Hormone testing in women: which tests and when

You sit across from your GP with a list of vague symptoms, tired, an erratic cycle, a short fuse, and you hear that your values are "within range". Yet you do not feel like yourself. At that moment the question we hear almost daily at Lunara comes up: which hormones should I actually have tested?

The honest answer is that it differs per woman, and that is exactly the problem with the standard "hormone test". Someone with a wish to conceive looks at different values than someone in the middle of menopause. A hormone investigation is therefore only useful once you know in advance which question you want answered.

A hormone investigation is a blood test that measures how your main hormones are doing, such as estradiol, progesterone, FSH, testosterone and your thyroid values. For women such a test can help to place symptoms like fatigue, an irregular cycle or menopausal symptoms. Below we set out what a hormone investigation measures, when it is worthwhile, and how to arrange it through a blood test.

What is a hormone investigation?

A hormone investigation is a blood test that measures the concentration of one or more hormones in your blood. Hormones are messenger substances that help steer your cycle, your mood, your energy and your metabolism. The result is a snapshot, not a diagnosis on its own.

Your body makes hormones in glands such as your ovaries, your thyroid and your adrenals. Those values fluctuate constantly, sometimes within one day, sometimes across your whole cycle. A blood test captures that moment, and a doctor reads the result in your context. A number is therefore a clue, not a final verdict.

When is a hormone investigation worthwhile for women?

A hormone investigation can be useful if you have symptoms that may fit a shift in your hormones and you want to know where you stand. Think of a cycle that suddenly changes, persistent fatigue, or menopausal symptoms that affect daily life. A test does not replace a conversation with your GP, but it does give you something concrete to bring to that conversation.

• An irregular or absent period
• Fatigue, low mood or sleep problems without a clear cause
• An active wish to conceive or questions about your fertility
• Menopausal symptoms such as hot flushes, night sweats or mood swings
• Symptoms that may fit PCOS or an underactive thyroid

If you recognise such a situation, it helps to first consider which question you want answered. Our guide on hormonal imbalance helps you recognise the signals.

Which hormones should women test?

Which hormones are worthwhile depends mainly on your life stage and your symptom. For many women it revolves around the sex hormones estradiol and progesterone, the regulating hormones FSH and LH, and additionally testosterone, SHBG and your thyroid values. Cortisol comes into play with stress-related symptoms.

The table below gives a guideline, not a prescription. Which combination fits you is best discussed with a doctor.

We briefly explain a few of these values:

• Estradiol is the main form of estrogen and helps steer your cycle. The value varies strongly per cycle phase.
• Progesterone rises after ovulation and says something about your second cycle phase.
• FSH drives the maturation of egg cells and gradually rises towards menopause.
• Testosterone women also have, in small amounts; an elevated value can fit PCOS.
• TSH gives a first impression of your thyroid, which can mimic many hormonal symptoms.

Want to read this in more detail per hormone, see our overview which hormones women should test.

Hormones per life stage

Cycle symptoms and a wish to conceive

With an erratic or absent cycle you often look at the sex hormones estradiol and progesterone, together with the regulating hormones LH and FSH. With a wish to conceive AMH is added, because it says something about your egg reserve. The NHG and the Dutch Society of Obstetrics and Gynaecology (NVOG) stress that one cycle rarely tells the whole story, and that the timing of the draw is important for a usable picture.

If you are unsure whether your symptoms relate to your cycle, read our pillar on irregular periods and which hormones to test. For fertility, read more about the AMH value by age.

Perimenopause and menopause

Around menopause the balance between estrogen, progesterone and FSH shifts. FSH gradually rises, while estradiol can fall, and that can explain symptoms like hot flushes and a changing cycle. The NVOG describes menopause as a natural phase that can last years, not a condition you need to fix.

If you recognise this, read our pillar on perimenopause, symptoms and solutions and on how your hormone balance changes in menopause.

Fatigue, mood and stress

With fatigue or a low mood you look more broadly than your sex hormones alone. TSH, free T4, ferritin and cortisol can help to bring other causes into view. Fatigue often has several causes at once, so a broad picture prevents you from missing an important explanation. Also read which blood values to test for fatigue and, for stress, about stress, adrenals and your hormone balance.

Why the timing of your test matters so much

A common mistake is to have your hormones drawn at a random moment. With sex hormones that can make the difference between a usable and a misleading result. Estradiol and progesterone follow your cycle: estradiol peaks around ovulation, progesterone rises only afterwards. If you draw progesterone in your first cycle phase, you see a low number that says nothing about your second half.

For FSH and estradiol the reverse holds: you measure those early in the cycle, on day 2 to 5, because that gives a comparable starting point. AMH barely varies with your cycle and may be drawn on any day. Cortisol does not depend on your cycle, but on the time of day: a morning draw gives the most usable value. If you have an irregular cycle, the timing is harder to determine, and it can help to first consult your GP about when drawing makes the most sense.

