new home blood test for hormonal health improves access and starts the conversation

“the one thing that i would say to women, if something feels off, you’re not necessarily imagining it and you’re not being difficult. just bring specifics, ask what’s being ruled out and keep asking. women know when something is off. and they need to know it doesn’t have to be that way.”

this is an important takeaway on how to talk to health-care providers from dr. kristy prouse. she wants women to advocate for the care they need, whether it’s menstrual cramping or sexual pain, headaches, night sweats, mood swings or anything else that’s bothering them. the ontario obstetrician and gynecologist is a leader in hormonal health and what it means for women across the lifespan.

“i’ve seen tens of thousands of patients in this area. it really is following women across the entire lifespan that is appealing,” she says. “you get to see them in adolescence and then potentially fertility issues, pregnancy, perimenopause and then decades afterward, right? so very few fields allow you to build that kind of longitudinal relationship with a patient.”

providing expert hormonal care for women at every age

dr. prouse studied genetics and cell biology and then psychology, all leading her to medicine. she specialized in obstetrics and gynecology for about 10 years before she left the conventional medical world to pursue functional medicine, an approach that emphasizes identifying why a condition develops rather than only naming or treating the disease. “it is really a paradigm shift on how we look at the body, more from a decentralized medicine perspective versus having specialties and silos.”

she’s dedicated to addressing what she calls the gap between what patients are experiencing and what the health-care system has become equipped to investigate in hormonal health.

in part, that stems from women as historically under-researched and “quite frankly under-explained as well,” she says. “so women could come in describing very real, very disruptive symptoms and be told their blood work was normal or that it was just part of being the woman.”

women have more complicated hormone health than men and, further to the complexity, each individual woman is different, she explains. there’s no one-size-fits-all explanation or treatment, but that doesn’t mean that women’s concerns shouldn’t be investigated.

why virtual care opens doors

among several roles in the field, dr. prouse is chief women’s health advisor for science & humans, a canadian digital health service focused on hormonal health. the platform offers access to experts for reproductive and sexual health, weight issues, skin and hair health, perimenopause and menopause. hormones play a role in all of these.

the aim is to meet people’s needs, especially as women are starting to speak up, asking for help, instead of accepting symptoms as things they just have to live with. these symptoms aren’t only physical, but psychological as well.

a national leger survey earlier this year, commissioned by science & humans, found that nearly six in 10 women say hormonal changes have impacted their sense of identity, shining a light on the emotional and psychological impact of hormonal health that many say is overlooked.

the survey also revealed that 52 per cent of women say they’ve faced barriers seeking hormone care; 32 per cent say they are not informed about how hormones affect their health, and 81 per cent say that health-care providers need better training and resources in hormone health.

“i think the biggest thing is to understand that hormones aren’t just a niche reproductive issue,” says dr. prouse, explaining that the molecules signal body processes. “estrogen, progesterone and testosterone act on the brain and on the bone and on our blood vessels and skin muscle metabolism. when they do shift in women, it’s not just a change in their menstrual cycle. they notice a change in how they think and sleep and feel and function. estrogen is really the clearest example of that. so as levels of estrogen decline, we see the downstream impact in almost every system.”

hormones affect bone loss, insulin sensitivity and more

the rate of bone loss accelerates sharply in the years around the last menstrual period, the window where osteoporosis risk is set. hormone shifts affect metabolism, where body composition shifts toward central fat and obesity, which is related to insulin sensitivity.

the cardiovascular system is affected as blood pressure and vascular stiffness tend to rise as estrogen levels decline. the tissues of the vagina thin, causing vaginal dryness and painful intercourse. bladder symptoms can arise and more frequent urinary infections.

“and it shows up in the brain, too. sleep disruption, mood change,” she notes. “when sleep, memory, mood, energy, libido, all change at the same time, women experience that as a change in who they are, not just as a shift in a lab value.”

recognizing this as hormonal is often the turning point because now women know what’s happening to them, ask questions and seek treatment.

science & humans has taken this a step further by introducing an at-home blood collection solution called healthspan, designed to make hormone testing more accessible. you use an upper-arm device to collect the blood sample and send it for analysis of hormone markers, including testosterone, estradiol (a form of estrogen) and progesterone.

results are reviewed and delivered through the platform and people can then connect with a health-care provider for a treatment plan. “we combine medical experts with personalized lifestyle support. hormone care isn’t just a prescription. it’s about the sleep and the nutrition, strength training and ongoing follow-up.”

dr. prouse notes that the at-home collection and virtual care with a clinician offers access to specialty care at a time when so many people don’t have a family physician. or they may wait weeks or months for an appointment to raise something that they’ve been sitting with and uncomfortable with for a long time. there’s also the logistics for people to get to appointments, get a blood work requisition and visit a lab during business hours.

she also points out the constellation of hormonal symptoms overlaps with other conditions like iron deficiency and sleep apnea. objective testing to rule out issues is just as important as identifying what relates to symptoms.

“menopause is largely a clinical diagnosis. so, i think there’s real value in being attached to a clinician who appreciates this whole spectrum and can address the person as a whole,” she says. while there is hormone replacement therapy, for example, hormone health can be managed with lifestyle habits that support physical and mental health and get ahead of problematic symptoms.

“what can you do in order to prevent some of the things that are potentially coming your way? and that’s really where we get into more of looking at hormones through a functional medicine lens that is preventive or proactive.”

preventive health could offset hormonal difficulties

replacement hormones is one answer, along with lifestyle modifications or possibly a supplement is worthwhile.

“the more that we can do to have lasting impact, the better,” she adds. “the more information we can collect on someone, the more we can hone in on what’s going to work for them.”

her outlook is about being proactive and self-aware when it comes to our health.

“we really need to start focusing our efforts on understanding what we can do in advance of hormones becoming dysregulated so that we can have a positive impact on the long-term consequences of dropping hormone levels. so all of the metabolic and cardiovascular and bone pieces of it, we can start actioning upstream long before hormones start shifting.”