In Part 1 of this topic we covered how to identify your main health concerns, establish a baseline, and assess your lifestyle. In this post I want to focus on choosing the most appropriate lab test based on your main concerns and then how to make a timeline to reassess and reflect. Before we jump into testing, I think it’s important that there isn’t pressure to test right away. If you read last week’s email, you can see that steps one through three can take time. If we jump right to lab testing before we establish our baseline for nutrition and our metabolism it can often feel like you have a lot of information and even lead to overwhelm. There’s so much you can learn about your body from tracking your food, paying attention to your digestion, bowel movements, and mood throughout the day. And of course from tracking your cycle. Sometimes that is all we need. Lab testing has a place though and can be very helpful. I think it comes down to choosing the most appropriate test to help you get to the root of your main concerns.
When it comes to selecting the most appropriate lab test, you want to go back to your main concerns. Below is a chart that has examples of how to choose the most applicable testing to help you uncover what is at the root. We will work through each section in detail! I think it goes without saying that I recommend hair tissue mineral analysis (HTMA) as a foundational test for all women. This helps you identify mineral deficiencies or imbalances that can help you get even more out of other lab testing. For example, if you get a thyroid blood panel done and it comes back normal showing you are making thyroid hormone, but you have many symptoms of hypothyroidism (feeling cold, hair loss, poor appetite, fatigue, etc.), then comparing to your HTMA will tell you how you’re using that thyroid hormone. The same goes for stool testing. If you see significant overgrowth on a stool test but maybe your digestive enzyme production looks good, you can compare to your hair test to see if you have enough sodium, potassium, and zinc, which would give you insights for stomach acid. Advanced testing for our gut and hormones can give helpful insights into what is going on and your HTMA will provide more of the why.
This is probably the most nuanced section since our hormones are the last thing to change and can be impacted by many different systems in the body. I like to break it into two main categories and go from there.
Painful Periods, Endometriosis, Fibroids, Hormonal Headaches/Migraines
Lab testing from both of these sections can overlap, but this first one has an especially important component with the gut. Painful periods and endometriosis typically have an inflammatory component. Endometriosis in particular can be influenced by our immune system. Women with endometriosis are also more likely to have low stomach acid, bacterial overgrowth, imbalances in beneficial and non beneficial bacteria, and a depleted immune system. This is why I recommend GI map stool testing with all of my endo clients. It’s a part of the puzzle that you can’t skip and often leads to relief in symptoms pretty quickly. Painful periods, fibroids, and hormonal headaches/migraines all have an estrogen component, which is greatly influenced by our gut health. In order to make sure estrogen detox is optimized and is not being impacted by the bacteria in our gut, doing a stool test can help you rule that out or create a plan for imbalances.
I also like to look at thyroid health for fibroids and those that struggle with migraines. Research has shown that women with fibroids and hypothyroidism typically have larger fibroids. There’s also been a connection with women having thyroid nodules and fibroids at the same time. Research has indicated that hypothyroidism should be considered a comorbidity for those that suffer with migraine headaches. Migraines are much more frequent and likely for those that have hypothyroidism
Fertility, PCOS, Irregular Cycles, Hair Loss
When it comes to concerns around fertility, PCOS, irregular cycles, and hair loss I tend to want to do DUTCH hormone testing and compare that to an HTMA. These can all often require thyroid testing as well. Thyroid health is crucial for ovulation, regular cycles, and energy production. Hypothyroidism can also lead to high androgens, which can exacerbate PCOS symptoms. If someone is wanting to limit testing, I think the most essential would be HTMA and thyroid blood panel (TSH, free T4, free T3). And if fertility is a concern you can add on a blood test for progesterone that you would complete 5-7 days after ovulation. This would give you the best picture of what is going on.
Constipation, Bloating, SIBO, Indigestion
What do all of these have in common? Sluggishness. This is typically related to thyroid health. Minerals can be very very helpful for these populations, especially for getting things moving. Increasing potassium by adding in two cups of coconut water each day has been incredibly helpful for supporting a daily bowel movement for many of my clients that struggle with constipation. Taking it a step further to assess thyroid health via blood work is also helpful. Most of these are related to low stomach acid production, which is often tied to hypothyroidism. The normal range for thyroid is huge, so you can have normal looking blood work, but then see on your hair test that thyroid is sluggish. It’s best to assess both if you can. Getting the thyroid functioning optimally and supporting minerals helps to support digestion, which improve constipation, bloating, and digestive juice production. These all help with SIBO.
