What Hormone Imbalance Tests Reveal About Women's Health

Checking estrogen, progesterone, FSH, and more

Hormone blood tests reveal important information about a woman's health. For example, these tests may check hormone levels that identify where a woman is in her menstrual cycle, reveal fertility problems, or signal that menopause is starting.

Blood tests to measure female hormone levels also can play a role in diagnosing medical conditions such as thyroid disease or diabetes. In some instances, such testing can help determine how well a medication is working.

Blood tests often include a comprehensive hormone panel, which means multiple hormones are analyzed using the same sample. There are several key hormones in women that doctors evaluate:

  • Estrogen
  • Progesterone
  • Follicle-stimulating hormone (FSH)
  • Testosterone/DHEA
  • Thyroid hormones

This article will look at the tests done for each of these. It will explain when they're needed and what the results could mean.

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Estrogen

Estrogen is not a single hormone, but rather a group of three hormones:

  • Estrone (E1)
  • Estradiol (E2)
  • Estriol (E3)

Of these, estradiol is the major sex hormone responsible for sexual functioning. It also plays a main role in healthy bones, female characteristics, and other elements of health. Estradiol is primarily produced by the ovaries.

Estradiol levels vary throughout the menstrual cycle. They are highest at ovulation and lowest at menstruation. They decrease slowly with age. The largest drop occurs at menopause when the ovaries "switch off."

When Estrogen May Be Tested

You may need an estrogen test if you have symptoms of an estrogen-related condition or:

  • You're having trouble getting pregnant
  • Your periods are irregular
  • Puberty appears to be delayed, regardless of biological sex
  • You're having menopause symptoms
  • You have vaginal bleeding after menopause
  • You're biologically male but displaying female characteristics (such as developing breasts)

Estrogen Test Results

Low estrogen levels may be a sign of:

Certain medications, such as Clomid (clomiphene), also can cause a decline in estrogen levels.

High estrogen levels may occur with conditions such as:

  • Obesity
  • Light or heavy menstrual bleeding
  • Worsened premenstrual syndrome
  • Fatigue
  • Loss of sex drive

Certain medications are also known to increase estrogen levels. These include steroid hormones, phenothiazines, tetracycline antibiotics, and ampicillin.

Progesterone

Progesterone is another important sex hormone that is essential for regulating menstruation and the development of a fetus. One of its main functions is to help prepare the uterus to receive a fertilized egg.

Once an egg is released by the ovarian follicle (corpus luteum) during ovulation, there is a release of progesterone along with small amounts of estradiol. At this point, the egg may be fertilized or not.

If the egg is not fertilized, the corpus luteum breaks down, progesterone levels plummet, and a new menstrual cycle begins.

If the egg is fertilized, progesterone levels remain high. This stimulates the growth of blood vessels that supply the lining of the womb (endometrium). Progesterone also stimulates glands in the endometrium to release nutrients to nourish the developing embryo.

When Progesterone Levels May Be Tested

You may need a progesterone test to determine:

  • Whether you're ovulating normally
  • Why you're having trouble getting pregnant
  • The risk of miscarriage or other pregnancy complications
  • If you have a pregnancy outside of the uterus (ectopic pregnancy)

Progesterone Test Results

If progesterone levels are low during pregnancy, it could be a sign that you're at risk of miscarriage or premature labor. You may be given a synthetic form of progesterone to prevent early labor.

High progesterone levels usually do not signal any health problems unless they continue for a long time. In those instances, high levels may indicate an increased risk of breast cancer.

Recap

Estrogen and progesterone are associated with sexual development and pregnancy. One or both of these levels may be checked if puberty is delayed, menstruation changes, menopause is suspected, or you are or are trying to get pregnant.

Follicle Stimulating Hormone

Follicle-stimulating hormone (FSH) is produced by the pituitary gland, a pea-sized gland located in the brain. FSH stimulates the growth of an egg in the ovary to get it ready for fertilization.

FSH can be checked with either blood or urine tests. Doctors may look at a single sample, or they may analyze several samples taken over 24 hours to see if there are changes in FSH.

The pituitary gland will produce more FSH when estrogen and other hormone levels begin to drop. This happens when the ovaries lose their reproductive potential.

