mila mend 2024 release

the optimal
lab guide
healing made simple.

©2024 Mila Mend. All rights reserved.

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Did you know that 80% of women experience
hormonal imbalances, but it often takes
6-7 years to get a proper diagnosis?

I personally experienced this struggle

for many years. That's why I've created
this guide – to simplify the headache of
lab testing, and explain why your results
might say "normal" even when you're
experiencing symptoms.
what to expect
In this guide we will cover:

How to order lab work

When to test your hormones
Understand lab markers
The importance of optimal ranges
How to advocate for yourself
Tools to find a better doctor
Hormone Testing
Hormone testing offers valuable insights into
your current hormone levels and can help
understand why you may be experiencing symptoms.

Here are some common symptoms of hormonal imbalances:

Irregular periods, heavy & painful periods,

or a complete absence of periods
Infertility or difficulty conceiving
Mood swings, depression, anxiety, and
irritability
Hot flashes, tender breasts, headaches
Low libido, fatigue, decreased sex drive, or
difficulty achieving orgasm
Weight gain or difficulty losing weight even
with diet and exercise
Insomnia, sleep quality, and cause difficulty
falling asleep or staying asleep
Vaginal dryness, painful intercourse, bone
loss, light periods

* not all women will experience the same symptoms.

All about testing
Your hormones fluctuate throughout the month,
therefore depending on which hormones you want
to test, the timing of when you get tested can
influence the results.

HOW TO GET LAB TESTS:

To request a lab test, you can ask your general
doctor, an OBGYN, or purchase your own online.
Specific to hormones, an OBGYN or Endocrinologist
will be the best fit to interpret your results.

TYPES OF TESTING:
Blood tests are the most commonly used method,
but there are also urine and saliva test.
DUTCH tests are commonly used by functional
medicine doctors.

WHEN TO TEST:
For testing your overall hormone levels, it's
best to schedule the test during the first 3
days of your menstrual cycle.
However, if you're specifically testing sex
hormones, it's best to schedule the test on days
19, 20, 21, or 22 after ovulation.

* Stop taking Biotin at least 72 hours before testing

since it can affect insulin, thyroid results.
Which lab tests to order
General Health Markers
CBC* - complete blood count
CMP* - complete metabolic panel

Inflammation
Cortisol*, Free Cortisol, HS-CRP

Hormones
Estrogen (Total), Estriadol* (E2)
Progesterone*
Testosterone*, Free Testosterone
SHGB, FSH*, LH

Thyroid
TSH*,
Free T4*,
Free T3*, Reverse T3,
Thyroid Peroxidase*, Thyroglobulin Antibodies*

Blood Sugar
Fasting Insulin*, Fasting Glucose,
Hemoglobin A1C*,

Other
Ferritin*,
Vitamin D*, Vitamin B12,
Magnesium, Melatonin

* starred markers are essential to order. The other ones are

not necessary, but ordering both will give a clearer picture
of where your health is at.
PCOS specific lab tests
LH:FSH
LH levels are often higher relative to FSH in
PCOS. This can result in an elevated LH/FSH ratio.

Testosterone (free)
High testosterone levels are often found in PCOS.

Progesterone & Estradiol

In PCOS, irregular periods can occur when estrogen
levels are higher than progesterone because of a
lack of ovulation.

Thyroid Hormones (TSH, T4, T3, FREE T3+T4.)

When diagnosing PCOS, thyroid function tests
assess for thyroid disorders as they may influence
symptoms.

Sex Hormone-Binding Globulin (SHBG)

In PCOS, when insulin levels are high due to
insulin resistance, SHBG levels decrease.

Insulin and Glucose Levels + (HbA1c)

Many women with PCOS have higher than normal
insulin levels or insulin resistance, which can
lead to increased insulin levels.
PCOS specific lab tests
Ultrasound
If your doctor suspects PCOS, they might recommend
a transvaginal ultrasound to look for cysts on your
ovaries. This scan can show enlarged ovaries with
small cysts or follicles arranged around the outer
edge, often resembling a "string of pearls."

Rotterdam criteria
To be diagnosed with PCOS, you typically need to
have the presence of two out of the following three
conditions:
Irregular or absent menstrual cycles.
Signs of hyperandrogenism such as hirsutism or
acne.
Polycystic ovaries observed via ultrasound.
The Science
CBC (COMPLETE BLOOD COUNT)
What it does: This test provides information about your
blood cells and overall health by measuring the volume
of different types of cells in your blood.
Why it's ordered: It helps assess overall health and
diagnose various conditions such as anemia, infection,
and leukemia.