Food Sensitivities, Loose Stools, Histamine Intolerance
For this population, I almost always recommend stool testing along with their hair test. This helps to identify stressors in the gut that can impact the immune system and lead to over-activation. This is often the main driver behind food sensitivities and histamine intolerance. There are also certain strains of bacteria that can release histamines or make histamine levels worse. Assessing gut health, digestion, immune system function, and gut bacteria can help get to the root of these main concerns.
Non-Autoimmune Thyroid
This is a pretty simple recommendation of hair mineral testing and a thyroid blood panel (TSH, free T4, free T3). Comparing these two labs will help you identify where the main issue is with thyroid function. Sometimes we need to take it a step further and assess iodine through urine testing as well, but I typically do not start there. The food journal and stress assessment are also crucial for this population. I’ve seen some pretty amazing changes in thyroid function and symptoms with optimizing diet and reducing stress. Sometimes it can really be that simple!
Autoimmune Thyroid
Hair mineral testing is still important for these folks. I also always do a GI map stool test since the immune system has a big impact on antibody levels. Autoimmune thyroid conditions are also linked with certain imbalances in the gut like H. pylori, a pathogen that lives primarily in the stomach. If we can identify stressors in the gut that could be impacting the immune system, that will help guide a healing plan. For those with Graves, I also recommend iodine urine testing. I have seen amazing results with supplementing iodine in Graves clients (and Hashimoto’s depending on their stress). Many clients have been able to get off their prescription antithyroid meds and use iodine instead. So amazing!
Acne
Acne is complex and can have a hormone, gut, and mineral component for many. If someone’s skin has reacted well to antibiotics or prescription topicals in the past, I often recommend stool testing. If someone is dealing with acne that increases or changes around changes in their cycle, I sometimes recommend DUTCH hormone testing. I think it’s important to connect this main concern with anything else that’s part of the health history. For example, if someone has acne and also has painful periods and loose stools, I’d consider stool testing. If someone has acne, hair loss, and constipation, I’d consider thyroid testing.
Eczema, Dermatitis, Psoriasis
When it comes to eczema, dermatitis, and psoriasis, the immune system, liver, and gut are the main areas to focus on. This is why I love pairing hair mineral testing with GI map stool testing. It allows you to see mineral imbalances that can impact our ability to detoxify and digest our food, which you can then compare to stool testing that will show you bacterial imbalances and how the immune system is functioning. Inflammation is a big factor for this population as well, which is very tied to our immune system. Working on gut health and supporting the immune system and fixing any imbalances in the gut will be key.
Once you completed your testing and created a plan for nutrition, supplement, and lifestyle changes (hopefully with the help of a practitioner), it’s important to reassess. I like to think big picture since it can take time for shifts to happen, depending on your main concerns and health history. I also find it helpful to do more frequent check ins to help build habits and see what is and is not working.
Weekly or Bi-Weekly Reflection
This is a great time to reflect on your smaller habits whether that be eating more consistently, eating breakfast, or trying to get more protein. Whatever your big takeaway was from your food tracking. If you have been experimenting with a different sleep routine or getting outside for a daily walk, how has that made you feel? How do you feel at the end of the week–tired, content, happy, energized? Looking back at previous reflections is also very fun. It’s easy to miss those small, positive changes. Taking a moment each week to reflect and look back helps you highlight them and keep that momentum going.
Monthly Reflection
This is when I like to look back at any changes in the menstrual cycle. How was ovulation? Did you have symptoms during your luteal phase or menstruation? Did you notice any difference in your sleep, energy, appetite? Is anything not working for you as far as nutrition, lifestyle changes, or supplements go? Do you have any concerns?
3 Month Reflection
The last 100 days impacts our current cycle, so doing a three month look back is very helpful. This is a time I also like to reassess the metabolic baseline. Reviewing basal body temperature, digestion, appetite, mood, and sleep will help you see where you are at.
6 Month Reflection
Reassessing your baseline again and going back to your main concerns. Have they improved at all? Was testing helpful? Do you need to retest anything like your hair test or thyroid? Will retesting change what you are currently doing? If not, it may not be necessary.
This is the process we take our 1:1 clients through. If you would like support on your healing journey, you can learn more about what it looks like to work 1:1 with the Hormone Healing RD here. If it sounds like a good fit, we also include the application and process for getting started in the email. We would love to support you!
