Questions and Answers for Post Tubal Women
about Hormone Testing to check Hormone Status and Ovarian Function

Q.  Why should post tubal women be hormone tested?

A.   Tubal ligations can cause ovarian isolation, catastrophic hormonal imbalances, castrative menopause, and hormone shock.  The symptoms of menopause/hormone shock  or that  of a depleted hormonal state often first manifest as sleep disturbances/insomnia, chronic fatigue, hot flashes, depression, mood swings, memory loss, urinary infections/incontinence, and loss of sex drive.   These symptoms and the condition of a depleted hormonal state can greatly affect a woman's well being, her social/work life, and family life.

Long term, a depleted hormonal state such as this if left untreated in a young woman can lead to accelerated bone loss, earlier and more severe cases of osteoporosis, and increased risk of and earlier onset of heart disease.

Q.  What are the different types of hormone testing available?

A.  Hormones can be measured using serum (blood), saliva, and urine ("Ru25 Plus^"  FSH Menopause Test). All three types of testing are explained here.

Q. Being post tubal, which type of testing is best for me? 

A. Serum testing, but before you request serum testing from your doctor, you may want to start off by using a home test such as the "Ru25 Plus" FSH Menopause Test. 

The "Ru25 Plus" FSH Menopause Test empowers and helps a woman determine in a timely manner if she is hormonally depleted, experiencing early menopause, or menopause, so that she can seek guidance and sound, appropriate advice/treatment from her personal physician. 

The usual reasons for constant elevated FSH levels throughout the cycle are related to menopause or the shutdown (failure) of the ovaries.

Positive results from a "Ru25 Plus" FSH Menopause Test would absolutely merit further testing by your physician.

Q.  Is this test only for Post Tubal Women?

A.  No.  ANY woman who thinks she may be experiencing menopause, early menopause (AKA peri-menopause), or a hormonal imbalance can benefit from using the "Ru25 Plus" FSH Menopause Test. 

Q. How does the "Ru25 Plus" FSH Menopause Test work?

A. The test works like a home pregnancy test. Urine is applied to activate the test.  The results will indicate if the FSH levels are either over 25 mIU/ml (test reads positive) or less then 25 mIU/ml (test reads negative).

Q. Does it mean that I am menopausal if my test FSH is positive?

A. There is a short time during a menstruating (non-menopausal) woman's normal cycle when her FSH levels surge. This surge usually occurs mid-cycle. For this reason, two FSH tests are provided so that in the event you do test positive you can re-check to see if your FSH levels remain evaluated.

The usual reasons for constant elevated FSH levels throughout the cycle are related to menopause or the gradual shutdown (failure) of the ovaries. As estrogen levels drop and diminish, the FSH levels rise. A positive test for elevated FSH (except at mid-cycle) is a clue to the onset of menopause or some other medical condition adversely effecting normal ovarian function.

Q.  Should I request serum testing?

A. YES!  The CPTwomen suggests that all women, including post tubal women, follow Dr. Hufnagel's outlined Base-line hormone testing and get serum tested.

The "Ru25 Plus" FSH Menopause Test is another tool that a woman can use to monitor her hormone health. This test is less expensive that serum testing, does not require a doctors appointment, does not require travel to a lab to have a blood draw, and gives a woman accurate results in a matter of minutes in the privacy of her own home.   Positive test results would absolutely merit further testing by your physician.

On the contrary, a negative test results does not mean that all your levels are in normal range.  Your FSH levels could be just below the positive cut off.  The only way to know if your sex-binding hormone levels are low or high is to be serum tested. Dr Hufnagel's protocal then calls for SHBG level to be compared to the serum results of your estrogen, progesterone and testosterone levels. 

Q.  I am 31 years old and had a tubal 3 1/2 years ago after the birth of my 3rd child. I do not think that I am suffering PTS, but have noticed that I am experiencing more intense PMS, intense  itching (in the vagina area but I don't have a yeast infection), and have noticed a slight change in my periods. Should I follow Dr. Hufnagel's Post Tubal Protocol?

