Understanding the process, limitations, and guidelines of a female hormone panel, and hormonal testing for women is something that I am often asked about as a women's health naturopath.
The reasons vary widely, from dealing with heavy or painful periods to navigating the challenges of perimenopause or fertility.
The quest for clarity is valid, as women are often dismissed or provided with little explanation as to why they are experiencing certain symptoms that may be significantly impacting their quality of life.
Diving into the world of hormonal testing can be daunting, with most women knowing that they want further testing done, but are unsure about what to test and when to have it tested.
In this blog post we will cover the basics of hormone testing for women so you can have a deeper understanding of your hormones and feel empowered to advocate for yourself and request testing.
Why Do Women Want Hormonal Testing?
The most common reasons women come to me for hormonal testing include:
Fertility concerns
PCOS assessment
Endometriosis assessment
Heavy Periods
Painful Periods
Irregular Cycles or lack of period
Hair Growth
Hormonal Acne
Perimenopause/Menopause
However, these are just some of the reasons why you might be interested in hormonal testing, and the benefits of investing in a professional analysis can reach far beyond these concerns.
Hormone Testing For Women: The Typical Process
Hormone testing for women begins with understanding the typical serum hormone panel, which includes six pivotal tests:
Estrogen Testing (Estradiol):
Estrogen is a hormone that is vital for regulating the menstrual cycle and maintaining fertility. It also plays a crucial role in bone health, brain health, sleep, mood, weight, the skin and the cardiovascular system.
High and low estrogen levels in women can lead to a variety of health issues, reflecting the hormone's critical role in the female body.
High Estrogen Levels
High estrogen levels, or estrogen dominance, can cause symptoms such as weight gain, mood swings, heavy or painful periods, breast tenderness and in some cases, increase the risk of endometrial and breast cancer, ovarian cysts, uterine fibroids and other hormonal imbalances.
Low Estrogen Levels
On the other hand, low estrogen levels are often associated with menopause but can also affect younger women. This can lead to issues like irregular periods, mood swings, hot flashes, insomnia, vaginal dryness and decreased bone density, which increases the risk of osteoporosis.
Both states underscore the importance of hormonal balance for overall health and well-being and an evaluation of estrogen can provide valuable information to direct treatment protocols.
Testing Progesterone:
Progesterone (or “pro gestation” = “gestational” = “pregnancy”) is essential for regulating the menstrual cycle and supporting early stages of pregnancy. Progesterone balances estrogen's effects and prepares the uterine lining for implantation if conception were to occur.
Progesterone plays a key role in women's health, and imbalances can lead to various symptoms and health concerns.
Low Progesterone Levels
Low progesterone can lead to menstrual irregularities, difficulty maintaining pregnancy, spotting between or before periods, and increased symptoms of premenstrual syndrome (PMS).
Low levels negatively impact sleep, mood and memory. Often “estrogen dominant” symptoms seen in women are not due to high levels of estrogen, but low levels of progesterone causing a relative estrogen excess.
Low progesterone can specifically affect fertility, making it challenging to conceive or sustain a pregnancy.
High Levels of Progesterone
High progesterone is often normal and non-problematic. Less commonly, it can occur due to specific medical conditions, such as ovarian cysts or overproduction by the adrenal glands, leading to symptoms like fatigue, dizziness, bloating, and changes in mood or libido.
Balancing progesterone levels is crucial for maintaining menstrual health, supporting pregnancy, and overall hormonal harmony within the body.
Follicle Stimulating Hormone (FSH):
Follicle Stimulating Hormone (FSH) plays a pivotal role in reproductive health, regulating the growth and development of ovarian follicles in women.
Abnormal levels of FSH can signal issues with fertility and menstrual health.
High Levels of FSH
High levels of FSH often indicate a decrease in ovarian reserve, common in women approaching or in menopause or those with conditions affecting their ovarian function.
This increase can lead to challenges with fertility, irregular menstrual cycles, and early menopause symptoms.
Low Levels of FSH
On the other hand, low FSH levels can suggest problems with the pituitary gland or hypothalamus, leading to insufficient ovarian stimulation, resulting in irregular or absent menstrual cycles and difficulty conceiving.
Understanding and managing FSH levels is crucial for addressing reproductive health issues, assessing fertility potential, and guiding treatment for conditions affecting menstrual and ovarian health.
Luteinizing Hormone (LH):
Luteinizing Hormone (LH) is crucial for managing reproductive health, as it triggers ovulation and supports the corpus luteum, which produces progesterone vital for sustaining a pregnancy.
Abnormal LH levels can indicate various reproductive issues.
High Levels of Luteinizing Hormone
High LH levels are often seen in conditions like Polycystic Ovary Syndrome (PCOS), where the balance between LH and FSH is disrupted, leading to irregular ovulation or anovulation, contributing to infertility and menstrual irregularities.
Elevated LH levels can also cause symptoms such as acne and excessive hair growth due to the associated increase in androgens.
Low Levels of Luteinizing Hormone
Conversely, low LH levels can result from pituitary gland disorders or hypothalamic dysfunction, leading to a failure to ovulate, irregular menstrual cycles, or amenorrhea (absence of menstruation).
Properly regulated LH levels are essential for normal menstrual cycles, ovulation, and fertility, highlighting the importance of hormonal balance for women's reproductive health.
Prolactin:
Prolactin, a hormone produced by the pituitary gland, plays a primary role in milk production for breastfeeding but also affects menstrual function and fertility.
