I. Introduction

According to the National Center for Biotechnology Information, approximately 1.3 million women enter menopause each year. Up to 20% of women over the age of 50 develop hypothyroidism, or underactive thyroid disease, a condition in which a woman does not have enough thyroid hormone in her bloodstream. In younger women, fertility problems are rather common; the U.S. Department of Health and Human Services reports that 6.1 million women between the ages of 15 and 44 have fertility problems, such as trouble getting pregnant or carrying a pregnancy to term. Polycystic ovary syndrome, a condition caused by an imbalance of the hormones that play a role in human reproduction, affects approximately 10% of all women of childbearing age.

This guide explains why women’s hormone testing is done, when it should be done, and how it’s done. Although hormone testing is useful in the diagnosis and management of many medical conditions, this guide focuses on four common women’s health issues: hypothyroidism, fertility problems, polycystic ovary syndrome, and menopause. The guide concludes with some of the most frequently asked questions regarding women’s hormone testing.

II. Overview of Women's Hormone Testing

The purpose of women’s hormone testing is to diagnose a hormonal imbalance or monitor the effects of treatment methods used to correct hormonal imbalances. Women’s hormone tests are used to diagnose hypothyroidism, fertility problems, and polycystic ovary syndrome. If a woman has stopped menstruating or started experiencing unusual vaginal bleeding, hormone tests can also be used to determine if she has started menopause or will be starting menopause soon.

A woman should have hormone testing if she experiences any of the following:

  • Symptoms of hypothyroidism, such as unexpected weight gain, joint pain, muscle pain, dry hair, or irregular menstrual periods
  • Difficulty conceiving
  • Inability to carry a pregnancy to term
  • Symptoms of polycystic ovary syndrome (PCOS), such as irregular menstrual periods, acne, weight gain, or too much facial hair
  • Symptoms of menopause, including night sweats and hot flashes
  • Postmenopausal vaginal bleeding
  • Lack of periods before menopause has started

Hormone testing is a simple procedure and requires just a small sample of blood. No special preparation is required for women’s hormone testing.

III. The Basics of Women's Health Issues

As women age, natural changes in the body can result in hormonal imbalances. Hormone levels are also influenced by medical conditions that affect the ovaries, uterus, and fallopian tubes.

Hypothyroidism (Underactive Thyroid)

Hypothyroidism, commonly referred to as underactive thyroid disease, develops when a woman does not have enough thyroid hormone circulating in her bloodstream. Symptoms of this condition include constipation, heavy periods, irregular periods, fatigue, dry skin, thinning hair, weight gain, weakness, and depression.

Hypothyroidism has several causes, including radiation treatments to the neck, tumors of the pituitary gland, a history of surgery on the thyroid gland or pituitary gland, and the use of certain medications. Medications associated with hypothyroidism include lithium, which is used for depression, and certain chemotherapy drugs, which are used to kill cancer cells. In some women, hypothyroidism is caused by swelling and inflammation of the thyroid gland. Thyroid swelling sometimes occurs during pregnancy, but it may also occur when a woman has a viral infection or if a woman has an autoimmune disorder that causes her immune system to attack healthy thyroid tissue.

Fertility Problems

The Centers for Disease Control and Prevention (CDC) defines infertility as the inability to conceive a child after at least one year of having unprotected sex. Women who get pregnant but cannot carry their pregnancies to term may also have fertility problems. Infertility has many causes, including a lack of ovulation, a low supply of eggs in the ovaries, polycystic ovary syndrome, endocrine problems that interfere with the function of the pituitary gland or hypothalamus, and any condition that affects the ovaries, uterus, or fallopian tubes.

Polycystic Ovary Syndrome

In women without polycystic ovary syndrome, ovarian follicles release eggs during ovulation. For women with PCOS, the immature ovarian follicles are unable to release eggs. The immature follicles develop into small cysts that accumulate on the ovaries, which can cause infertility. Women with PCOS tend to have increased levels of testosterone and decreased levels of follicle-stimulating hormone, a hormone that plays a role in the menstrual cycle and stimulates egg production in the ovaries. Symptoms of PCOS include weight gain, difficulty losing weight, an excessive amount of facial hair, irregular periods, darkening of the skin, and thinning hair. Medical imaging can determine if a woman with these symptoms has multiple cysts on her ovaries.

Menopause

Menopause is not a disease; it is a normal phase of a woman’s life that occurs 12 months after a woman has her last menstrual period. The period leading up to menopause, sometimes called the menopausal transition, typically lasts from 7 to 14 years and begins sometime between the ages of 45 and 55; however, it may occur earlier or later in some women. Although menopause is not a disease, the menopausal transition can cause some uncomfortable symptoms. Some women experience hot flashes, night sweats, irregular menstrual periods, spotting, heavy bleeding, and vaginal dryness. These symptoms are caused by changes in women’s estrogen and progesterone levels. Estrogen and progesterone are hormones that play a role in menstruation, ovulation, and pregnancy.

How Women’s Hormone Testing Works

When a woman has symptoms of a problem that could be caused by a hormonal imbalance, her physician may order several hormone tests. These tests check the levels of thyroid-stimulating hormone, estrogen, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone in a woman’s bloodstream.

TSH

Thyroid-stimulating hormone (TSH) stimulates the thyroid gland to produce several other hormones. If a woman has too much TSH in her bloodstream, it can indicate that she has an underactive thyroid.

Estrogen

Estrogen, LH, FSH, and testosterone are all part of a woman’s reproductive system. Hormone tests usually check for three types of estrogen in the blood: estrone, estradiol, and estriol. Estrone is the main form of estrogen produced by women who have already gone through menopause. Estradiol is the main form of estrogen made by women who are not pregnant. Estriol levels typically increase in pregnant women.