A. Yes.  All Post Tubal Women should get their hormone levels tested.  Hormone testing for post tubal women should be standard care.  Tubal ligations are know to cause castrative menopause, severe hormone imbalances, and PMS.  The only way you can monitor your hormone health is to be tested.  Surgical or sudden menopause is very serious and can cause the condition of "hormone shock".  You could be experiencing a minor estrogen deficiency and experiencing slow bone loss with out even realizing that this is happening.  

Vaginal itching is one symptom of having an estrogen deficiency. 

Q. I am 31 years old and had a tubal ligation three years ago after the birth of my second son.  I became extremely tired and fatigued and had had some dizzy spells so my doctor ordered some testing.  I was told that "all" my levels were fine.    That was one year ago.   Now I'm having hot flashes.  How can this be if all my levels are fine? I feel like I'm losing my mind! 

A.  For complaints of fatigue, it's common for doctors  to order one or two tests.   Generally  only the TSH (thyroid stimulating hormone) and iron levels are checked.  If  your TSH came back came back normal that does not mean your estrogen, progesterone, SHBG, testosterone, FSH, LH, and other levels are normal.  If your TSH comes back out of range, that too does not mean all your other levels are normal.

Women often told, "All your levels are fine", when in fact only the TSH and iron levels were checked.   Women hear the word "all", and believe that all their levels were checked, and that no more testing is available or necessary.

Being post tubal you need to have the correct serum hormone testing done and you need to monitor your hormone levels.  The doctor does not know how you feel, what you experience, and how you are functioning on a day to day basis.   He is not going to be keeping track of your health, only you can do this. 

Request a copy of the blood work that was done.   You have a right to this information.  Check and see what tests were ordered and what levels were checked.   Where do your levels fall within the ranges? If hormone testing was done, it might be possible you were one or two points from being in a high/low range. Technically you may be within "normal range", but should be on an "alert" status. 

If the correct basic hormone testing was ordered, and your levels were indeed within normal range then you will have this information as a base line and you should have the tests repeated in one year AND voice your concern now as to why you are not feeling up to par.   One women early on with the CPTwomen went on for further testing and found out she had Lupus!

Q.What are the basic serum tests suggested a woman get?  

A.  Follow this link for suggested basic testing.   Not only should post tubal women get as a minimum the suggested testing, but ALL women should obtain these as baseline hormone levels starting at age thirty to thirty-five. 

Baseline hormone testing for ALL women should be as standard as mammograms are for women at age forty.  Loss of hormones or of hormone production can affect both your physical and mental health (examples include bone health, memory, and libido). In the U.S., your odds are more then one in four of one day having a tubal ligation or hysterectomy. Your chance of one-day having a surgery that could affect your hormone production or possibly castrate you is much higher then getting breast cancer, yet women are not routinely offered hormone testing as they are with mammograms.  Having information about what your levels are when you are in the prime of your life and feeling your best is good information to have in your medical files if you ever need HRT or wish to match your baseline levels.

All women (including women younger then 30) should be hormone tested before all surgical procedures or medical treatments which could affect her hormone levels short term or long term: This would include being tested before a hysterectomy, tubal ligation, UAE, prior to donating eggs, lupron shots, and so on.

Women who are experiencing irregular periods or cycles. (regardless of age) This would include missing cycles (in absent of pregnancy), experiencing long periods (longer then 10 days of bleeding) long or short cycles (having two periods in a month, going 45 days between cycles).

All women who have had a tubal ligation, hysterectomy, UAE, one or both ovaries removed one or both fallopian tubes removed, or any type of surgical or medical treatment that could have affected her hormone production. (regardless of age)

Women who are suffering hormonal or menopausal symptoms such as: hot flashes, chills, night sweats, bouts of rapid heart beat, irritability, mood swings, trouble sleeping, loss of libido/sexual drive, crashing or chronic fatigue (CFS), anxiety, difficulty concentrating, fuzzy logic, memory lapses, sore joints/muscles, increase in headaches/migraines, depression, allergies developing or increasing, irritable bowel syndrome (IBS), sudden weight gain or loss, hair loss or thinning, episodes of dizziness or light-headedness, and loss of balance.   (regardless of age)

Cholesterol levels start to rise as the hormones start to go, so women in menopause or experiencing a hormonal imbalance are at greater risk for heart disease.   

