What Hormone Imbalance Tests Reveal About Women's Health

Checking estrogen, progesterone, FSH, and more

A blood test for female hormones can reveal important information about your health. They can detect fertility problems, where you are in your menstrual cycle, or whether you're starting perimenopause.

Hormone tests also can play a role in diagnosing medical conditions such as thyroid disease or diabetes. In some instances, they can show how well a medication is working.

This article looks at the tests done for each sex hormone, when tests are needed, what's considered normal and abnormal, and what the results could mean.

Close up of nurse hand applying adhesive plaster on arm of patient after blood collection in the hospital

okskukuruza / Getty Images

What's Being Tested?

Hormone blood tests can look at several key female hormones:

In most cases, healthcare providers use hormone test results combined with other factors—such as symptoms, medical history, and other test results—to reach a diagnosis.

Estrogen

Estrogen isn't a single hormone. You have many types of estrogens. Only three of them are commonly tested:

  • Estrone (E1): The main post-menopausal hormone.
  • Estradiol (E2): The main female hormone before menopause and outside of pregnancy.
  • Estriol (E3): Increases during pregnancy.

E2 is the most often tested form. It's the major hormone responsible for sexual function and also plays a major role in:

  • Healthy bones
  • Female characteristics
  • Other aspects of health

Estradiol is primarily produced by the ovaries and levels vary throughout the menstrual cycle. They're highest at ovulation and lowest at menstruation.

E2 levels slowly decrease as you age. The largest drop occurs at menopause when the ovaries "switch off."

Everyone has some estradiol in their bodies, regardless of their biological sex. It's the most common estrogen to be tested.

When Estrogen May Be Tested

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

Estrogen Test Results

What's considered normal for estradiol levels depends on your menstrual cycle and phase of life. Testing for fertility looks at three phases of the menstrual cycle:

  • The follicular phase: First day of your period until ovulation, usually about 14 days long. Named for the follicle housing the egg before it's released during ovulation.
  • Periovulatory phase: An approximate 3-day period around the time of ovulation.
  • Luteal phase: From ovulation until the start of menstruation. After ovulation, the follicle releases estrogen and progesterone to prepare your uterus for a fertilized egg to implant.

Estrogen levels are measured in picograms (one-millionth of a gram) per mililiter (pg/mL).

ESTROGEN TEST TIMING RANGE (pg/ml)
Follicular phase 19.5-144.2
Periovulatory phase 63.9-256.7 
Luteal phase 55.8-214.2 
Postmenopausal 32.2 or lower
Source: University of North Carolina Medical Center

What the Results Mean

Low estrogen levels may be a sign of:

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

High estrogen levels may occur with conditions such as:

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

Progesterone

Progesterone is essential for regulating menstruation and fetal development. During the luteal phase, it helps prepare the uterus to receive a fertilized egg. What happens next depends on whether the egg is fertilized:

  • 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 uterus (endometrium) and makes glands in the endometrium release nutrients to nourish the developing embryo.

When Progesterone Levels May Be Tested

You may need a progesterone test to determine:

Progesterone Test Results

As with estrogen, what's considered normal for progesterone depends on the timing of the test. Midway through the menstrual cycle, progesterone levels start climbing. Between six and 10 days later, if there's no fertilized egg, levels drop off.

If the egg is fertilized, levels rise through the earliest stage of pregnancy.

Progesterone levels are measured in nonograms per mililiter (ng/mL) or nanomoles per liter (nmol/L).

PROGESTERONE TEST TIMING RANGE (ng/mL) RANGE (nmol/L)
Follicular phase 1 or lower 3.18 or lower
Mid-cycle 5-20 15.9-63.6
1st trimester 11.2-90 35.62-286.2
2nd trimester 25.6-89.4 81.41-284.29
3rd trimester 48-above 300 152.64-above 954
Postmenopausal 1 or lower 3.18 or lower
Source: University of North Carolina Medical Center

What the Results Mean

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, a pea-sized gland 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. Healthcare providers may look at a single sample or, to look for fluctuations, several samples taken over a 24-hour period.

