When you go to the hospital for infertility, spontaneous miscarriage, menstrual disorders, or amenorrhea, your doctor will often recommend you to check the six sex hormones. When you get the test report form, you are often confused by the dense numbers on it, and even if the doctor gives you an explanation, it is only a few words, and you still don’t get it. This article teaches you how to do, read, and interpret these six hormones.
I. How to draw blood?
Except for progesterone (P), the other five hormones should be drawn on day 2-4 of the menstrual cycle (the first day you see blood), when the results represent a person’s basal hormone level. It is usually advisable to have blood drawn in the morning on an empty stomach. Sitting still for half an hour or more before the blood draw avoids fluctuations in hormone levels due to exercise. Progesterone (P) should be drawn on the 22nd-24th day of the menstrual cycle (seeing blood is considered the first day). Testosterone (T) and prolactin (PRL) are not restricted by the menstrual cycle, meaning that blood can be drawn on any day. Prolactin is best taken between 10:00am and 11:00am, and it is best to sit still for at least an hour before the blood is drawn. If you have been amenorrheic for more than 3-6 months and are not pregnant, you can have your blood drawn on any day. If you are pregnant, only progesterone and estrogen (and HCG) are usually checked, but not the other hormones.
The secretion patterns of the six hormones in the ovarian cycle have their own patterns at different times in the ovarian cycle. For example
Estradiol (E2, indicated by the purple line) is usually maintained at a low level during menstruation and early follicular phase. There is a peak just before ovulation, and the luteal phase maintains a long plateau, followed by a rapid decline at the onset of menstruation.
Progesterone (P, indicated by the blue line) remains at low levels until ovulation. After ovulation, the corpus luteum matures and secretes large amounts of progesterone. The corpus luteum reaches its peak of maturity 8-9 days after ovulation (i.e. day 22-24 of the cycle), which is why your doctor usually asks you to have an endocrine panel of five instead of six during your menstrual period. This is because there is no point in checking progesterone before ovulation. Your doctor recommends that you have your progesterone levels drawn on day 22-24 of your period to check for ovulation.
In non-pregnant women, the follicular membrane cells in the ovary synthesize and secrete P. P is very low in the follicular phase ( < 2ng/ml), while LH rises sharply after the peak and lasts for 10-14 days, and then drops to follicular phase levels four days before menstruation. In the first trimester, P is derived from the corpus luteum, and after placental formation, all P is derived from the placenta, and P concentrations S remain > 20 ng/ml until term.
Follicle stimulating hormone (FSH, indicated by the red line) and luteinizing hormone (LH, indicated by the green line) are secreted by the pituitary gland and they represent the function of the ovaries. The peak of LH usually occurs 24-48 hours before ovulation, which is why we use LH test strips to monitor ovulation.
Testosterone (T) and pituitary lactogen (PRL) have no significant cycle variation and are usually checked on any day of the cycle.
III. Interpretation of the six hormones.
1. Estradiol E2 menstrual period (early follicular phase) check estradiol can understand the reserve function of the ovaries. The mean value of estradiol in the early follicular phase is 40.68 ± 19.55 pg/ml, usually between 20 and 50 pg/ml. The literature suggests that an E2 value greater than 100 pg/ml during the early follicular phase (menstrual phase) indicates poor ovarian function and that values above 100 pg/ml during this phase indicate poor ovarian reserve function. The E2 trend starts to rise significantly three days before ovulation, reaching 200 pg/ml three days before ovulation and 300 pg/ml two days after ovulation (mean value 291.08±75.61 pg/ml). E2 peaks 24-46 h before ovulation and ovulates 24-48 h after peak E2. It drops to a low value three days after ovulation. Near ovulation, each mature follicle secretes about 200-300 pg/ml of E2. The maturity of the follicle and the estimated number of mature follicles can be reflected by the level of E2 concentration.
For women of different ages, E2 levels vary; E2 >9 pg/ml is a sign of gonadal function initiation and can be measured before puberty to help determine whether sexual precocity is present; it can also be used to assess whether menopause is imminent and E2 <30 pg/ml during menopause; in cases of premature ovarian failure, E2 is also below normal levels.
High E2 levels are also seen in granulosa cell tumors, plasmacytoid cystic adenocarcinoma, cirrhosis, SLE, obesity, smokers, normal pregnancies, and pregnant women with diabetes mellitus. decreased E2 is seen in primary gonadal insufficiency (ovarian), secondary gonadal insufficiency (hypothalamic or pituitary), congenital adrenocortical hyperplasia (17-a hydroxylase deficiency), fetal adrenocortical insufficiency during pregnancy ( anencephaly, Down’s syndrome children).