Q. As a post tubal woman, is it important to have all the tests done? 

A. YES. Measuring hormones and analyzing hormonal health is like putting together a puzzle. Many different levels are measured and then compared to each other. To check just one or two levels would be like looking at just one or two pieces of a 50-piece puzzle. Levels or measurements are grouped and analyzed in conjunction with others. For example, it would not make sense to look at a woman's FSH level with out also measuring her LH level. One is always compared to the other. Looking at only one of the levels would be like looking at only 1/2 of picture because you are getting only 1/2 of the information. Information from just one level is useless with out knowing the other level(s).

Q. I had a tubal ligation 4 1/2 years ago. Since then my periods have become very irregular. I believe I'm suffering a hormonal imbalance but my doctor told me that I'm too young to be menopausal (I'm only 34). He told me that I will not experience menopause until one year after my last period. He suggested to me a D&C to correct the bleeding disorder that I've developed.

A.  First of all, IF your symptoms (heavy bleeding)  are being caused by a hormone imbalance, having a D&C will not correct (a hormone imbalance), it would only mask the symptom that is telling you something is wrong.  Also, as was stated above, hormone testing should be done BEFORE any type of female reproductive surgery. 

As women, we are taught that menopause is our periods stopping and ending. Some physicians state that a woman is not menopausal until she has gone for one full year without a period or bleeding. 

Contrary to popular belief, your hormone levels (estrogen, progesterone, and testosterone) can be in the menopausal ranges and greatly depleted long before you experience your last period.  To forgo testing (and there for treatment) until one year has pasted with no period may mean one (or more) years of living with a condition which could be causing bone loss, increasing your risk of heart disease, and causing other physical and psychological changes.  If you are a young woman and having a catastrophic menopause, the harder it may be to adjust your hormone levels later. 

Irregular and heavy bleeding can be caused by and IS one  symptom of menopause, soon pending menopause, or hormonal imbalance.   Irregular bleeding can also be a symptom of a tubal pregnancy, fibroids, and a number of other reasons, many which are not corrected by a D&C.

Your doctor can not say by simply looking at you if you are experiencing a hormonal imbalance or not, or  if you are menopausal or not. The only way to tell is to have the proper tests ordered for you and to be hormone tested.

In the end, it may be a D&C which is required as your treatment, but wouldn't it be horrible to learn that you underwent a D&C only to find out later that it was a hormonal imbalance? 

Q. My doctor recently checked my levels (TSH and estrogen) and both came back normal. He told me that my levels are  normal and that I am not suffering a hormonal imbalance. I do not understand how my hormones could be normal because I am still experiencing hot flashes and other hormonal symptoms. Why could this be?

A.  A TSH test will not tell if you are menopausal or if you are suffering a hormonal condition  but will diagnose a thyroid condition.  It is possible to have a normal TSH level and to be suffering a severe hormonal imbalance (or to be post menopausal). Having your TSH checked is not a bad idea, but it is not going to tell you about your overall hormonal condition.

Analyzing just the estrogen level alone with out analyzing other levels is again like looking at just one piece of large puzzle. You are only seeing a small portion of the total.

It is possible to have your estrogen level come back normal, but if your SHBG is low or high it could mean your estrogen deficient or dominant. It is also possible to have normal estrogen levels but to have no progesterone which can greatly affect your health.

Your SHBG levels affect how much estrogen and testosterone your ovaries produces and and how much is stored.  If your SBHG level is high, low, or normal and comparing it to other hormone levels, and seeing if those levels are high, low, or normal gives a much clearer picture of your overall hormonal health.

