How to Read Your Perimenopause Hormone Panel Results

Why Hormone Lab Results Are Confusing in Perimenopause

Getting your hormone panel back and staring at a column of numbers with a reference range next to each one can feel more confusing than reassuring. You might be told everything looks "normal" while you are waking up at 3am in a sweat and barely functioning.

The problem is that hormone levels fluctuate dramatically during perimenopause. A single blood draw captures a snapshot in time, not a full picture. Your estradiol on day 3 of your cycle is not the same as your estradiol on day 20. Your FSH today may be different from your FSH in three months.

Understanding what each marker means, what the reference ranges actually represent, and what the results look like specifically during perimenopause will help you have a much more productive conversation with your provider.

FSH: Follicle-Stimulating Hormone

FSH is produced by your pituitary gland and tells your ovaries to develop a follicle each cycle. As your ovarian reserve declines in perimenopause, your pituitary sends more and more FSH trying to get the ovaries to respond. This is why FSH rises during perimenopause.

Reference ranges vary by lab, but broadly: premenopausal FSH is usually below 10 IU/L during the follicular phase. FSH above 10 to 12 IU/L on day 2 or 3 of your cycle can suggest declining ovarian reserve. Values above 25 to 30 IU/L are often seen in perimenopause. Values consistently above 40 IU/L suggest menopause.

Here is the critical caveat: FSH fluctuates enormously during perimenopause. A single high reading does not confirm perimenopause, and a single normal reading does not rule it out. Two FSH tests taken one week apart can return very different results. Many providers require two elevated readings to confirm menopause (no period for 12 months plus FSH above 40 IU/L).

If you are on hormonal birth control, FSH levels will be suppressed and are not interpretable for perimenopause assessment.

Estradiol: Your Primary Estrogen

Estradiol (E2) is the form of estrogen your ovaries primarily produce during reproductive years. In the follicular phase of a typical cycle, estradiol ranges from about 30 to 400 pg/mL. At ovulation it peaks even higher. In the luteal phase it is lower.

During perimenopause, estradiol levels become erratic. You may see unusually high spikes early in perimenopause, followed by more sustained lower levels later on. Eventually estradiol settles below 30 pg/mL in postmenopause.

When reading your estradiol result, timing matters enormously. An estradiol drawn on day 3 should be interpreted differently than one drawn on day 14 or day 21. Always note where you were in your cycle when the blood was drawn.

Low estradiol can cause hot flashes, vaginal dryness, brain fog, and sleep disruption. High estradiol relative to progesterone can cause breast tenderness, bloating, and heavy periods. Context from your symptoms matters as much as the number itself.

Progesterone

Progesterone is primarily produced after ovulation by the corpus luteum, the follicle remnant left after the egg is released. It should be at its highest in the mid-luteal phase, typically around day 21 of a 28-day cycle.

A mid-luteal progesterone above 10 ng/mL usually confirms ovulation occurred. Values of 5 to 10 ng/mL suggest ovulation but possibly a weak luteal phase. Values below 5 ng/mL at mid-luteal phase suggest an anovulatory cycle or luteal phase deficiency.

During perimenopause, anovulatory cycles become more frequent. You may have a period without having ovulated, which means progesterone did not rise normally that cycle. This is one reason why perimenopause can involve relative estrogen dominance even when estrogen itself is not dramatically elevated.

Progesterone drawn at the wrong point in the cycle is nearly uninterpretable. If your provider ordered a progesterone test on day 3 of your cycle expecting a mid-luteal reading, ask to have it redrawn at the right time.

LH: Luteinizing Hormone

LH works alongside FSH to trigger ovulation. Like FSH, LH rises during perimenopause. It is often assessed in combination with FSH.

The FSH to LH ratio can be informative. In reproductive years, FSH and LH are roughly similar in the follicular phase. In perimenopause and menopause, FSH tends to rise more than LH, so the ratio shifts.

LH is not always included in a basic hormone panel. If you see it on your results, a value above 15 to 20 IU/L outside of the ovulatory surge may suggest you are in perimenopause or have elevated pituitary activity.

LH is less commonly used as a standalone perimenopause marker compared to FSH, but it adds useful context when both are drawn together.