The pituitary gland produces more FSH when estrogen and other hormone levels begin to drop before menopause, when the ovaries are losing their reproductive potential.

When FSH Levels May Be Tested

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

FSH Test Results

This hormone also changes over the course of your menstrual cycle and lifetime.

FSH is measured in milli-international units per milliliter (mIU/mL).

FSH TEST TIMING  RANGE (mIU/mL)
Follicular phase 3.5-12.5
Ovulatory phase 4.7-21.5
Luteal phase 1.7-7.7
Postmenopausal 25.8-134.8
Source: Laboratory Corporation of America.

What the Results Mean

Abnormal FSH levels are often caused by a disease of the pituitary gland or the hypothalamus (a part of the brain.) The hypothalamus has several functions, including:

  • Balance
  • Temperature regulation
  • Hunger and satiation

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

Testosterone and DHEA

While 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.

Dehydroepiandrosterone (DHEA) is also classified as a male hormone (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

Testosterone doesn't fluctuate like female hormones, so the timing of tests isn't important. Testosterone is measured in nanograms per deciliter (ng/dL) or nmol/L.

TESTOSTERONE RANGE (ng/dL) TESTOSTERONE RANGE (nmol/L)
15-70 0.5-2.4
Source: Icahn School of Medicine at Mount Sinai

Normal DHEA levels depend on your age. It's measured in micrograms per deciliter (mg/dL) or micromoles per liter (mmol/L).

 AGE DHEA RANGE (mg/dL) DHEA RANGE (mmol/L)
18-19  145-395 3.92-10.66
20-29 65-380 1.75-10.26 
30-39 45-270 1.22-7.29
40-49 32-240 0.86-6.48
50-59 26-200 0.7-5.4
60-69 13-130 0.35-3.51
69-older 17-90 0.46-2.43
Source: Icahn School of Medicine at Mount Sinai

What the Results Mean

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 levels of a group of hormones. These hormones are produced by the pituitary and thyroid glands. The three main ones are:

  • Thyroid-stimulating hormone (TSH): A pituitary hormone that tells the thyroid gland to produce more or less hormone
  • Thyroxine (T4): An inactive thyroid hormone that can be converted to an active state
  • Triiodothyronine (T3): The active thyroid hormone created, most of which comes from converted thyroxine

Thyroid function tests are 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 of either an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism).

Hypothyroidism symptoms include:

  • Fatigue
  • Unintended weight gain
  • Puffy face
  • Intolerance of cold
  • Pain in the joints and muscles
  • Constipation
  • Dry skin
  • Dry, thinning hair
  • Decreased sweating
  • Heavy or irregular menstrual periods
  • Fertility problems
  • Depression
  • Slow heart rate
  • Goiter (enlarged thyroid gland causing a lump in the front of your throat)

Hyperthyroidism symptoms include:

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

Thyroid Test Results

Healthcare providers may use TSH alone or a combination of TSH, T4, and T3 tests to diagnose thyroid disorders.

TSH is measured in milli-international units per liter (mIU/L). There's a range for non-pregnant females as well as trimester-specific ranges.

TSH TEST TIMING  RANGE (mIU/L)
Non-pregnant  0.5-5
First trimester 0.1-2.5
Second trimester 0.2-3
Third trimester 0.3-3.5
Sources: UCLA Health, study by Galoiu S.

T4 is measured in micrograms per deciliter (µg/dL). T3 is measured in nanograms per deciliter (ng/dL).

THYROID HORMONE RANGE
T4 (Thyroxine) 5-12 µg/dL
T3 (Triiodothyronine) 80-220 ng/dL
Sources: UCLA Health

What the Results Mean

Interpreting TSH results can be confusing. That's because high TSH means low thyroid activity, and low TSH means high thyroid activity.

Your provider may look at TSH alone or all three hormones together in order to reach a diagnosis.