When FSH Levels May Be Tested

In adult women, the FSH test may be used to in diagnosing:

  • Abnormal menstrual bleeding
  • Infertility
  • The start of perimenopause or menopause
  • Ovarian function issues and PCOS
  • Pituitary gland tumors
  • Ovarian cysts

FSH Test Results

Abnormal FSH levels are often caused by a disease of the pituitary gland or the hypothalamus, a part of the brain that regulates body's internal balance. The hypothalmus has several functions, including keeping you from being too hot or too cold, alerting you when it's time to eat and stop eating, and more.

These glands can be affected by PCOS, cancer treatment, a congenital defect (a condition you're born with), or other diseases and disorders.

Testosterone/DHEA

Although testosterone is usually regarded as the "male sex hormone," it's also part of the female hormonal makeup. In fact, testosterone is produced in the ovaries and adrenal glands. Most of it is then converted to estradiol with the help of an enzyme called aromatase.

Like testosterone, dehydroepiandrosterone (DHEA) is classified as a male hormone (also known as an androgen).

When Testosterone/DHEA Levels May Be Tested

You may need a testosterone or DHEA test because of:

  • Irregular or missed periods
  • Possible ovarian conditions, including PCOS and ovarian cancer
  • Weight gain
  • Acne
  • Development of male traits (excess hair growth, male pattern baldness, deepening voice)
  • Infertility
  • Decreased sex drive

Testosterone/DHEA Test Results

High testosterone could mean steroid abuse or any of the above, with the exception of decreased sex drive.

Low libido is associated with low levels of testoterone. A drop in testosterone can also indicate perimenopause.

Testosterone in Menopause

Testosterone naturally drops during menopause, causing myriad symptoms including:

  • Diminished sex drive, sexual pleasure, and orgasmic response
  • Low energy
  • Depression

High DHEA levels on blood tests may be a sign of conditions such as congenital adrenal hyperplasia or cancer of the adrenal gland.

Recap

FSH test results can be used to help diagnose menopause and problems such as infertility and ovarian issues. Testosterone and DHEA test results can aid in the diagnosis of PCOS, cancer, and other disorders.

Thyroid Hormones

Thyroid function is determined by the presence of a group of hormones. These hormones are produced by the pituitary gland or the thyroid gland itself. The three main ones are:

  • Thyroid-stimulating hormone (TSH): A pituitary hormone that tells the thyroid gland to produce more or less hormone
  • (T4)Thyroxine: A hormone that needs to be converted to an active state
  • (T3)Triiodothyronine: The "active" thyroid hormone created from the conversion of thyroxine

Thyroid function is often included in a female hormone panel because thyroid diseases are more common in women than men. It may also be included to examine whether the thyroid is affecting fertility and pregnancy.

When Thyroid Levels May Be Tested

You may need a thyroid hormone test if you have symptoms such as:


Hyperthyroidism symptoms include:

  • Anxiety
  • Fatigue
  • Frequently feeling cold or hot
  • Irregular or light menstrual period
  • Hair loss
  • Weight loss or gain
  • Tremors
  • Rapid heart rate
  • Bulging eyes
  • Goiter
  • Hyperactivity

Thyroid Test Results

High thyroid levels indicate hyperthyroidism, or overactive thyroid.

Low thyroid hormones indicate hypothyroidism, or underactive thyroid.

Summary

Hormone tests are often done as part of regular blood work, but your doctor may order them if you're having menstrual issues, changes in sex characteristics, fatigue, loss of sex drive, or problems getting pregnant.

Doctors specifically check estrogen, progesterone, FSH, testosterone/DHEA, and thyroid hormone levels. Abnormal readings can indicate that you have a condition such as PCOS, ovarian cysts, or, possibly, cancer.

Tests are one step in the process of diagnosing a condition. If the results are concerning, your doctor will order additional tests.

Frequently Asked Questions

  • When should you get a hormone blood test?

    You may need one if you're having symptoms of a hormonal imbalance. It's usually best to have your blood drawn in the first half of your menstrual cycle, as that's when levels are more distinct. However, if you're having a progesterone test to see if you're ovulating properly, it will likely be measured on day 21 of your cycle.

  • How early can a blood test detect that you're pregnant?

    Blood tests can detect pregnancy between six and eight days after ovulation. By contrast, to be accurate, home pregnancy (urine) tests should be taken after your period is late. That is between 12 and 16 days after ovulation.

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