LH and FSH

LH plays a role in the menstrual cycle, and it also signals the ovary to release an egg. FSH is involved in sexual development, plays a role in the menstrual cycle, and stimulates egg growth.

Testosterone

In women, testosterone is necessary for normal growth and development of the reproductive organs. Testosterone also affects mood and helps women maintain their bone mass.

During the blood draw, a phlebotomist prepares the patient by cleansing the skin with an alcohol pad and tying a tourniquet around the upper arm. This makes the veins easier to see and helps the phlebotomist determine which vein to use to draw the sample. Once a needle is inserted into the vein, blood collects in a small tube labeled with the patient’s name and date of birth. If the patient’s doctor ordered several hormone tests, the phlebotomist may collect several tubes of blood. These tubes are sent to the laboratory so the blood can be analyzed.

Women’s hormone tests are done in several medical settings, including medical clinics, diagnostic laboratories, and hospital laboratories. Several laboratories have also made home testing kits available. For example, the Everlywell women’s health test includes estradiol, LH, FSH, testosterone, and six other hormones.

IV. Treatment for Common Women's Health Issues

Hypothyroidism

The most common treatment for hypothyroidism is levothyroxine, which replaces the missing thyroid hormone in a woman’s bloodstream. It can take time to determine the right dose of levothyroxine, so it is important for any woman with hypothyroidism to see her health care provider regularly. Each time a woman’s dose of levothyroxine is changed, she must have another blood test approximately six to eight weeks later. Annual blood testing is required to ensure that the woman’s hypothyroidism remains under control.

Fertility Problems

The most common treatments for fertility problems include lifestyle changes, medications, and surgery. A treatment plan must be customized for each woman, so it is important for anyone dealing with fertility problems to visit a gynecologist or reproductive endocrinologist. Because fertility problems sometimes develop in women who are overweight or obese, losing weight is one of the lifestyle changes recommended to help women conceive. Women with fertility problems are also advised to stop smoking, drinking alcohol, and engaging in other unhealthy behaviors.

Medications are typically used to correct hormonal imbalances that make it difficult for a woman to get pregnant or carry a pregnancy to term. In some women, gonadotropins are prescribed to stimulate ovulation. Surgery is performed to correct problems that make it difficult to conceive, such as endometriosis, uterine polyps, and damaged fallopian tubes. If a woman still cannot conceive after making lifestyle changes, taking medications, or undergoing surgery, it may be necessary to use assisted reproductive technology to have a baby. In vitro fertilization is a form of assisted reproductive technology that involves combining sperm with an egg and then transferring the embryo to a woman’s uterus.

Polycystic Ovary Syndrome

For women with polycystic ovary syndrome, lifestyle changes are usually the first line of treatment. Losing weight, exercising regularly, and eating a balanced diet can help women with PCOS control their symptoms, according to the National Institute of Child Health and Human Development. If lifestyle changes are not effective, a physician may prescribe oral contraceptives or anti-androgens, both of which help correct the hormonal imbalances caused by PCOS. Some women with PCOS also develop insulin resistance; for these women, it may be necessary to take medications to improve the body’s response to insulin.

Menopause

Not all women need treatment for the symptoms of menopause, but those who do have several options. Hormone-replacement therapy, oral contraceptives, and other medications can be used to ease the hot flashes, night sweats, and other symptoms caused by lower levels of estrogen. Some antidepressants have also been approved to help treat hot flashes. Over-the-counter treatments are available to help with vaginal dryness and vaginal discomfort.

V. Frequently Asked Questions

Q: What kind of doctor should a woman see if she suspects she has a hormonal imbalance?

A: Any primary care provider, including a nurse practitioner or physician assistant, can order blood tests to determine if a woman has hypothyroidism, fertility problems, or polycystic ovary syndrome — or if she is close to going through menopause. If a hormonal imbalance is detected, it may be necessary to see an endocrinologist, a doctor who specializes in treating disorders that affect the glands of the human body, or a gynecologist, a doctor who specializes in the female reproductive system.

Q: How long does it take to receive the results of a hormone test?

A: Some laboratories perform hormone testing in-house, while others send samples to specialty laboratories for analysis. Therefore, it can take anywhere from a few days to a week for the test to be completed. It may also take several days for a woman’s health care provider to review the lab report and share the results.

Q: Why would a woman need a testosterone test? Isn’t testosterone a male hormone?

A: Men have higher levels of testosterone than women, but testosterone plays an important role in the female body. It is produced by the ovaries, giving it an important role in the development of a woman’s sexual organs. Testosterone also affects a woman’s fertility, sex drive, and vaginal health.

Q: If initial testing shows that a woman has a hormonal imbalance, will additional tests be necessary?

A: If a woman has a hormonal imbalance, she may need to get her hormone levels checked every six months to one year to ensure the treatment is working. Following the diagnosis of a hormonal imbalance, a woman may also need additional hormone tests to determine if the imbalance is causing other problems. For example, if a woman has an abnormal level of TSH in her blood, her doctor is likely to order T3 and T4 hormone tests to determine why the TSH level is abnormal.

Q: Why is weight loss recommended for women with certain hormonal imbalances?

A: In women with hormonal imbalances, excess weight can make the symptoms worse. Medical professionals recommend weight loss to help women control their symptoms and reduce their discomfort. For women with fertility problems, excess weight can also make it more difficult to conceive. Losing weight is recommended to give a woman the best possible chance of having a baby.