The six sex hormones are often referred to as the following.
(i) FSH-follicle stimulating hormone, also called follicle stimulating hormone.
②LH-Luteinizing Hormone.
③PRL-prolactin.
④E2-Estradiol.
⑤T-Testosterone.
⑥P-progesterone.
When to check the sex hormone 6 items, or some of them?
1. The sex hormone 6 is mainly used to assess the function of the H-P-O axis. It is indicated for the following conditions.
2. Menstrual cycle disorders, amenorrhea, abnormal uterine bleeding.
3, before and after menopause (flushing, night sweats, sleep disorders, mood abnormalities, senile vaginitis, osteoporosis, etc.).
4, pregnancy assistance – assessment of ovarian reserve function.
5, determination of ovulation.
6, suspected abnormal sexual development, assisting in the diagnosis of CAH and other diseases.
7, gynecologically related tumors, especially those suspected to have endocrine function.
The level of sex hormones changes cyclically, is it okay to draw blood at any time?
Of course not, there is a specific time for blood sampling. When determining whether ovulation is normal or assessing luteal function, progesterone is generally required on day 21 of the menstrual cycle (mid-luteal phase); when assessing ovarian reserve function, all items are on days 2-5 of the menstrual cycle (early follicular growth); for patients with scanty menstruation or those who have been amenorrheic for 3-6 months, any day is acceptable if the ultrasound indicates endometrial thickness <5mm and follicles <1cm. PRL Levels increase with sleep, eating, breastfeeding, sexual intercourse, stress, and are generally more reliable when blood is taken at 10 am and in a quiet state.
The levels of sex hormones are cyclical, so can we just pick a time to draw blood?
Of course not. There is a specific time for blood sampling. When determining whether ovulation is normal or assessing luteal function, progesterone is generally required on day 21 of the menstrual cycle (mid-luteal phase); when assessing ovarian reserve function, all items are taken on days 2-5 of the menstrual cycle (early follicular growth); for patients with scanty menstruation or those who have been amenorrheic for 3-6 months, any day is acceptable if the ultrasound indicates endometrial thickness <5mm and follicles <1cm. PRL Levels increase with sleep, eating, breastfeeding, sexual intercourse, stress, and are generally more reliable when blood is taken at 10 am and in a quiet state.
There are so many hormone tests, how should they be interpreted?
For different diseases, we have different sex hormones to focus on.
Gonadotropins (FSH and LH)
To determine menopause: after complete follicular depletion, FSH is basically stable at elevated levels, usually above 40 IU/L, accompanied by a decrease in estrogen levels.
To assist in determining the cause of amenorrhea: Basal FSH﹥40IU/L and low E2 are high gonadotropin (Gn) amenorrhea, i.e. ovarian failure; if it occurs before the age of 40, it is called premature ovarian failure (POF). Basal FSH and LH are both <5IU/L for low Gn amenorrhea, suggesting hypothalamic or pituitary hypofunction (identification of the two requires gonadotropin-releasing hormone (GnRH) test).
Ovarian reserve function: Basal FSH/LH>2-3.6 and FSH over 10 IU/L suggest inadequate ovarian reserve function, which often indicates poor response to superovulation (COH), and the COH regimen and Gn dose should be adjusted promptly to improve ovarian responsiveness and obtain the desired pregnancy rate. Because elevated FSH/LH only reflects ovarian insufficiency of reserve (DOR), not decreased ability to conceive, ideal pregnancy rates can still be obtained once a period of ovulation is obtained. Basal FSH>12IU/L, retest in the next cycle, continuous>12IU/L indicates DOR.
Polycystic ovary syndrome (PCOS): Basal LH/FSH>2-3 can be used as the main reference indicator for the diagnosis of PCOS (Basal LH level>10IU/L is considered elevated, or LH maintains normal level while basal FSH is relatively low level, it forms an elevated LH to FSH ratio). Checking 2 times basal FSH >20IU/L can be considered as insidious stage of premature ovarian failure, suggesting possible amenorrhea after 1 year.
Progesterone (P)
Determination of ovulation: P>16nmol/L (5ng/ml) at mid-luteal phase (21st day of menstruation for women with a 28-day menstrual cycle) suggests ovulation. If the progesterone level is consistent with ovulation and there is no other cause of infertility, it is necessary to observe the follicular development and ovulation process with ultrasound, except for unruptured follicular luteinization syndrome. In addition, blood progesterone levels can be used to observe the effect of ovulation-promoting drugs (multiple corpus luteum to increase progesterone levels).