CMP (COMPREHENSIVE METABOLIC PANEL)

What it does: This blood test provides insights into
your overall metabolic health.
Why it's ordered: It evaluates kidney and liver
function, electrolyte levels, and blood sugar levels,
helping to diagnose and monitor conditions like
diabetes, kidney disease, and liver dysfunction.

CORTISOL
What it does: Produced in the adrenal glands, cortisol
helps manage stress, regulate blood sugar, metabolism,
fight infection, and maintain blood pressure.
Why it's ordered: It's ordered to get information about
one’s stress response and to assess adrenal gland
function and diagnose conditions like Addison's
disease, Cushing's syndrome, and adrenal insufficiency.

FREE CORTISOL
What it does: This measures the amount of cortisol not
bound to proteins in the blood.
Why it's ordered: It's ordered to get information about
one’s stress response and to assess adrenal gland
function and diagnose conditions like Addison's
disease, Cushing's syndrome, and adrenal insufficiency.
The Science
HS-CRP (C-REACTIVE PROTEIN)
What it does: C-reactive protein (CRP) is made in the
liver in response to inflammation, particularly driven
by interleukin 6.
Why it's ordered: It helps assess inflammation levels
in the body and one’s risk of cardiovascular disease
and other inflammatory conditions.

DHEA-S
What it does: Produced by the adrenal glands, DHEA-S
evaluates adrenal gland function and serves as the
foundation for sex hormones such as testosterone,
progesterone, and estrogen.
Why it's ordered: It aids in diagnosing adrenal
disorders like adrenal insufficiency and adrenal tumors
as well as providing valuable information about adrenal
function in cases of hormonal imbalance.

ESTROGENS (TOTAL) + ESTRADIOL (E2)

What it does: This measures the overall amount of
estrogen in the body, including both active and
inactive forms.
Why it's ordered: It offers insights into menopause,
menstrual irregularities, infertility, and other
estrogen-related conditions.

ESTRADIOL (E2) As the primary estrogen in non-pregnant

women of childbearing age, estradiol is mainly produced
in the ovaries and is essential for fertility. It also
supports brain and bone health.
It helps assess ovarian function, fertility, and
estrogen levels in various conditions like menopause
and menstrual irregularities.
The Science
PROGESTERONE
What it does: Progesterone levels rise after ovulation,
indicating that an egg has been released from the
ovary. In early pregnancy, progesterone helps maintain
the uterine lining, supporting a healthy pregnancy.
Why it's ordered: It helps determine if ovulation has
occurred and is used in investigating infertility,
menstrual irregularities, and pregnancy-related
conditions.

TESTOSTERONE + (FREE) TESTOSTERONE

What it does: Testosterone contributes to muscle and
bone strength, brain function, fat distribution, heart
health, energy levels, and sex drive.
Why it's ordered: It provides information about
symptoms such as hirsutism, low sex drive, fatigue, and
irregular menstrual cycles, helping diagnose conditions
like and PCOS.

High levels are linked to hirsutism, polycystic ovary

syndrome (PCOS), and a higher risk of insulin
resistance.
Low levels are associated with a greater risk of
osteoporosis, reduced lean body mass, and decreased
libido.

SHGB (SEX HORMONE-BINDING GLOBULIN)

What it does: This protein binds to sex hormones,
primarily testosterone, in the body.
Why it's ordered: SHBG testing is commonly used to
assess how testosterone functions in the body and
diagnose conditions like hypogonadism and PCOS.
The Science
FSH (FOLLICLE-STIMULATING HORMONE)
What it does: FSH helps control menstruation and
prompts the release of eggs from the ovaries.
Why it's ordered: Imbalances in FSH can lead to
infertility and affect puberty, menstrual cycles, and
sex drive. It helps diagnose conditions like PCOS and
assess fertility.

LH (LUTEINIZING HORMONE)
What it does: LH regulates the menstrual cycle and
triggers the ovaries to release eggs.
Why it's ordered: Imbalances in LH can result in
fertility issues. Testing can predict ovulation through
the LH surge.

FSH : LH RATIO
What it does: This ratio provides insights into ovarian
function.
Why it's ordered: It helps identify infertility and
conditions like PCOS, where LH levels are higher than
FSH.

TSH (THYROID STIMULATING HORMONE)

What it does: TSH stimulates the thyroid gland and
reflects thyroid function.
Why it's ordered: It's used to screen for primary
hypothyroidism and hyperthyroidism and diagnose
thyroid disorders.
The Science
FREE T3
What it does: This is the most active form of thyroid
hormone, crucial for regulating metabolism.
Why it's ordered: Measuring free T3 levels aids in
diagnosing thyroid disorders like hyperthyroidism.
Levels may be elevated with hyperthyroidism and
decreased with hypothyroidism.

