and are intending to pursue an aggressive fertility program.


5 Reasons Why Blood and Saliva Testing Can Be Misleading In Treating Menopause?

The most accurate and scientific way of hormone balancing is patient symptoms.

When it comes to treating menopause and hormonal imbalances many patients have been lead to believe that blood and saliva testing are essential information before the physician is able to prescribe hormone supplementation.

The truth however is that blood analysis is very inaccurate when it comes to determining a patients true hormone levels. Here are the reasons why -

  1. Measuring hormones in the blood measures the total hormone levels, most of which are bound to proteins and make these hormones unavailable for the body to use.

Relying on blood work to determine a patients hormone level will mislead both the patient and the doctor into believing that the patients hormone levels may be normal, when in fact the available hormones (or unbound hormones) are well below normal levels leaving the patient with an undiagnosed condition of hormone deficiency.

  1. Measuring hormone levels in the saliva measures the free or available hormone are a more accurate way of determining hormone levels in patients. The problem with this however is that saliva testing measures the patient's hormones only at that particular moment in time, and can also lead to misdiagnose the patient's real state of hormone levels, as these fluctuate greatly over the course of the day or month especially during menopause or peri-menopause.
  2. The outcome of blood or saliva readings by the physician to diagnose and accurately prescribe the right dosages is also well misunderstood as there is no exact formula used by doctors to calculate the right strength prescription to bring the patients levels back to normal. Doctors need to use their experience and mainly rely on the reported symptoms that patients relay to the doctor to determine the starting doses .
  3. Each patient is different in their need and uptake (metabolization) of the supplementation of their hormones. Therefore two different patients may receive the same prescription dosage, one will find relief and the other may not.

Therefore proper hormone balancing starts with the patient and ends with the patient.
You as the patient are essential in being able to accurately and safely balance your hormones day to day. Your hormones fluctuate daily and the key to continuous and long term balancing of your hormones is for you to get to know your signs and symptoms and to become your own doctor.


Blood FSH levels correlate poorly with menopausal symptoms. Since the blood FSH test isn't a reliable marker of predicting a woman's menopausal status, then neither is the urine test a reliable marker.

As disappointing and surprising as it may seem, many aspects of the menopause process remain a mystery to medical science. The medical definition of menopause is when menstrual periods stop for 12 months as a consequence of the ovaries shutting down. Menopause is not defined by a blood test, or a urine test, or any laboratory test for that matter.

A woman might then say, "Okay fine, but I want to know if my current symptoms could be because I am in menopause." So, then does FSH testing meet that need? Well, women can have terrible menopause symptoms and yet their FSH level may remain in the "premenopausal" range. Conversely, women can be having no hot flash symptoms at all and yet their FSH level may be considered in the "menopausal range."

To further complicate matters, the FSH test is highly variable during the time when periods are irregular just before periods cease permanently. For example, a woman might skip 3 periods, and then have periods for a few months, and then skip several periods again. During this time of irregular periods the FSH level can fluctuate tremendously. When the woman has had no periods for 12 months, by that time, she already knows she's menopausal what is the use of the FSH test?

For all of these reasons, FSH testing is not suited to be a routine test (like cholesterol screening, say) for every woman around the age of menopause. Encouraging women without any menopausal symptoms to check their FSH levels is not doing them any service.

If women don't have menopause symptoms, they don't need to have any menopause tests (even if the FSH were a perfect marker of menopause, which it isn't). Doctors are not going to prescribe therapy to a woman who is feeling fine without any menopause symptoms, no matter what her FSH levels. The FSH test only tells you if you have a high FSH level. It doesn't tell you if you are definitely in menopause (or premenopausal or perimenopausal) .

The bot***** *****ne is that, if you have menopause symptoms, see your doctor, because even if your FSH level is not in the menopausal range, your symptoms can be due to menopause.


Interestingly enough, if you can be pregnant during menopause, then I would say it is not so strange to have normal hormone levels during menopause.

Is it possible to become pregnant during the perimenopausal stage?
While the chances of becoming pregnant during perimenopause are fairly low, it is possible. Until you have reached menopause (i.e. at least a year has passed since your last period), you should use contraception (birth control).

If you have been taking the oral contraceptive pill (OCP, or ‘the pill'), you should talk to your doctor about whether this is still appropriate, because it may be associated with health risks when taken during the postmenopausal years. What's more, you may not realise that you've reached menopause, because taking the pill can mask the symptoms. Consider stopping the pill if you're older than 50 years of age.


Here is a file I found that may be useful for you to read. Click here
AND here
I would read this page too, here

I hope I've helped you answer your question. Thank you

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