Puberty is a rite of passage. Pregnancies call for celebration. But when menopause rolls around, we suffer “the change” in silence. Why doesn’t the last third of a woman’s life merit as much support as her reproductive years?
More than 1 million women in the U.S. go through menopause each year, with 80% of them experiencing menopausal symptoms. Yet awareness and access to menopause-related information and services remain a challenge. Menopause is rarely even discussed within families, communities, or healthcare settings.
“Women are demanding change, unwilling to suffer as their mothers did,” says Dr. Vinita Tandon, Lifeforce’s Medical Director and a board certified endocrinologist. “No one’s helping them through this biological shift, much less advising them that what they’re experiencing should have been addressed 10 years earlier.”
The average American woman hits menopause at age 51, but for many, Dr. Tandon says perimenopause starts changing their bodies as early as their late 30s. In between is more than a decade of mounting symptoms that women are expected to ride out.
“Sure, menopause is as inevitable as death and taxes,” says Dr. Tandon. “But the weight gain, insomnia, hot flashes, night sweats, decline in mood, brain fog, and risk for osteoporosis and heart disease that come along for the ride don’t necessarily need to sit in the front seat.”
The 40-5
There are a variety of non-hormonal and hormonal interventions that can manage your menopause and mitigate menopausal symptoms. The science shows the benefits of starting menopause hormone therapy early, but to get ahead of it, you need to know where your hormonal health currently stands.
That means getting your blood work tested and getting to know the 40-5 — five very important hormones to track by your 40th birthday: testosterone, estradiol, progesterone, follicle-stimulating hormone, and DHEA, says Dr. Tandon.
Read on to learn more about how these five biomarkers impact menopause, and how to know if and when hormone replacement therapy is right for you.
The 5 Biomarkers Women Should Know by Age 40
1. Total + Free Testosterone
What it is: Testosterone plays a crucial role in women's health. The hormone exists in two forms: total and free. Total testosterone is the overall amount of testosterone in your body, including the portion bound to proteins like SHBG (sex hormone-binding globulin) and the free testosterone that is unbound and can affect your body.
Why it’s important: Both forms of testosterone are essential for maintaining women’s health, but it’s often free testosterone that drives functions like muscle growth, mood regulation, and libido. Even if your total testosterone levels are normal, a low level of free testosterone can still contribute to mood changes, fatigue, decreased libido, and difficulty maintaining muscle mass.
How to optimize levels: In women, total testosterone should ideally be between 50 and 80 ng/dL, and free testosterone between 6.7 and 9 pg/mL. Supplementing with omega-3s and DHEA — the precursor to testosterone — can help support hormone production. Your Lifeforce doctor may also consider prescribing a testosterone cream, which is an effective way to increase your levels.
2. Estradiol
What it is: Estradiol is the primary form of estrogen during a woman’s reproductive years. It plays a crucial role in regulating the female reproductive system, including the menstrual cycle and fertility. Estradiol also influences skin and hair health, cognitive and metabolic function, and sleep quality. By supporting neurotransmitters in the brain, it helps stabilize mood and emotional well-being.
Why it's important: “Estradiol is arguably, one of the most important hormones for women,” says Dr. Tandon. “It impacts how a woman feels and functions.” As we approach menopause, estradiol levels drop significantly, leading to several hallmark symptoms of menopause, including hot flashes, night sweats, insomnia, weight gain, mood changes, and vaginal dryness. Without sufficient estradiol, postmenopausal women are also at a higher risk for osteoporosis and fractures.
How to optimize levels: For women in menopause, the optimal estradiol range is typically 50–100 pg/mL if hormone therapy is involved. Monitoring should begin as women approach perimenopause, and regular testing can help ensure estradiol levels remain within the optimal range for symptom management and overall health. When levels drop, estradiol replacement therapy with a transdermal application — such as an estradiol patch — is an option. To treat vaginal dryness and painful intercourse specifically, Lifeforce offers an estradiol cream.
3. Progesterone
What it is: Progesterone is one of the primary hormones in women, playing a key role in regulating the menstrual cycle and supporting pregnancy. But progesterone also has a calming effect on the brain, helping to reduce anxiety and improve mood. It plays a vital role in promoting restful sleep.
Why it's important: As women approach menopause, progesterone levels decline, contributing to many of the changes women experience during this transition. According to Dr. Tandon, a decline in progesterone is often the first hormone imbalance that contributes to changes in perimenopause, including irregular periods, increased PMS symptoms, insomnia, and mood swings.
