Hormones act as chemical messengers that regulate various physiological processes. By offering hormone testing for women, healthcare providers can gain important insights into patients’ health status, identify potential hormonal imbalances, and tailor individualized and effective treatment plans accordingly.
The importance of hormone testing for women
Hormone lab testing for women is an important tool for healthcare providers to identify and manage various health conditions. By testing hormone levels, providers can gain insights into menstrual cycle irregularities, fertility concerns, and other health challenges, such as thyroid disorders or symptoms associated with menopause. These tests provide crucial information for selecting therapeutic interventions and developing personalized treatment plans for patients. It’s important for healthcare providers to stay informed about the latest advancements in hormone testing methodologies necessary for optimal patient care.
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Women’s hormones: What’s being tested and why?
A hormone test can examine several key hormones and provide important information about a patient’s health. Additionally, a hormone test may be used to help diagnose certain health conditions, such as thyroid disorders and other medical issues. (17)
Estrogens
Estrogens are a group of hormones that play an important role in reproductive health over the course of a menstruating person’s life, including during puberty, menstruation, pregnancy, and perimenopause and menopause. Additionally, estrogens support bone, heart, and brain health. (4)
Estrogen tests
An estrogen test measures the level of estrogens in a sample of a patient’s blood or, in certain cases, urine. (4) Estrogen levels are measured in the serum picograms (one-millionth of a gram) per milliliter (pg/mL).
Although there are various types of estrogens, three types are routinely tested. These types include:
- Estrone (E1): Estrone is the estrogen form that menstruating people produce throughout life, even after menopause, and is the dominant form postmenopause. It’s produced in the adrenal glands, body fat, and ovaries. (4)
- Estradiol (E2:) Estradiol, produced in the ovaries, is the estrogen that’s most abundant in people who aren’t pregnant but of childbearing age. It’s important for fertility, brain, and bone health. (4)
- Estriol (E3): Estriol is an estrogen the placenta produces that increases during pregnancy. Menstruating people who aren’t pregnant produce relatively lower levels of estriol. (4)
Why test estrogen levels?
Healthcare providers may test estrogen to help identify certain health conditions (e.g., early or late puberty, menstrual irregularities, or infertility), to monitor health during certain therapies (e.g., during infertility treatments, hormone replacement therapy (HRT)), or to monitor the health of the pregnant person and baby during pregnancy. (4)
Estrogen levels fluctuate throughout a menstruating person’s life and monthly menstrual cycle; therefore, providers may test estrogen levels at a specific phase of their patient’s cycle or life, depending on their needs. (4)
Did you know? When testing for fertility, providers often test estradiol at three phases of the menstrual cycle: the follicular phase (from the first day of the period until ovulation), the periovulatory phase (during ovulation), and the luteal phase (from ovulation until the start of menstruation). (4)
There are various reasons why a menstruating person would benefit from their estrogen levels being tested. These may include:
- If they’re experiencing early or delayed puberty
- If they have abnormal periods or no periods during childbearing age
- If they’re pregnant or have a high-risk pregnancy
- If they’re having difficulty becoming pregnant
- If they have menopausal symptoms (e.g., night sweats and/or hot flashes)
- If they’re using hormone replacement therapy (HRT) after menopause
- If they’re experiencing vaginal bleeding after menopause
- If they have a tumor that could be producing estrogen (4)
Estrogen test results
It’s important for providers to use their medical knowledge and consider the patient’s symptoms and life experiences when interpreting lab test results. What’s considered a normal range for estrogen levels depends on the individual’s menstrual cycle and phase of life.