Reading a result: a pattern says more than a number

Hormones rarely work apart from each other. It is often the ratio between values that tells the story, not one single number. An elevated LH relative to FSH can fit a PCOS pattern, for example, while a rising FSH together with a falling estradiol can fit the lead-up to menopause. A low testosterone with a high SHBG can explain why you have little free testosterone available, even though the total number looks normal.

That is exactly why a panel is often more useful than a single value: you see the pattern instead of a snapshot. At Lunara you get context per marker from a registered doctor, so you do not have to puzzle out yourself whether a combination of values means something. An abnormal number is a starting point for a conversation with your GP, not an end point.

Cost, preparation and what a test cannot do

The price of a hormone investigation depends on how many hormones you measure; a broad panel costs more than a single value, and you find the current price on the product page. If you test without a referral, you usually pay for the test yourself. Whether a test through your GP is reimbursed depends on your policy and on whether the test is seen as medically necessary.

Good preparation makes your result more usable: account for the right cycle day, report in advance which contraception or medication you use, and draw cortisol in the morning. At the same time, be aware of what a test cannot do. A hormone value makes no diagnosis, does not predict your future and does not replace a physical examination. It gives you a snapshot that, together with your story, helps a doctor decide the next step.

How does a hormone investigation through a blood test at Lunara work?

At Lunara you arrange a hormone investigation without a referral from the GP. You order online, schedule an appointment at a draw location near you and give a tube of blood. You receive your result digitally, usually within a few working days, with context per marker from a registered doctor.

For some hormones the day of your cycle matters. That is because estradiol and progesterone vary strongly during your cycle. So account for the timing:

• Progesterone you measure best in your second cycle phase, around day 21 in a 28-day cycle.
• FSH and estradiol are often measured on day 2 to 5 for a fertility picture.
• AMH and TSH may be drawn on any cycle day.
• Cortisol is best drawn in the morning, because it has a strong daily rhythm.

Which panel fits your question differs per situation. For a broad look at your female hormones, see Women's Hormones. If you are in menopause, the Menopause Check fits better, and for a wish to conceive the Fertility Test.

What do your hormone values mean?

You always read a hormone value in context: your age, your cycle phase and your symptoms help determine what a number means. One value outside the reference range does not automatically mean something is wrong. Conversely, a value within range can still fit symptoms. That is why interpretation is tailored work, not a calculation.

Want to read more per value, our articles on which values a blood test in women measures help. If you suspect your thyroid plays a role, see our overview on thyroid symptoms in women. Always discuss an abnormal or unexpected result with your GP. They can help you decide whether further steps are worthwhile.

Lifestyle and your hormone balance

Your hormones respond to how you live: to your sleep, your activity, your diet and the stress you experience. According to the Health Council of the Netherlands (Gezondheidsraad), enough physical activity and a varied diet are part of the foundation of your health. This does not mean your hormones can be steered with lifestyle alone, but it does mean fluctuations often have several causes at once.

Cortisol is a good example. It has a natural daily rhythm, with high values in the morning and low values in the evening. Ongoing stress can influence that rhythm. A test can help to support a suspicion before you change anything. What you do afterwards is best discussed with your GP.

Frequently asked questions about hormone investigation

Which symptoms can point to a hormonal imbalance?

Commonly mentioned signals are fatigue, an irregular cycle, mood swings, sleep problems and weight change. These symptoms can also have other causes, so a test gives at most a direction.

How quickly do I get the result of a hormone investigation?

At Lunara you usually receive your result within a few working days, digitally and with context per marker from a registered doctor.

Do I need a referral from the GP?

No, for a hormone investigation through Lunara you do not need a referral. You order online and schedule an appointment yourself at a draw location.

On which day of my cycle do I test my hormones?

That depends on the hormone. Progesterone you measure around day 21, FSH and estradiol often on day 2 to 5, and AMH on any cycle day.

In closing: start with your question

A hormone investigation is most useful when you know in advance which question you want answered. If you are unsure which hormones fit your symptom or life stage, start with the life-stage table above and choose the matching panel. Then discuss your result with your GP before making decisions.

Sources

• NHG Guideline Amenorrhoea and NHG Guideline The menopause. Dutch College of General Practitioners. Available via richtlijnen.nhg.org.
• Thuisarts.nl. I want to know whether my hormones are in balance. Dutch College of General Practitioners. Available via thuisarts.nl.
• Dutch Society of Obstetrics and Gynaecology (NVOG). Patient information on the cycle and the menopause. Available via degynaecoloog.nl.
• Health Council of the Netherlands (Gezondheidsraad). Physical activity and nutrition guidelines. Available via gezondheidsraad.nl.