Do you know what your hormone levels are? Should you?

Your body is home to more than 50 hormones — chemical messengers that compose the endocrine system — and hormonal changes may reflect any number of medical conditions. For example, low levels of the pancreatic hormone insulin may indicate diabetes, while high levels of the stress hormone cortisol can play a role in obesity.

But some hormones such as melatonin, which is important for sleep, naturally fluctuate throughout the day. Other hormonal changes are normal at different phases of life, such as a woman’s drop in the reproductive hormones estrogen and progesterone preceding menopause.

Hormones are having a moment.

The Food and Drug Administration announced Nov. 10 it was removing the black box warning on hormone replacement therapy for menopause. Agency leaders said the listed risks, including breast cancer, don’t outweigh the treatment’s long-term health benefits, such as reductions in bone fractures and cognitive decline.

The news has sparked interest among women who may be candidates for the therapy. Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, joked that her patients have since been “going wild.”

In an age when over-the-counter hormone tests are a dime a dozen and supplements boast of alleviating hormonal imbalances, it can be tough to know whether you may need hormonal testing and treatment or are falling prey to marketing schemes.

Dr. Jan Shifren, director of the Midlife Women’s Health Center at Massachusetts General Hospital, said women experiencing perimenopause, the years leading up to their final menstrual period, are a prime target for such “meno-profiteering” or “meno-washing,” the practice of selling pseudoscience for women during menopausal transition.

“I actually never use the words ‘hormone imbalance’ with my patients,” Shifren said. “There are a lot of people out there marketing very expensive hormone testing — often not covered by insurance — these very large panels of multiple hormones that essentially tell us nothing.”

The U.S. endocrine testing market, which encompasses hormone tests, has flourished since the pandemic, according to Grand View Research, an international consulting and market research firm. Its market size was about $4.1 billion in 2022 and is estimated to soar at a 7.7% compound annual growth rate from 2024 to 2030, mirroring global projections.

While hospitals commanded the global endocrine testing market in 2023, commercial laboratories are expected to see the fastest annual growth through 2030, projections show.

In the U.S., commercial labs such as Labcorp and Quest Diagnostics offer prescription-free options ranging from a single $49 test measuring the luteinizing hormone, which helps regulate the menstrual cycle, to an in-depth hormone panel exceeding $500.

Numerous telehealth companies sell similar tests, which may involve blood, urine or saliva collection, with some approaching $1,000 per panel. HealthLabs.com, for example, offers a “comprehensive female hormone panel” that measures hormones including estrogens, thyroid hormones, testosterone and human growth hormone. The panel, which also includes tests for cholesterol, folic acid and vitamin B12, has a list price of $1,598 but was on sale for $799 as of Nov. 13.

“I see women in my practice all the time who have spent $600 for an online consult, they’re spending $600 or $700 every few months for a very large panel of unnecessary hormone levels,” Shifren said. “Then when they come to see me, I don’t want to look at any of those levels. I want to talk to them about what’s bothering them, what their symptoms are.”

Follow the symptoms, not hormone levels

Perimenopause typically begins between the ages of 45 and 55 and can last up to a decade. Menopause marks a single point in time, 12 months after a woman’s final period, followed by postmenopause for the rest of a woman’s life.

More than 1 million women in the U.S. reach menopause each year, at age 52 on average, according to the National Institute on Aging.

“Half of all people on this planet will go through menopause if they’re fortunate enough to live long enough,” Shifren said. “That’s an important time of life.”

It can also be a time when quality of life diminishes for women experiencing symptoms, which may include hot flashes and night sweats, brain fog, mood swings, weight gain, painful sex, breast tenderness, incontinence, insomnia, vaginal dryness and irregular periods.

When Minkin sees a patient in her 40s or 50s with such symptoms, treatment is the goal — no hormone testing needed.

“In general, I try to discourage people [from testing] as much as possible,” Minkin said. “Particularly in the perimenopausal situation, hormones fluctuate all over the place.”

Not to mention, Minkin said, even a premenopausal woman’s reproductive hormones vary widely throughout her cycle.

Minkin also advises patients against purchasing hormone panels on their own.

“My standard example is, if I have a patient who’s 53 years old … hasn’t had a period for three months and she’s up every night, sweating and not sleeping and not feeling good, and she wants her hormone levels tested,” Minkin said. “[I’d] say to her, ‘Please, go out and buy a dress with that money. I can tell you you’re perimenopausal.’”