In menstruating women, low estrogen levels may be associated with:
- Anorexia nervosa (18)
- Hypopituitarism (7)
- Polycystic ovary syndrome (PCOS) (26)
- Low body fat (10)
In menstruating women, high estrogen levels may be associated with:
- Breast tenderness or fibrocystic lumps
- Fatigue
- Light or heavy menstrual bleeding
- Low libido
- More intense premenstrual syndrome
- Obesity
- Uterine fibroids (13)(21)
Progesterone
Progesterone is a steroid hormone that belongs to a group of hormones called progestogens. Progesterone is essential for regulating menstruation and fetal development. It’s produced in the ovaries, secreted by the corpus luteum (a temporary gland produced after ovulation) during the second half of the menstrual cycle, and by the placenta in a pregnant person. (21)
Did you know? Progesterone also prepares the body for milk production in pregnant people with breasts. (16)
Progesterone tests
A progesterone test measures the progesterone levels in a patient’s blood sample. Urine or saliva testing is also available but less commonly utilized, and a blood test is considered the most accurate. Progesterone levels are measured in serum in nanograms per milliliter (ng/mL) or nanomoles per liter (nmol/L). (16)
When’s the best time to test progesterone? Like estrogen, what’s considered normal for progesterone levels depends on when the patient takes the test. Midway through the menstrual cycle, progesterone levels begin to rise. Between six and ten days after the luteal phase, if there’s no fertilized egg, levels drop. If an egg is fertilized, progesterone levels remain high. (16)
Why test progesterone?
A progesterone test can help determine if low levels of progesterone are a factor in female infertility or complications during pregnancy. Additionally, the test can aid in identifying adrenal gland issues that may result in elevated progesterone levels in both females and males. (16)
There are various reasons why a menstruating person would benefit from testing their progesterone levels. These may include:
- Checking the health of a high-risk pregnancy
- Checking whether fertility treatments are showing positive results
- Diagnosing an ectopic pregnancy
- Identifying a patient’s risk of miscarriage
- Identifying ovarian cancer or an adrenal gland disorder
- Investigating what may be causing infertility. (13)(16)(21)
Did you know? In addition to blood or urine testing, certain hormones can be measured by collecting a small saliva sample and sending it to a lab for analysis.
Progesterone test results
The normal range for progesterone levels depends on the individual’s menstrual cycle phase or whether they’re pregnant. It’s important for providers to consider the patient’s symptoms and life experiences when interpreting lab test results. (16)
If progesterone levels are low during pregnancy, it may be a sign that the individual is at risk of miscarriage or early labor. In this case, the patient may benefit from using a hormone replacement form of progesterone. (16) Low levels during pregnancy can also be related to ectopic pregnancy or pre-eclampsia. If progesterone levels are low when a patient isn’t pregnant, it may indicate irregular ovulation or no ovulation. (16)
Higher progesterone levels generally don’t signal health issues. However, high levels of progesterone, especially for longer periods, may be associated with certain cancers or adrenal gland disorders. (13)(16)(21)
Follicle-stimulating hormone (FSH)
The pituitary gland, a pea-sized gland in the brain, produces follicle-stimulating hormone (FSH). In people who menstruate, FSH stimulates the growth of an egg in the ovary to prepare it for fertilization. (5)
Additionally, as menopause approaches and the ovaries begin to decline in reproductive function, the pituitary gland increases its production of FSH in response to decreasing estrogen and other hormone levels. (5)
FSH tests
Follicle-stimulating hormone levels can be assessed using blood or urine tests. FSH levels change over the course of a person’s menstrual cycle and lifetime. Providers may examine a single sample or, to monitor fluctuations, analyze multiple samples collected over a 24-hour period. FSH is usually measured in blood in milli-international units per milliliter (mIU/mL). (5)
Why test FSH?