Testosterone: Total and Free

Many women are surprised to find testosterone on their hormone panel. Your ovaries and adrenal glands both produce testosterone, and it plays a role in libido, energy, mood, and muscle maintenance.

Total testosterone measures all testosterone in your bloodstream. Free testosterone measures only the portion not bound to proteins, which is the biologically active fraction. Many women with adequate total testosterone feel low-T symptoms because most of it is bound and unavailable.

For women, total testosterone typically ranges from 15 to 70 ng/dL depending on the lab. Free testosterone ranges vary considerably by measurement method. Reference ranges for women are wide, and "normal" does not always mean optimal.

Testosterone often declines during perimenopause, though the trajectory is more gradual than estrogen. If your free testosterone is low and you are experiencing low libido, fatigue, or loss of muscle mass, that is a conversation worth having with your provider.

SHBG: Sex Hormone Binding Globulin

SHBG is a protein made by your liver that binds to sex hormones in your bloodstream. When SHBG is high, more of your testosterone and estrogen is bound and unavailable to your cells.

High SHBG is common in women taking oral estrogen or certain contraceptives. It can also rise with hyperthyroidism or with a low-fat, high-fiber diet. When SHBG is elevated, you can have technically normal total hormone levels while experiencing symptoms of hormone deficiency because the free fractions are suppressed.

Low SHBG is associated with insulin resistance, excess weight, and high testosterone conditions like PCOS.

Reading SHBG in context with total and free testosterone gives a more complete picture. If SHBG is high and free testosterone is low, that is a more informative story than total testosterone alone.

The Thyroid Panel: TSH, Free T3, Free T4

Thyroid conditions are significantly more common in women during perimenopause, and thyroid symptoms overlap heavily with estrogen-related symptoms. Fatigue, brain fog, weight changes, mood shifts, and sleep disruption can all have thyroid roots.

TSH (thyroid-stimulating hormone) is the pituitary signal to your thyroid. A high TSH suggests your thyroid is underactive (hypothyroidism). A low TSH suggests it is overactive (hyperthyroidism). Most labs flag TSH above 4.5 to 5 mIU/L as abnormal, though some practitioners consider levels above 2.5 mIU/L suboptimal.

Free T4 is the main hormone your thyroid produces. Free T3 is the active form that your cells use. Some people convert T4 to T3 poorly, meaning their TSH and T4 look fine but their free T3 is low and they still feel hypothyroid symptoms. This is why testing both free T3 and free T4 matters, not just TSH alone.

If a thyroid panel was not included with your hormone workup, ask your provider to add it. Treating a thyroid issue that was mistaken for perimenopause symptoms can be genuinely life-changing.

Normal Range vs. Optimal Range

Reference ranges on lab reports are calculated from large populations. They represent what is statistically common, not necessarily what is optimal for health and symptom relief.

For example, a total testosterone of 16 ng/dL might fall in the "normal" range for women, but a woman with that level who has low libido, no energy, and difficulty building muscle may genuinely benefit from support. Normal range and symptom-free are not the same thing.

This is why your symptoms matter alongside your numbers. A provider skilled in perimenopause hormones will look at your results in the context of how you actually feel, not just whether the numbers fall within the printed reference range.

Questions to Ask After Receiving Results

When you get your results, come prepared with specific questions. Here are several worth asking.

When in my cycle was this blood drawn, and does the timing affect how we should interpret these numbers? Can we look at free testosterone and SHBG together, not just total testosterone? Does my thyroid panel warrant any further follow-up? What would these same tests look like in two or three months if we repeated them?

Also ask: what are your treatment thresholds? Some providers will not treat until values are out of range by lab standards. Others treat based on symptoms and clinical picture. Knowing your provider's approach helps you understand whether a referral to a menopause specialist might serve you better.

PeriPlan's symptom tracking lets you log exactly how you are feeling each day, which gives you concrete data to bring to your appointment rather than trying to summarize weeks of symptoms from memory.

The Bottom Line

Your hormone panel is one piece of the puzzle. No single number tells your whole story. Timing, cycle phase, your symptoms, and how the markers relate to each other all matter as much as the individual values.

Come to your appointments having tracked your symptoms, knowing when in your cycle the blood was drawn, and ready to ask specific questions. You are the expert on how you feel. Your provider is the expert on the numbers. Good care happens when you bring both together.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.