Similarly, older women don’t often benefit from sex hormone testing, Shifren said.

“There’s absolutely no reason to check estradiol [a form of estrogen] or progesterone in a postmenopausal woman,” Shifren said. “We can tell them — before they spend any money — that those levels are low.”

Who would benefit from hormone testing?

When it comes to perimenopausal symptoms, age matters, said Dr. Shamita Misra, a clinical professor of family and community medicine at the University of Missouri School of Medicine.

Menopause occurring between the ages of 40 and 45 is considered early, while reaching the milestone younger than 40 constitutes premature menopause. Roughly 5% of women hit early menopause naturally, as opposed to the condition being induced by surgical or other medical interventions, according to the federal Office on Women’s Health.

Because early or premature menopause is associated with a higher risk of conditions including heart disease and osteoporosis, a patient under 40 reporting perimenopausal symptoms may benefit from hormone testing, Misra said.

“Are we suspecting premature menopause, or is there any other endocrine problem?” Misra said. “We have to be open and not just focus on perimenopause. We have to also get [the patient’s] history.”

On the other hand, if you’re of normal perimenopausal age and dealing with symptoms, don’t shy away from discussing any hormonal concerns you may have with your health care provider, Misra said. Shared, informed decision-making is your safest option.

“Some women don’t talk candidly about their symptoms,” Misra said.

If your doctor does recommend hormone testing, keep in mind that some medications, including birth control, may affect your levels.

“You would have to be off birth control for 90 days — minimum three months — before your hormones get back to being at their baseline,” Misra said. “When a person is breastfeeding, for example, when a person is on oral contraception or some hormones already, it’s impossible to check for hormone levels accurately.”

Risks from unnecessary hormone testing

It’s natural to be curious about hormone levels — reproductive or otherwise — whether you’re symptomatic or not, doctors say. Some of Dr. Debra Bell’s patients have told her they need data to feel comfortable about their health, even when she doesn’t need data to treat them.

“My approach is, How will this test help us in our decision-making for your situation?” said Bell, director of education at the Osher Center for Integrative Health at the University of Washington School of Medicine. “It doesn’t always help.”

But just because hormone testing isn’t typically beneficial for peri- and postmenopausal women doesn’t mean it’s harmless, Bell said. Cost is one such harm.

“I know people who have maxed out their credit card for these kinds of things,” Bell said.

Not all over-the-counter menopause diagnostics are pricey. For instance, pharmacy chains and big-box stores sell rapid menopause test sticks hovering around $30, sometimes less.

The questions then become: How accurate are the results and who’s interpreting them?

“If [a patient has] done the test, then I will interpret it for them,” Bell said. “A lot of times, what the test shows is what we might already presume based on the symptoms they’re having and what’s happening with their menstrual cycle.”

Another danger in self-testing is self-treating one’s perceived hormone imbalance, Bell said. Unlike prescription medications, the FDA doesn’t approve herbal and dietary supplements for safety or effectiveness before they hit store shelves.

Last year’s global menopause market was nearly $18 billion, Grand View Research reports, with dietary supplements carving out a 94% share.

As a practitioner of integrative medicine, Bell is hardly antisupplement. But be sure to discuss any supplements you’re considering with your doctor, she said. Even supplements marketed as natural may be toxic depending on your lifestyle, medical history and other medications you’re on.

Hot flash treatments in particular have a high placebo effect rate in clinical trials, at 30% to 35%, Minkin estimated. For that reason, she said she has no problem with patients who claim that home remedies such as evening primrose oil provide symptom relief.

“As long as it’s something that I know is pretty safe,” Minkin said. “[If] she says it’s arsenic, I’d say, ‘Probably not a good idea.’ So I have to look at the potential toxicity of what she might be using.”

Minkin is thrilled that menopause, once taboo, is not only making headlines but also being celebrated — an “estrogen festival,” she called it. However, she warned that some wellness companies are crashing the party, hoping to make money off women in midlife.

“For 20 years, we could attribute nothing to menopause; it was a dirty topic,” Minkin said. “But at this point, I think we’re leaning toward saying that everything is perimenopause, because perimenopause is very amorphous.”

“You can’t test for it, really.”

This article was originally published on NBCNews.com