In menstruating people, testing FSH levels may help in identifying:
- Abnormal menstrual bleeding
- A chromosomal disorder, such as Turner syndrome
- Infertility
- Low libido
- Ovarian cysts
- Ovarian function problems and PCOS
- The beginning of perimenopause or menopause
- Tumors in the pituitary gland or ovaries
- Thyroid diseases or adrenal gland disorders (5)
FSH test results
Elevated levels of FSH may indicate a dysfunction in the reproductive glands (ovaries), resulting in inadequate production of sex hormones. In response, the pituitary gland increases FSH production in an attempt to stimulate normal function. High FSH levels can also signal non-reproductive gland-related conditions that impact glandular function. (5)
Below-normal FSH levels may indicate issues with the pituitary gland or hypothalamus, hindering the body’s ability to produce FSH and luteinizing hormone (LH). Decreased FSH levels may also be associated with rapid weight loss, severe underweight conditions, or intense physical exercise. (5)
Luteinizing hormone
The pituitary gland produces luteinizing hormone, which is essential for regulating a menstruating person’s menstrual cycle. LH triggers ovulation (the release of an egg from the ovary), with levels temporarily increasing just before ovulation. This surge in LH can help individuals trying to conceive to identify their most fertile period. (11)
In addition, LH is important for sexual development in children and reproductive health in adults. In girls with ovaries, LH prompts the ovaries to produce estrogen, a hormone involved in the onset of menstruation and the development of breasts and body hair. (11)
Testing LH
LH can be tested through the blood or urine (e.g., ovulation test strips from the pharmacy). LH is measured in blood tests in international units per milliliter (IU/mL) or international units per liter (IU/L). Lastly, normal LH levels vary during the menstrual cycle and are different for someone who has reached menopause. (11)
Why test LH?
LH levels are controlled by a complex system of hormones in different body parts. Abnormal levels of LH may be a sign of a problem in these various parts, including the pituitary gland, hypothalamus, or reproductive glands. (11)
A provider may test a patient’s LH levels to help:
- Confirm the beginning of perimenopause
- Determine possible causes of infertility
- Determine when/if the patient is ovulating
- Determine why they’re experiencing irregular periods (11)
LH test results
When an individual has LH levels that are irregular, they may have difficulty becoming pregnant or have issues with menstruation, such as irregular periods. The test may also be used to help determine whether menopause or perimenopause has begun for individuals. (11)
High LH levels may be associated with:
- PCOS
- Ovarian insufficiency
- Thyroid diseases or adrenal gland disorders
- The beginning of perimenopause
- Turner syndrome (11)
Low LH levels may be associated with:
- A health issue with the pituitary gland or hypothalamus
- Extreme exercise, stress, an eating disorder, or malnutrition (11)
Testosterone
In menstruating people, testosterone is produced in the ovaries and adrenal glands.
Blood contains various forms of testosterone. Most testosterone is bound to proteins, which restricts immediate use by tissues and helps regulate the amount of “active” testosterone in the body. Unbound testosterone, known as free testosterone, is available for the body’s tissues to act upon.
Testosterone tests
A testosterone test measures the concentration of testosterone in a blood sample. Since testosterone levels don’t fluctuate like estrogen, progesterone, FSH, and LH, the timing of the test isn’t crucial in menstruating people. (22)
Testosterone levels are measured in nanograms per deciliter (ng/dL) or nanomoles per liter (nmol/L). Three types of blood tests assess different forms of testosterone levels:
- Total testosterone: A total testosterone test measures free and testosterone bound to proteins. It’s the most common type of test.
- Free testosterone: A free testosterone test evaluates only the “active” form of testosterone. It’s less commonly used but can be helpful for diagnosing specific medical conditions.
- Bioavailable testosterone: A bioavailable testosterone test assesses free testosterone and testosterone loosely bound to the blood protein albumin. It’s not commonly used. However, similar to a free testosterone test, it can aid in identifying specific medical conditions. (22)
Why test testosterone?