FREE T4
What it does: Produced by the thyroid gland, free T4
is vital for metabolism, growth, and development.
Why it's ordered: It's commonly used to diagnose and
manage hypothyroidism and hyperthyroidism. It will be
elevated in hyperthyroidism and decreased in
hypothyroidism.

THYROID PEROXIDASE (TPO)

What it does: TPO is an enzyme in the thyroid gland.
TPO antibodies attack it, leading to inflammation and
damage to the thyroid.
Why it's ordered: Testing TPO antibodies helps
diagnose autoimmune thyroid disorders like Hashimoto's
thyroiditis and Graves' disease.

THYROGLOBULIN ANTIBODIES (TGAB)

What it does: These antibodies attack thyroglobulin, a
protein involved in thyroid hormone production.
Why it's ordered: TgAb levels evaluate thyroid
function and diagnose autoimmune thyroid disorders
like Hashimoto's thyroiditis and Graves' disease.
The Science
FASTING INSULIN
What it does: Insulin is secreted when blood glucose
levels increase, helping to lower blood glucose by
facilitating the transport of glucose into cells.
Why it's ordered: It's useful for diagnosing and
managing diabetes, PCOS, and insulin resistance.

GLUCOSE:
What it does: Glucose is a sugar in the blood and a
primary source of energy for the body's cells.
Why it's ordered: Increased blood glucose levels are
associated with types 1 and 2 diabetes, metabolic
syndrome, and insulin resistance.

HEMOGLOBIN A1C
What it does: also called glycohemoglobin, forms when
glucose attaches to hemoglobin during the lifespan of
a red blood cell, which is about 120 days.
Why it's ordered: It's used to monitor and diagnose
diabetes, offering insights into long-term blood sugar
control.

FERRITIN
What it does: Ferritin stores iron in the body.
Why it's ordered: Measuring its levels helps diagnose
and manage conditions related to iron metabolism like
iron deficiency anemia and hemochromatosis.
The Science
VITAMIN D
What it does: Essential for bone health, immune
function, and hormone production.
Why it's ordered: Vitamin D deficiency is linked to
insulin resistance and can impact thyroid hormone
production and secretion.

VITAMIN B12
What it does: Vitamin B12 is crucial for nerve
function, red blood cell production, DNA synthesis,
myelin sheath formation, and nerve maintenance.
Why it's ordered: B12 deficiency can cause various
health issues including anemia, fatigue, weakness, and
neurological problems like numbness and tingling.

MAGNESIUM
What it does: Magnesium is a vital mineral crucial for
energy production, muscle function, and various
enzymatic reactions in the body, including carbohydrate
and protein synthesis, nucleic acid metabolism, and
blood clotting.
Why it's ordered: Magnesium deficiency can cause muscle
weakness, cramps, fatigue, and mood changes. Elevated
levels may signal kidney dysfunction and renal failure.

MELATONIN
What it does: This hormone regulates sleep-wake cycles
and may aid in diagnosing sleep disorders. It may also
influence the regulation of other hormones such as
cortisol and growth hormone.
Why it's ordered: Provides insights into the body's
stress response and circadian rhythm.
The problem with “normal”
I got my results back, but they are "normal"

The Standard Reference Range

2.5% 95% of the TESTED population will fall in here 2.5%

abnormal
low “Normal” Abnormal
high

If you fall in this range, you are considered to be

healthy regardless of your symptoms.

Normal lab reference ranges are based on averages,

which can be problematic for those of us who
present symptoms while in these ranges.

These ranges are derived from testing a broad

population, which may not represent peak health.

That’s why normal ranges might not be the best

representation of optimal health, which helps
explain why so many of us have symptoms, but are
told that our labs are normal.
The Functional “Optimal” Range

Functional
Abnormal functionally functionally Abnormal
Physiological
low low
Range
high high

We know that even small changes in hormone

levels can affect how we feel.

That’s why Optimal lab testing is the best way

to assess your health.

The detailed ranges help us see if our levels

are where they should be for our body to feel
its best- we want to be better than normal.

This gives us a better idea of what's going on

and can help explain any symptoms we have.
Let’s take a closer look

THE FUNCTIONAL OPTIMAL RANGE

still in the still in the normal

normal range but peak performance range but on the
on the low end scores higher side

room room
very very
low to optimal to high
low high
improve improve
slightly below slightly above
speak to your speak to your
peak performance peak performance
doctor ASAP doctor ASAP
levels levels

Early symptoms of health conditions may not always

show up on standard lab tests.