Elevated levels of prolactin, a condition known as hyperprolactinemia, can lead to a variety of symptoms and issues in women not breastfeeding.
These include irregular or absent menstrual cycles, galactorrhea (unexpected milk production), and difficulties with conception due to the inhibition of ovulation.
High Prolactin Levels
High prolactin levels can be caused by various factors, including pituitary disorders, certain medications, and stress.
Low Prolactin Levels
On the flip side, low levels of prolactin are less commonly a concern and usually do not present significant health issues, as prolactin's critical functions are most relevant during pregnancy and breastfeeding.
Managing abnormal prolactin levels often involves addressing the underlying cause and can significantly improve menstrual health and fertility outcomes.
Testosterone:
Testosterone in women, though present in much lower levels than in men, plays a crucial role in overall health, influencing libido, bone density, muscle strength, stamina, and the distribution of fat.
Abnormal levels of testosterone can lead to different health concerns.
High Testosterone Levels
High testosterone levels in women can cause symptoms associated with conditions like Polycystic Ovary Syndrome (PCOS), including irregular menstrual cycles, acne, excessive hair growth (hirsutism), hair loss, polycystic ovaries and difficulties with fertility.
Elevated testosterone levels may also contribute to mood changes and an increased risk of insulin resistance.
Low Testosterone Levels
Conversely, low testosterone levels in women can lead to decreased libido, fatigue, loss of muscle strength, weight gain and reduced bone density, which can increase the risk of osteoporosis.
Low levels can also affect mood and the overall sense of well-being.
Balancing testosterone levels is crucial for maintaining physical health, reproductive function, and quality of life in women, with treatment options varying based on the underlying cause of the imbalance. Additional testosterone testing can include free testosterone and bioavailable testosterone.
Additional Hormonal Tests for Specific Conditions
For those looking to do a deeper dive into hormone testing or those facing specific challenges such as PCOS or fertility issues , additional testing can offer more thorough insights.
Tests such as Sex Hormone Binding Globulin (SHBG), Dehydroepiandrosterone Sulfate (DHEA-S), Cortisol, Anti-Müllerian Hormone (AMH), Fasting Insulin, and Thyroid Stimulating Hormone (TSH)/a thyroid panel can provide a more comprehensive view of one’s hormonal landscape.
We will cover these in a later blog post, so be sure to bookmark our site for further updates!
When Do I Test My Hormones?
Testing for serum hormone levels at the right time is crucial for accurate diagnosis and management of various conditions. The menstrual cycle has very obvious fluctuations in hormone levels based on the phase and the job of the hormone. It only makes sense to test with this flow. Here's a guideline on the ideal timing for testing the hormones discussed:
Estrogen (Estradiol)
Best Time to Test: Early in the menstrual cycle, typically on days 3 to 5. This timing helps evaluate baseline levels that influence follicle development and overall menstrual health. On cycle day 3, estrogen should be at a relatively low level because it is at the beginning of the follicular phase where it will eventually build up in order to influence ovulation (typically mid-cycle).
Progesterone
Best Time to Test: About 7 days post-ovulation, usually around cycle day 21 of a 28-day cycle, to assess the peak level of progesterone when its concentration is highest, indicating ovulation has occurred. Progesterone levels are only going to increase significantly after ovulation, it only makes sense to target the post-ovulatory luteal phase (the second half of our cycle).
Follicle Stimulating Hormone (FSH)
Best Time to Test: Early in the menstrual cycle, typically on days 3 to 5, alongside estradiol and LH. This assesses ovarian reserve and function, particularly in evaluations for fertility or menopause.
Luteinizing Hormone (LH)
Best Time to Test: Early in the menstrual cycle, typically on days 3 to 5, alongside estradiol and FSH. Testing alongside FSH allows us to determine the ratio of LH:FSH.
Prolactin
Best Time to Test: This hormone can be tested at any time, but it's best to do so in the morning and after resting, as levels can rise due to stress, physical activity, or after eating.
Total Testosterone
Best Time to Test: Testosterone levels can be checked at any time of day, but for consistency and accuracy, it is often recommended to test in the morning when testosterone levels are typically highest, especially if evaluating for conditions like PCOS.
For all these hormones, it's crucial to consider individual health status, symptoms, and specific concerns when planning testing.
Factors like age, menstrual irregularities, symptoms of hormonal imbalances, and specific health goals (e.g., fertility assessment) can influence the timing and necessity of these tests.
Always consult with a healthcare provider to determine the best timing for hormonal tests based on personal health conditions and objectives.
Special Considerations For Hormonal Testing
It’s essential to consider life stages and external factors that can influence hormone levels.
For example, oral contraceptives can suppress hormone levels, making it less ideal for testing.
Similarly, pregnancy and menopause bring about significant changes in hormones, which are both expected and necessary.
Conclusion
Understanding your hormonal health is a journey that requires patience, knowledge, and professional guidance.
While this post outlines the basics, every woman’s body is unique, and thus, a personalized approach is key.
I encourage anyone looking to explore hormonal testing to consult with a women’s health naturopath so you can navigate the intricacies of your hormonal health, ensuring a path tailored to your individual needs and goals.
Remember, your body’s signals are worth listening to, and exploring your hormonal health is a significant step towards overall wellness.
**Disclaimer: This is not medical advice. This post is for informational purposes only.