For menstruating people, the test is often used for symptoms of high testosterone, including:
- Abnormal hair growth on the face or body
- Acne
- A lower voice
- Hair loss on the head
- Infertility
- Irregular menstrual periods (22)
Did you know? Testosterone naturally drops during menopause and may be associated with symptoms like low libido, energy, and mood. (22)
Testosterone test results
In menstruating people, low testosterone levels are normal; however, exceptionally low levels may be associated with:
- An adrenal gland disorder
- A pituitary gland disorder
- An ovarian disorder (22)
In menstruating people, high testosterone levels may be associated with:
- A disorder of the pituitary gland
- An adrenal gland disorder, such as congenital adrenal hyperplasia (CAH)
- Ovarian cancer
- Polycystic ovary syndrome (PCOS)
- Steroid abuse (22)
Thyroid hormones
Thyroid function is determined by the levels of a group of hormones produced in the pituitary and thyroid glands. The three main thyroid hormones readily tested are:
- Thyroid-stimulating hormone (TSH): a pituitary hormone that signals the thyroid gland to produce more hormone
- Thyroxine (T4): the main circulating form of thyroid hormone; inactive but can be readily converted to an active state.
- Triiodothyronine (T3): the active thyroid hormone, most of which comes from converted thyroxine
T4 can be measured directly (FT4) or calculated as the free thyroxine index (FTI). The FTI helps determine how much free T4 is present compared to bound T4. The FTI can help determine if abnormal amounts of T4 are present because of abnormal amounts of thyroxine-binding globulin (a carrier protein that helps transport thyroid hormones to tissues). (24)
Thyroid tests
Providers may test TSH alone or a combination of TSH, T4, and T3 and use the results to determine the likelihood of a thyroid condition.
TSH is measured in milli-international units per liter (mIU/L), and T4 is measured in micrograms per deciliter (µg/dL). Units used to measure T3 vary and can be measured in nanograms per deciliter (ng/dL), nanograms per liter (nmol/L), picograms per deciliter (pg/dL), or picomoles per liter (pmol/L). High TSH may mean low thyroid activity, and low TSH may mean high thyroid activity.
Antibody testing may be recommended to help identify autoimmune thyroid conditions such as Hashimoto’s or Graves’ disease. Two commonly measured antibodies are thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) (23), often measured in international units per microliter (IU/mL). Thyroid stimulating immunoglobulin (TSIs) are antibodies that are increased when the thyroid gland becomes overactive and produces excess thyroid hormone. Elevated TSI is a helpful diagnostic tool for identifying Grave’s disease. (23)
Did you know? Blood tests aren’t the only way to determine thyroid health. CT scans, ultrasounds, and nuclear medicine tests use imaging to help diagnose thyroid-related health conditions. (23)
Why test thyroid hormones?
Individuals may need a thyroid hormone test if they have symptoms of an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism).
Symptoms of an underactive thyroid may include:
- Cold intolerance
- Constipation
- Decreased sweating
- Depression
- Dry skin
- Face swelling
- Fatigue
- Fertility issues
- Goiter (enlarged thyroid gland resulting in a lump in the front of the throat)
- Irregular or heavy menstrual periods
- Pain in the muscles and joints
- Slow heart rate
- Thinning hair
- Weight gain (23)
Symptoms of an overactive thyroid may include:
- Anxiety
- Bulging eyes
- Fatigue
- Feeling cold or hot often
- Goiter
- Hair loss
- Hyperactivity
- Irregular or light menstrual periods
- Rapid heart rate
- Tremors
- Weight loss or gain (23)
Thyroid test results
Thyroid function tests are frequently part of a menstruating person’s hormone panel because thyroid disorders are more prevalent in females than in males. (6) Additionally, the tests can help assess whether thyroid function influences fertility and pregnancy. Lastly, they may help determine the root cause of thyroid-related symptoms and conditions.
| Lab results | Possible health concern |
|---|---|
High TSH, low thyroid hormone level |
Underactive thyroid |
High TSH, normal thyroid hormone level |
Potential for an underactive thyroid |
Low TSH, high thyroid hormone level |
Overactive thyroid |
Low TSH, normal thyroid hormone level |
Early or mild overactive thyroid |
Low TSH, low thyroid hormone level |
Pituitary health concern |
Did you know? If a patient’s thyroid test results first show low TSH (high thyroid hormones) and then, with further testing, show the reverse, it may signal inflammation of the thyroid gland (thyroiditis).