How to optimize levels: For premenopausal women, testing should be done during the luteal phase of the menstrual cycle (about a week after ovulation) for the most accurate assessment of progesterone levels. However, women who are perimenopausal or menopausal can get tested at any time. Optimal progesterone levels range from 1.5–8 ng/mL during the luteal phase. For women using hormone therapy, optimal levels may fall between 10–20 ng/mL. Lifeforce’s HRT treatments for women include micronized progesterone, which means that it is molecularly identical to the progesterone our ovaries produce naturally.
4. Follicle-Stimulating Hormone (FSH)
What it is: Follicle-stimulating hormone (FSH) is essential for fertility and regular menstrual cycles. In women, FSH stimulates the growth and maturation of ovarian follicles, which are responsible for releasing eggs during ovulation and regulating the menstrual cycle.
Why it's important: Monitoring FSH levels can help detect the onset of menopause, allowing for early intervention to manage symptoms and maintain overall health. As women approach menopause, Dr. Tandon says FSH levels rise significantly, indicating that the ovaries are no longer responding as effectively to hormonal signals. When FSH levels are out of balance, women may experience irregular periods and low libido.
How to optimize levels: To assess for fertility, FSH testing should be done around day three of the menstrual cycle, when hormone levels are stable. However, women who are close to menopause can get their levels checked at any time. In women, FSH levels vary by age and reproductive stage. In women on hormone therapy, the optimal range is 0 - 7 mIU/ml. FSH levels can be lowered with estrogen, but supplements like DHEA and omega-3s have also been known to lower FSH.
5. DHEA (Dehydroepiandrosterone)
What it is: Dehydroepiandrosterone (DHEA) is a hormone that serves as a precursor to both testosterone and estrogen, playing a foundational role in maintaining hormone balance. Most of DHEA converts to these potent androgens and estrogens at the tissue level, making it essential for various bodily functions.
Why it's important: DHEA is often called the 'fountain of youth' hormone because it supports everything from muscle mass and bone health to sexual and cognitive function. When DHEA levels are low, you may experience fatigue, depression, and low libido. Monitoring its levels can help you maintain vitality as you age.
How to optimize levels: Regular testing of DHEA levels is recommended to maintain a healthy hormone balance as you approach menopause. Tracking these levels can provide insights into changes in energy, mood, and muscle mass, helping guide treatments to support well-being. Ideal levels in women are 250 - 350 ug/dL. If you’re suboptimal, Lifeforce’s DHEA supplement will give you a major assist.
Take Your Hormones Into Your Own Hands
Ready to stop flying blind? By regularly checking hormone levels before symptoms emerge or worsen, it’s possible to get ahead of the imbalances that can lead to more disruptive issues such as osteoporosis or cardiovascular disease. You’ll also get a fuller clinical picture to better manage your overall health.
“At Lifeforce, we manage menopause in the context of overall health which allows for personalization,” says Dr. Tandon. “Other menopause clinics treat in a siloed approach, prescribing hormones generically, without having visibility on the rest of a woman's health status.”
The Lifeforce Diagnostic tests for 50+ biomarkers, including those essential for female hormone balance. Lifeforce's HRT plans for women also use hormones scientifically proven to have maximal benefit and minimal risk. And because we have regular check-ins and lab work, we're able to adjust treatment regimens quickly if needed.
As a Lifeforce member, you will have your levels re-tested every three months and work closely with your Lifeforce clinician to monitor your levels. You’ll also get a dedicated health coach to help with lifestyle adjustments including nutrition, exercise, sleep, and stress management.
Do You Know Your 40-5?
It’s time to find out. Get tested for the five key biomarkers crucial in managing your health before and during menopause — and save $250 when you become a member.
Even better: $100 of every Lifeforce Membership purchased will go directly toward funding menopause research led by Dr. JoAnn Mason of Harvard Medical School and Brigham and Women’s Hospital. Dr. Mason was the lead investigator behind the recent debunking of the 2002 WHI findings that cast doubt on the safety of hormone replacement therapy. Her work has underscored the benefits of HRT and is helping change the conversation at both the provider and individual level.
Learn more about HRT and how to save $250 on your Lifeforce Membership HERE.
This article was medically reviewed by Vinita Tandon, MD, ABIM Board Certified in Endocrinology and Metabolism.