Healthcare professionals love labels. They use them to name conditions, classify symptoms and guide treatments. But when it comes to women’s hormone health, I’ve become increasingly convinced that some of these labels can sometimes do more harm than good.

It may come as a surprise, but I don’t particularly like terms such as perimenopause, menopause, PCOS/PMOS, PMS or PMDD. That’s because they do not explain what is actually happening in the body to cause these symptoms. They also can distract us from the questions women are really asking: What’s happening to my hormones, and what treatment is most likely to help me?

Beyond the label

A diagnosis should be the beginning of understanding, not the end of the conversation.

Instead of relying on broad diagnostic labels, clinicians should be asking whether a woman has an estradiol deficiency, a progesterone deficiency, a testosterone deficiency – or a combination of two or all three hormonal changes. We should then consider how those changes relate to a woman’s symptoms and use that understanding to guide evidence-based hormone treatment options.

Too often, women are given a diagnosis without anyone exploring the underlying hormonal changes that are causing their symptoms. The result is that symptoms are managed rather than the underlying cause being properly understood.

Many women leave the consulting room with a non-hormonal treatment aimed at managing their symptoms, without anyone discussing whether hormonal changes could also be playing a role.

Important questions

If you’re experiencing changes in your mood, sleep, energy, concentration or physical health, it’s worth asking whether changes in your hormone levels could be contributing. Asking that question can open the door to a more complete understanding of what’s happening and you can have conversations about hormones treatments that are likely to help.

An outdated definition

The term menopause itself illustrates the problem. It has become loaded with politics, stigma and misunderstanding. Some people see it as a natural biological transition that women should simply endure. Others recognise it as a stage of life that can bring significant symptoms and long-term health consequences if hormone deficiency is left untreated. When experts can’t even agree on what menopause represents, it’s hardly surprising that women receive conflicting advice about treatment.

Even its definition is surprisingly imprecise. Menopause is defined as 12 months after a woman’s last menstrual period. But what does that really tell us? Hormonal changes often begin years before that point and continue long afterwards. The definition identifies a date in retrospect rather than helping explain why someone is experiencing symptoms today or which hormones may be changing.

Who gets missed?

So many women are excluded if menopause is only defined by periods stopping. Women who have had a hysterectomy, use a synthetic hormonal coil such as the Mirena, take synthetic hormonal contraception that stops their periods, do not fit neatly into this definition at all. Yet these women often experience profound hormone deficiencies and its consequences. I’ve spoken to countless women who have spent months, and even years, struggling to access diagnosis and hormone treatments simply because they didn’t fit an outdated definition.

Diagnostic labels aren’t answers

I’ve written a lot about the topic of labels in my latest book, The Power of Hormones. In the book, I recalled how early in my medical career, I was taught to write TAAT – ‘tired all the time’ – in the notes of patients whose fatigue couldn’t easily be explained. It was convenient shorthand, but it didn’t identify the cause of tiredness or help with the right treatment. In many ways, some of the diagnostic labels used in women’s hormone health risk doing exactly the same thing.

This doesn’t mean diagnostic labels have no value. They can validate women’s experiences, support research and help women access appropriate care. But they should never replace curiosity about what’s happening inside a woman’s body.

Rather than stopping at a diagnosis of menopause, PMS, PMDD, or PCOS/PMOS, we should ask what hormonal changes may be occurring and how they relate to that woman’s symptoms. Other diagnoses such as fibromyalgia, chronic fatigue syndrome, functional neurological disorder and personality disorder should not be made until a hormonal imbalance has been excluded.

Understanding hormones

Women deserve more than a diagnostic label. They deserve to understand what’s happening in their bodies and to have treatment that’s tailored to their individual symptoms and needs.

By looking beyond labels and considering changes in estradiol, progesterone and testosterone, conversations about hormone treatments become more personalised and more meaningful. For many women, that includes bioidentical hormone treatments.

The important thing is that treatment should be guided by a woman’s symptoms, her medical history and an understanding of the hormonal changes that are affecting her – not simply by the label written in her medical notes.

Click here for more information about The Power of Hormones.