Other hormones
Healthcare providers may test various other types of hormones depending on the patient’s symptoms. Some of these other hormones include:
- Cortisol: Cortisol is a hormone that impacts metabolism, blood pressure, and stress response. (1)
- DHEA: DHEA is a hormone produced by the adrenal glands. It can be converted to other hormones with weak male (androgenic) effects in females if levels are elevated (e.g., hair growth on the face). (2)
- Ghrelin: Ghrelin is a hormone produced in the stomach that helps individuals know whether they’re hungry or full. If the individual has obesity, they may have low ghrelin levels. (15)
- Growth hormone: Growth hormone is most often tested in childhood if the child is growing too fast or slow. Growth hormones are also tested in adults, particularly if levels are thought to be too high. (8)
- Insulin: Insulin supports the body to use blood glucose. A blood insulin test can help diagnose insulin resistance or determine the root of hypoglycemia. Insulin may also be tested to help the provider develop a treatment plan for patients with type 2 diabetes. (9)
- Leptin: Leptin helps the body maintain weight. Low leptin stimulates appetite, while elevated leptin suppresses appetite. Leptin resistance is common in individuals who have trouble managing how much they eat. (3)
- Melatonin: Melatonin is a hormone that helps regulate the circadian rhythm. Melatonin may be tested if a patient is having trouble sleeping. (12)
- Relaxin: Relaxin is a hormone secreted in the ovary by the corpus luteum during the second half of the menstrual cycle and during pregnancy. (21)
- Sex-hormone binding protein (SHBG): SHBG is a protein made predominantly in the liver that binds to sex hormones in the blood and controls the amount of sex hormones that are actively working in the body. SHBG may be tested if the individual shows signs of abnormal sex hormone levels, such as testosterone. (20)
Gender-affirming care
Hormone testing is crucial in providing safe and effective gender-affirming care. By monitoring hormone levels, healthcare providers with the appropriate experience can adjust dosages to help patients use hormone therapy safely and achieve their desired results. Hormone testing is an essential component of gender-affirming care and can contribute to positive physical and mental health outcomes for patients.
Integrating hormone testing for women into your practice
Supporting menstruating women with hormonal imbalances requires a multifaceted approach that addresses underlying causes and includes symptom management and patient education. By including hormone lab testing as a part of care plans, providers can facilitate personalized treatment strategies tailored to patients’ needs and preferences. This may include lifestyle modifications, dietary interventions, medications, or referrals to another medical specialist. Regular monitoring of hormone levels enables healthcare providers to track treatment responses, adjust interventions as needed, and optimize patient outcomes over time.
Testing options
In most cases, patients will have their hormone levels tested through a blood draw test after a visit to a healthcare provider because of a symptom or other health concern they’re experiencing.
Testing locations
At a clinic or lab
Blood tests are often performed in a provider’s clinic or a separate testing facility such as a blood lab. Some hormones are checked with a urine or saliva test, which can also be done at a testing facility or in a provider’s clinic.
At home
Home testing kits are available that examine female reproductive hormones, cortisol, and thyroid hormones. These tests require collecting a small saliva sample and sending it to a lab for analysis.
Home tests may offer greater convenience than tests conducted at a healthcare provider’s office or in a lab. However, these types of tests may not produce consistent results due to fluctuating hormone levels and a higher likelihood of errors with at-home testing. (25) Lastly, it’s important that patients discuss at-home results with their provider rather than trying to interpret them on their own.
The bottom line
Women’s hormone testing is a vital tool in modern healthcare that offers invaluable insights into hormonal balance and health status. By understanding the clinical significance of hormone testing, selecting appropriate tests, interpreting results effectively, and integrating findings into patient care plans, healthcare providers can support their patients to improve their health status significantly. Lastly, with a patient-centered approach and evidence-based practice, provider can empower women to feel their best throughout their lifespans.
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