TSH  T4+T3 DIAGNOSIS 
High  Low Hypothyroidism
High Normal Borderline hypothyroidism
Low High Hyperthyroidism
Low Normal Early or mild hyperthyroidism
Low Low Pituitary disease
Source: UCLA Health

If results start out with low TSH and high thyroid hormones and then reverse with further testing, it indicates thyroiditis, which is inflammation of the thyroid gland.

Autoimmune Thyroid Disease

Testing for thyroid disease may include antibody testing. That's to see if you have an autoimmune thyroid condition such as Hashimoto's or Graves' disease.

Summary

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

Providers 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, thyroid disease, or, possibly, cancer.

Tests are one step in the process of diagnosing a condition. If the results are concerning, your provider may 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. These are often done during the first half of your menstrual cycle, when levels are more distinct. However, progesterone tests to check ovulation are typically done 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's between 12 and 16 days after ovulation.

23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Khattar D, Sodhi C, Parmod J, Dutta A. Correlating estrogen levels and cognitive functions in regularly menstruating females of reproductive age group and post menopausal women of North IndiaJ Family Reprod Health. 2015;9(2):83-88.

  2. Saran S, Gupta BS, Philip R, et al. Effect of hypothyroidism on female reproductive hormonesIndian J Endocrinol Metab. 2016;20(1):108-113. doi:10.4103/2230-8210.172245

  3. Ajayi O, Charles-Davies M, Anetor J, Ademola A. Pituitary, gonadal, thyroid hormones and endocrine disruptors in pre and postmenopausal nigerian women with ER-, PR- and HER-2-positive and negative breast cancersMed Sci (Basel). 2018;6(2):37. doi:10.3390/medsci6020037

  4. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Estrogen levels test.

  5. Victoria State Government, Victoria, Australia: Better Health Channel. Menstrual cycle.

  6. Schorr M, Miller KK. The endocrine manifestations of anorexia nervosa: mechanisms and managementNat Rev Endocrinol. 2017;13(3):174-186. doi:10.1038/nrendo.2016.175

  7. Ko SH, Kim HS. Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal womenNutrients. 2020;12(1):202. doi:10.3390/nu12010202

  8. Endocrine Society. What is estrogen?

  9. Mesen TB, Young SL. Progesterone and the luteal phase: a requisite to reproductionObstet Gynecol Clin North Am. 2015;42(1):135-151. doi:10.1016/j.ogc.2014.10.003

  10. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Progesterone test.

  11. Haas DM, Hathaway TJ, Ramsey PS. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiologyCochrane Database Syst Rev. 2018;10(10):CD003511. Published 2018 Oct 8. doi:10.1002/14651858.CD003511.pub4

  12. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Follicle-stimulating hormone (FSH) levels test.

  13. Mikhael S, Punjala-Patel A, Gavrilova-Jordan L. Hypothalamic-pituitary-ovarian axis disorders impacting female fertilityBiomedicines. 2019;7(1):5. doi:10.3390/biomedicines7010005

  14. Davis S, Wahlin-Jacobsen S. Testosterone in women—the clinical significance. Lancet Diabetes Endocrinol. 2015 Sept;3(2):980-92. doi:10.1016/S2213-8587(15)00284-3

  15. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Testosterone levels test.

  16. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. DHEA sulfate test.

  17. Vegunta S, Kling JM, Kapoor E. Androgen therapy in women [published correction appears in J Womens Health (Larchmt). 2020 Nov;29(11):1487]. J Womens Health (Larchmt). 2020;29(1):57-64. doi:10.1089/jwh.2018.7494

  18. Achilli C, Pundir J, Ramanathan P, Sabatini L, Hamoda H, Panay N. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysisFertil Steril. 2017;107(2):475-482.e15. doi:10.1016/j.fertnstert.2016.10.028

  19. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Hypothyroidism.

  20. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. TSH (thyroid-stimulating hormone) test.

  21. Society for Endocrinology: You and Your Hormones. Laboratory tests: Introduction to laboratory tests.

  22. U.S. Department of Health & Human Services. Knowing if you are pregnant.

  23. U.S. Food and Drug Administration. Pregnancy.

Additional Reading

By Cathy Wong
Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman's World, and Natural Health.