High SHBG levels also plays a possible role in the development of endometriosis.

When analyzing hormone levels SHBG must also be analyzed.  SHBG is key.  SHBG should be routinely ordered every time your hormone levels are checked. If your doctor only ordered for you an estrogen test  but no other levels hormone levels then your hormone testing was incomplete.

Q. What is the difference between blood testing, saliva testing, and tests such as the "Ru25 Plus" FSH Menopause Test?

A. Hormones are found in the system in two types of states, bound and unbound (free). Saliva testing measures the hormones that are unbound (free), or what is available for use at that very moment. Serum (blood) testing measures the total of both the bound and unbound (free).  The "Ru25 Plus" FSH Menopause Test looks for unbound human follicle stimulating hormone (FSH) in your urine at a sensitivity cutoff level of 25 mIL/ml (anything less is negative, and thing more is positive).  To compare the different  types of testing is like comparing apples, oranges, and pears.

Serum hormone analysis has been and still is the industry standard, ordered and understood by all doctors.  

There has been a big push by the manufactures and promoters of the saliva tests to sell, sell, and sell! Part of the marketing of these tests has been statements such as saliva tests are "more accurate" and "better". The truth is serum testing is accurate and is still the industry standard because saliva testing has limitations.

Saliva testing is good if you only want to know what is available for immediate use but bad if you want to know what your body is storing.  Despite what some promoters of the saliva tests say serum testing is accurate, especially when the tests are grouped and ordered together so that they can be properly analyzed. 

Q.  Which type of  testing is more accurate for testing estrogen and progesterone, the serum (blood testing) or saliva? 

A. Serum analysis (blood test) measures the true total (100%) of both the unbound (free) hormones and the bound (stored) hormones. When serum tests are measured and analyzed it is known that 100% is the amount being analyzed.

The saliva testing and results can be greatly affected or altered by outside influences such as what you've recently eaten, drank, smoking, by use of the pill, hormone replacement therapy (HRT) and many other influences.

Measuring hormones by saliva does not measure 100% of all the hormones present but just the free, unbound hormones within your system. The amount of hormones that are free and unbound at any given moment is has been stated to be anywhere from 1% to 5% of the entire total so it's never really known if what is being measured is 1% of the total hormone present or 5 % of the total hormones present. Because it is known that serum testing measures 100% of the total this makes the serum testing a more exact measurement because there are no unknown variables.

Because the saliva testing measures the amounts what your body can actually use at that moment it has been strongly inferred and often outright stated by the promoters of these tests that the saliva testing is better then serum testing.    Women have been told, "what's the point of knowing how much hormones you're  storing, you can't use them anyway so what's the point?"  Women are told that, "it doesn't matter how much is being stored…"   Yes, women have been told that this information is not necessary!  Saliva testing is can measure what is free and unbound but to infer because saliva can make this measurement that it's better then serum at determining a woman's overall hormonal health is just not true.

A comparison could be made to fat and energy. We have energy stored in fat as calories. Energy is continuously available to us (we even burn calories when we sleep.)

A small portion of energy is always available for immediate use and the rest is stored. To tell a woman how much "energy" she has at any given moment, or how many calories she is currently burning but then to tell her that it doesn't matter how much she weighs, that it doesn't matter what percentage of her body weight is fat, or to make statements that it is not necessary to know this information for good health would be inaccurate. The same goes for hormones.   When analyzing a women's hormonal health it is very important to know how much is being stored and in what levels.

Only serum analysis (a blood test) can measure SEX BINDING HORMONE (SHBG)  because saliva testing can not measure proteins. Do not get confused that SHBG is a hormone because of the word hormone is in its title. SHBG is not a hormone. SHBG is a protein. SHBG is the principle protein that regulates and binds hormones together leaving just a small percentage (1% to 5%) free and unbound.   Saliva testing only measures hormones, it can not measure proteins.  You can spit out hormones but you cannot spit out proteins.