To understand luteal function: P<32nmol/L (10ng/ml) at mid-luteal phase, or P<95.4nmol/L (30ng/ml) on three measurements on days 5, 7 and 9 after ovulation, or P<47.7nmol/L (15ng/ml) by 10 weeks of gestation are the criteria for the diagnosis of luteal insufficiency (LPD).
To understand the pregnancy status: the placenta secretes progesterone levels over the ovarian corpus luteum from the 7th week of gestation onwards. In placental hypoplasia, the blood P level decreases. In pre-eclampsia, if there is a tendency for the blood P level to decrease, there is a possibility of miscarriage. Blood P levels are low in ectopic pregnancy, with most patients having blood P < 47.7 nmol/L
(15ng/ml). If the progesterone level is >78.0 nmol/L, ectopic pregnancy can be basically excluded. A single blood P ≤ 15.6 nmol/L suggests loss of embryonic activity.
Estradiol (E2)
To determine the cause of amenorrhea: If the E2 level is consistent with normal cycle variation, it indicates normal follicular development and can be considered as uterine amenorrhea. If E2 level is low, it can be due to primary or secondary ovarian hypofunction or suppressed by medication, or it may be central amenorrhea, hyperprolactinemia, etc.
Monitoring of hormone replacement therapy during menopause: blood E2 is usually controlled at around 60 pg/ml.
Adjuvant superovulation therapy: monitor follicle maturation, guide HCG dosing, and determine the timing of egg retrieval: when follicles are ≥18mm and blood E2 reaches 1100pmol/L (300pg/ml), discontinue HMG and inject HCG 10000IU on the same day or 24-36 hours after the last HMG injection.
High blood E2 during the treatment cycle is a high-risk factor for ovarian hyperstimulation syndrome (OHSS): if blood E2 ≥ 4000 pg/ml (14800 pmol/L) before HCG injection, 100% of OHSS occurs; while blood E2 < 1000 pg/ml (3670 pmol/L), it usually does not occur; E2 > 2500 pg/ml ( 9175pmol/L), the dosage of HMG should be discontinued or reduced in time, and HCG should be disabled to support luteal function.
Diagnosis of female precocious puberty: clinical diagnosis of precocious puberty is mostly based on the development of secondary sexual characteristics before the age of 8. Blood E2 level >275pmol/L is one of the hormonal indicators.
Prolactin (PRL)
Blood PRL over 500mU/L is considered hyperprolactinemia.
PRL should be measured in patients with amenorrhea, infertility, and menstrual disorders with or without lactation, except for hyperprolactinemia.
Prolactinoma of the pituitary gland should be considered in patients with pituitary tumors with abnormally high PRL.
Elevated PRL levels are also seen in precocious puberty, primary hypothyroidism, premature ovarian failure, poor luteal function, certain medications such as birth control pills, and large amounts of estrogen.
Decreased PRL is seen in hypopituitarism, etc.
Testosterone (T)
Don’t forget that women also have androgens in their bodies (from the ovaries and adrenal cortex).
Testosterone levels are mildly to moderately elevated in patients with PCOS.
Testosterone levels are elevated in patients with androgen-secreting tumors of the ovaries or adrenal glands and in patients with hirsutism.
Differentiation of hermaphroditism: testosterone levels in male pseudohermaphrodites are within the normal range for males; in females, they are within the normal range for females.
Gynecologic tumor related
Granulosa cell tumors and follicular membrane cell tumors are characterized by the secretion of estrogen and sometimes androgens. In contrast, tumors originating from ovarian mesenchymal support cells and mesenchymal cells are characterized by androgen secretion. These tumors have excessive secretion of steroid hormones, causing functional manifestations such as precocious puberty, menstrual disorders, or androgenization, and are also known as functional tumors.
Trophoblastic tumors can secrete various hormones, such as hCG, placental prolactin (HPL), pregnancy-specific glycoprotein (SP1) and steroid hormones estradiol (E2), estriol (E3) and progesterone (P). β-hCG is the main indicator for the diagnosis and monitoring of trophoblastic tumors.