P is secreted by the ovaries, mainly by the corpus luteum, and the mean value of P is 0.92±0.52 ng/ml in the early follicular phase and remains at a low level of < 2 ng/ml until ovulation. After ovulation, the corpus luteum matures and secretes large amounts of progesterone, which remains at high levels for 10-14 days. P values are measured on days 22-24 of the menstrual cycle and if they are >3 ng/ml, ovulation is likely.
Progesterone levels in non-pregnant women of normal reproductive age.
Early to mid follicular phase: less than 1 ng/ml Late follicular and perifollicular phase: 1-3 ng/ml Mid luteal phase: >10 ng/ml Progesterone levels during pregnancy predict embryonic development. Before 3 months of gestation, P is mainly secreted by ovarian corpus luteum, P < 5 ng/ml predicts embryonic death. p < 15 ng/ml indicates embryonic dysplasia or ectopic pregnancy. p ≥ 25 ng/ml can basically exclude ectopic pregnancy; in women with normal early pregnancy above 6 weeks, P value is usually ≥ 25 ng/ml and it is more appropriate to maintain a level of ≥ 30 ng/ml.
3. Follicular estrogen FSH is produced by anterior pituitary basophils and is a good indicator to assess ovarian function. In normal women of reproductive age, a FSH of 4-6.8 IU/L is the best performance. The literature suggests that when FSH is between 6.8-10 IU/L, it indicates a slight decrease in ovarian function, and FSH >10-15 IU/L in the early follicular phase suggests hypovarianism. Some literature says that when FSH is >15 IU/L on multiple tests, it suggests that IVF is a bad reflection of superovulation. FSH >20 IU/L has a very low success rate of IVF. FSH >40 IU/L suggests ovarian failure, which is the threshold value for the diagnosis of menopause.
4. Luteinizing hormone LH is produced by basophils in the anterior pituitary gland. It is also one of the indicators to evaluate ovarian function. The basal LH level should be <10 IU/L. LH has a peak 24-48 hours before ovulation with a mean value of 52.98 ± 24.35 IU/L. The sudden increase in LH is secreted into the urine and maintained for several hours to disappear before ovulation occurs. So if we get a positive LH test in the urine, then ovulation may have occurred between 24 and 48 hours.
In addition to ovulation monitoring, LH and FSH measurements can also identify central or ovarian amenorrhea; LH and FSH >40 IU/L are considered hypergonadotropic (ovarian) amenorrhea, i.e. menopause; FSH and LH <5 IU/L are considered hypogonadotropic (hypothalamic or pituitary) amenorrhea, e.g. Silhan's syndrome; blood LH/FSH ratio >2-3 or LH >25 IU/L are considered The LH/FSH ratio >2-3 or LH >25 IU/L is one of the reference diagnostic indicators for polycystic ovary syndrome (PCOS) (note that LH and LH/FSH ratio are not necessary indicators for the diagnosis of PCOS).
Testosterone Testosterone is secreted by the ovaries. The normal basal value is 0.29±0.14 ng/ml. testosterone may be increased in polycystic ovary syndrome. Some people with polycystic ovary syndrome do not have high testosterone test value but have Kaohsiung’s manifestations, such as acne, heavy hair, and acanthosis nigricans, etc. This may be due to more sensitive androgen receptors, or other forms of high testosterone, such as dihydrotestosterone.
High testosterone in the blood or the manifestation of Kaohsiung is an important indicator for the diagnosis of polycystic ovary syndrome. However, it is not a necessary indicator. The Kaohsiung blood sign should also be noted for other diseases, such as testosterone-secreting tumors, or adrenal cortical hyperplasia.
Prolactin PRL is a hormone secreted by the pituitary gland. Prolactin is secreted in a pulsatile manner, with a peak of about 13-14 times a day. The average amplitude can be up to 20-30% of the upper line. The valley of PRL is usually at the 10:00-11:00 am point, so PRL needs to be tested at this time. The usual basal value of prolactin is 12.02 ± 6.09 ng/ml. The accepted normal range is 5-25 ng/ml or 10-28 ng/ml (between 200-800 mIU/L) and a normal woman should not exceed 2-30 ng/ml.