SHBG levels can determine if your hormones are being bound and in what amounts. Your SHBG levels also affect how much estrogen and testosterone your ovaries produces. If your SBHG level is high, low or normal and comparing it to your hormone levels, and seeing if those levels are high, low, or normal gives a much clearer picture of your overall hormonal health then saliva testing.

Q.  So is serum hormone analysis better then saliva testing?

A.  Both types of tests are good at what they do. They both look for the same thing (hormones) but in different forms.

For applications such as obtaining baseline levels and yearly monitoring the serum testing is better. Saliva testing is good for other applications such as women under going fertility treatments, and the FSH Smart Strips also has a place in women's healthcare.   Women at times might choose to all types of testing in combination.

For anyone to state that one type of testing is better then the other, or that saliva testing is the only testing women need is wrong.  Each  type of testing has their place and role in the arena of women's health care.

Q.  How does the "Ru25 Plus" FSH Menopause Test compare to the serum and saliva testing?

A.  The "Ru25 Plus" FSH Menopause Test is very good at what it does.  It measures  and detects  human follicle stimulating hormone (FSH) in urine at a sensitivity cutoff level of 25 mIL/ml (anything less the test reads negative, anything more the test reads positive).  

The usual reasons for constant elevated FSH levels throughout the cycle are related to menopause or the gradual shutdown (failure) of the ovaries.

In order for your FSH levels to be evaluated, other hormone levels (i.e., estrogen) first need to be low (in the menopausal range).  Consequently, a positive test for elevated FSH (except at mid-cycle) is a clue to the onset of menopause or some other medical condition adversely effecting normal ovarian function.  

The "Ru25 Plus" FSH Menopause Test  is for home use.  A positive qualitative test for elevated levels of FSH does not, under any circumstance, confirm or deny a diagnosis of menopause or ovarian failure.  If you do home testing such as this and have positive test results, further tests and consultation with a healthcare professional are required.

Q.  What if I get  serum hormone tested and all my levels are normal?

A.  If your levels are in normal range the information will provide you with a baseline for future reference. If they are not in normal range you may want to consider therapy options.

Q. Where can I get more information about hormones and their function?

A. Try searching the internet. Use the search terms, Pituitary Hormones, hormones, menopause, TH - thyrotropin; thyroid stimulating hormone, Estrogen or Estradiol - test (E2), FISH. HL (lutinizing hormone ) , Progesterone (serum), SHBG -Sex hormone binding globulin, Hormone Binding , Testosterone, RHEA-sulfate (dehydroepiandrosterone sulfate), Cortical (Cortical level), Prolactin (PRO), Insulin

...here is an example of some information you will find.

Follow this link for more information about Hormone Binding. This site has some good information about "Hormone Loops" and "Feedback and Regulation".

...Hormones act on their target cells by way of receptors: specific sites on or inside the cell bond with the incoming hormone and initiate the cell's response to the hormone. Feedback loops often involve changes in the receptor content of target cells; an increased or decreased receptor content results in increased or decreased responsiveness of the cell to any given level of incoming hormone.

FYI:  The fallopian tube is loaded with "receptor cells" which plays an important role in regulating your hormones.   How much of your fallopian tube was removed at the time of your Tubal Ligation? 

Note: Diagnoses of health/medical conditions are not made at this web site, by www.HormoneCheck.com,  or by any of its associates.  This site and offered FSH testing is for informational and educational purposes only.  No treatment is provided.  A positive qualitative test for elevated levels of FSH does not, under any circumstance, confirm or deny a diagnosis of menopause or ovarian failure.  Further tests and consultation with a health care professional are required. The Ru25 Plus FSH Menopause Test is not a treatment or a cure for any condition or disease. Taking, the "pill" (oral contraceptives) may cause a false negative reading with this test. Results of this test are not to be used to determine fertility or lack of fertility. Decisions about contraception should not be made on the results of this test. Direct questions concerning this test, menopause, and treatment for menopausal symptoms to a health care professional.

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