Detecting these subtle deviations before they

exceed the "normal" range allows for timely
intervention to prevent worsening health problems.

Optimal hormone testing considers individual

needs, uncovering imbalances missed by standard
tests.

By addressing these imbalances early, optimal lab

testing not only improves how you feel but also
helps prevent diseases.
Optimal reference ranges
STANDARD OPTIMAL
TEST
REFERENCE RANGE REFERENCE RANGE

TSH 0.45-4.12 mlU/L 0.5-2.5 mlU/L

T3 2.8-4.0 mlU/L 2.8-4.0 mlU/L

T4 0.93-1.70 mlU/L 1-1.70 mlU/L

FREE T3 3 -7 pmol/L 5 - 7 pmol/L

FREE T4 9 - 23 pmol/L 15 - 23 pmol/L

REVERSE T3 8-25 ng/dl < 15 ng/dl

ANTI- TPO <35 IU/mL <2 IU/mL

ANTI- TG <35 IU/mL <2 IU/mL

VITAMIN D 30-100 ng/mL 50-80 ng/mL

FASTING GLUCOSE 70 – 125 mg/dL 70- 85 mg/dL

FASTING INSULIN 2.6-24.9 mcIU/ml 4.6 – 5.5 mcIU/ml

HGBA1C Under 5.7 4.6-5.5

7-28 μg/dL morning 10-15 μg/dL morning

CORTISOL (SERUM)
2-18 μg/dL afternoon 6-10 μg/dL afternoon
Advocating for yourself
MY DOCTOR WON'T ORDER MY LABS:
If your doctor refuses to test you, consider
changing doctors as your care team plays a crucial
role in your health journey.

If you’re unable to switch doctors, ask them to

write down in your chart that they refused to test
your hormones... they hate that and will usually go
ahead and order them.

Bringing a male companion to your appointment to

advocate for you can also improve communication
with doctors. It’s sad, but it’s true.

Here is a link to a letter you can send to your

stubborn doctor, made by Iszabella Wentz.

HOW CAN I FIND A DOCTOR WHO WORKS WITH

THESE RANGES AND AIMS FOR OPTIMAL HEALTH?
Finding a doctor who uses optimal lab testing may take
some research and effort, but there are a few
strategies you can use to increase your chances of
finding one:

Here is an incredible international database of

functional doctors.

I also highly recommend speaking to Lark Swofford, who

has guided me in optimizing my labs, navigate the
supplement world, and has been my guiding mentor.
Here is the link for booking a consultation with her.
 FAQ’s
WHAT IF I DON'T HAVE A PERIOD?
If you don't have a menstrual cycle, testing
your hormones at any day of your cycle is ok.

WHAT IF I'M ON BIRTH CONTROL?

Unfortunately, you will not be able to test
FSH, LH, estradiol or progesterone accurately.

ADDITIONAL THYROID TEST:

Having a doctor feel your thyroid is very
important. If your insurance covers it, I
highly recommend getting an ultrasound of your
thyroid.
You are not alone.
Since I first began experiencing symptoms of hormonal
imbalance, I've consulted more than 20 medical
professionals, including specialists, OBGYNs,
endocrinologists, naturopaths, generalists, internists,
gastroenterologists, ENTs, neurologists, and more.

Despite numerous visits, my lab results consistently

came back as "normal," and I was repeatedly prescribed
birth control pills, spironolactone, metformin,
antidepressants, and ADHD medications to alleviate my
symptoms.

Some doctors even attributed my issues to genetics or

suggested that my symptoms were imaginary. This left me
feeling utterly helpless and defeated.

However, after enduring many long years of worsening

symptoms, I finally took matters into my own hands and
insisted on thorough testing.

That appointment, where I stood up for myself despite

my discomfort with confrontation, turned out to be my
greatest act of self-care. After years of being told
that my blood work was normal and that nothing was
wrong, I received a diagnosis of hypothyroidism and
polycystic ovarian syndrome.

Remember that you are your own best advocate.

You’ve got this, and I’m rooting for you.

All my love,
©2024 Mila Mend. All rights reserved.
 disclaimer
Information provided in this document is
for informational purposes only and are
not intended to diagnose, treat, cure, or
prevent any disease.

This information is NOT intended as a

substitute for the advice provided by your
physician or other healthcare
professional.

If you have or suspect that you have a

medical problem, contact your health care
provider promptly.

Do not disregard professional medical

advice or delay in seeking professional
advice because of something you have read
in this document.