Hormonal Health
This is the domain where people are most often told that what they are experiencing is simply age. Much of it is treatable, the evidence has changed considerably over the last decade, and the change has not yet reached most of the advice being given.
What this means for healthspan
Hormones help regulate energy, sleep, mood, body composition, bone strength and sexual and reproductive health. They change across life, including during perimenopause and menopause, and with age in men. Some of these changes are normal. Others have a treatable cause.
The aim is to tell the two apart. Symptoms such as poor sleep, hot flushes, low energy or low libido can come from hormones, but also from thyroid disease, medicines, sleep apnea, mood conditions or iron deficiency. A careful look at the whole picture comes before any hormone test or treatment.
What we assess, and why
We begin with your symptoms, menstrual and reproductive history, medicines and general health. Testing is chosen based on what you describe, because blood hormone levels often vary and may not match how you feel.
For people with menopause symptoms, we discuss the options, including hormone therapy and treatments that do not use hormones, along with their benefits and risks for you. For bone health, we look at risk factors and whether a bone density test is appropriate.
What we may assess
Symptoms, menstrual and reproductive history, menopause-related concerns, relevant thyroid function and targeted hormone testing based on the clinical presentation.
What is used is chosen for you, according to your individual risk, clinical appropriateness, the evidence and what you decide with your physician.
Why it matters
A focused assessment can help distinguish normal physiological changes from potentially treatable conditions and inform individualized management.
Examples of assessments and investigations
These are examples of what may be considered. Which of them are used for you depends on your history, your risk and what you decide with your physician.
Symptom and history review
A structured conversation about hot flushes, sleep, mood, periods, sexual health and energy. For many people in the usual age range for menopause, this is enough to guide care without blood tests.
Menstrual and reproductive history
Changes in cycles, pregnancy history, early menopause, and surgeries or cancer treatments that affect hormones. It helps tell perimenopause from other causes of irregular bleeding.
Menopause and perimenopause assessment
A review of symptoms and what may help, including hormone and non-hormone options. Blood hormone levels are not usually needed to diagnose menopause in midlife.
Thyroid function (TSH)
A blood test considered when symptoms or risk factors suggest thyroid disease. It is not recommended as routine screening for adults with no symptoms.
Testosterone testing in men
Considered for men with symptoms and signs of low testosterone. A morning blood sample is used, and a low result is usually repeated before a diagnosis is made.
Other targeted blood tests
Tests such as blood count, iron stores, vitamin B12 or prolactin may be chosen if symptoms point to them. They are not ordered as a general panel.
Bone density testing (DXA)
A scan that estimates bone strength. Osteoporosis Canada suggests it for adults at certain ages and for people with specific risk factors, such as past fractures or early menopause.
Fracture risk assessment
A calculation of ten-year fracture risk that combines age, history and, where available, a bone density result. It helps decide whether treatment is worth considering.
Sexual health and genitourinary symptoms
Discussion of vaginal dryness, pain, urinary symptoms and changes in desire. Many of these are treatable, including with local treatments.
What the evidence supports, and where it is uncertain
What the evidence supports
- For moderate to severe hot flushes and night sweats, estrogen-based hormone therapy is considered the most effective treatment in Canadian and North American guidance.
- For many healthy people under 60 or within 10 years of menopause, guidance describes the balance of benefits and risks as favourable, when there are no contraindications.
- Symptoms and age are usually enough to diagnose perimenopause and menopause in typical cases; routine hormone testing is generally not needed.
- Bone density testing, guided by age and risk factors, helps identify people who may benefit from treatment to lower fracture risk.
- Testosterone is diagnosed as low only when both symptoms and consistently low morning blood levels are present.
Limits and uncertainties
- Hormone levels in perimenopause swing from day to day, so a single blood test can be misleading.
- Hormone therapy has risks that depend on the type, dose, route, timing and your own history, including a higher risk of blood clots with some forms and a small increase in breast cancer risk with some combinations. The balance is less favourable when started later in life.
- Testing testosterone in men with no symptoms is not recommended. Levels vary with time of day, illness, sleep and weight, and testosterone treatment has its own risks, including effects on fertility, blood thickness and sleep apnea.
- Routine thyroid screening in adults with no symptoms has not been shown to improve outcomes and may lead to treating mild changes that do not need treatment.
- Some marketed tests, such as saliva hormone panels or broad 'hormone balance' profiles, do not have good evidence to guide care.
From findings to a plan, and what follows
How findings can inform a plan
Findings can help shape a plan that fits your symptoms, health history and preferences. That might include treatment for menopause symptoms, treatment of a thyroid or other underlying condition, changes in sleep, activity or nutrition, or steps to protect bone. Any hormone therapy is discussed in terms of its likely benefits, known risks and alternatives, and started only where clinically appropriate.
Follow-up, monitoring and coordination
Follow-up may include a review of how symptoms respond, adjustment or stopping of treatment, and repeat bone density testing at intervals that depend on your risk. Hormone therapy is reviewed regularly rather than continued automatically. We coordinate with your family doctor, gynaecologist, endocrinologist or other specialists when needed, and arrange referral if a result or symptom needs further assessment.
What happens here
The approach is the same in every area: establish where you are, change something on a cadence, then measure again to find out whether it worked. In hormonal health that work is organized into the programs below.
Menopause & Perimenopause
Clinically grounded care through a transition that is often navigated alone.
What this involvesMen's Health
Structured assessment of changes men often do not raise.
What this involves
Reliable places to read more
These are independent organizations. Monarch Health does not control their content and has no arrangement with them.
Osteoporosis Canada
Bone mineral density testing(opens in a new tab)
Thyroid Foundation of Canada
Thyroid information and support(opens in a new tab)
HealthLink BC
Health information and 8-1-1 nurse line(opens in a new tab)
Where to go next
The other areas we work on