When it comes to testing your hormones, timing is everything! So often my patients ask their doctors to test their hormones but it is done during the wrong part of the menstrual cycle. Hormones need to be tested at specific times during your menstrual cycle in order for the results to have meaning.

If you are struggling with infertility,  having period problems or symptoms during perimenopause, testing blood levels of hormones is a good place to start. But in order for the results to give useful information,  make sure you are testing during the correct part of your menstrual cycle.

All of the hormones except progesterone can be tested on Day 2 or 3 of your menstrual cycle. (Day 1 is the first day of full bleeding , not spotting).

Progesterone needs to be tested during the second half of your menstrual cycle which would be day 19-21 (approx. 1 week before you expect your period)

The other thing to pay attention to is the reference ranges for the hormones. Reference ranges are very broad and non-specific, so often your doctor is going to tell you everything is in the “normal” range,  and this is where issues get missed.  If levels are on either side of the normal range – either the very low end or the very high end of normal, this can indicate a problem as well.

Here are the hormones I recommend testing through blood and details about when and why you should test them:

1. FSH
   • When to test:  Day 2 or 3 of menses
   • Why test: Trouble conceiving, irregular periods, long cycles, skipping periods or no periods, very light or heavy periods, menopausal symptoms before age 45
   • Optimal lab range:  <9 pg/mL
   • What results mean:
     • Levels > 15pg/mL could indicate ovarian insufficiency and could explain inability to conceive.Levels > 30 = Menopause
   • NOTE: If you estradiol is over 60, FSH typically tests falsely low and is not accurate.   
2. LH
   • When to test:   Day 2 or 3 of menses
   • Why test: Trouble conceiving, irregular periods,  long cycles, skipping periods or no periods.
   • Optimal lab range: 2-15 mIU/mL
   • What results mean:
     • LH  that is  2-3 times higher than your FSH could indicate Polycystic ovarian syndrome
3. Estradiol
   • When to test:   Day 2 or 3 of menses
   • Why test:  Infertility/Trouble conceiving, irregular periods, skipping periods or no periods, Perimenopause symptoms, PMS  heavy periods, light periods,  early menopause symptoms
   • Optimal lab range: 27-45 pg/mL
   • What results mean:
     • Levels >45 could indicate perimenopause or ovarian insufficiency
     • Levels <27 can indicate ovarian insufficiency or hypothalamic amenorrhea. Levels are typically low in menopause
4. Testosterone (free and total)
   • When to test: any day of the menstrual cycle is okay
   • Why test: Acne, hair loss, long cycles, missing cycles, infertility
   • Optimal lab range: Total:  32-60ng/mL. Free: 0.3-1.9 ng/dL
   • What results mean:
     • High levels: polycystic ovarian syndrome
     • Low levels: ovarian insufficiency, contributing factor to infertility. Low levels contribute to symptoms of perimenopause and menopause
5. DHEA – S
   • When to test: any day of the cycle
   • Why test: infertility, trouble conceiving, hair loss, acne, perimenopause or menopause symptoms, fatigue and brain fog especially in women over 40.
   • Optimal lab range:  57.3-279.2 ug/dL (ideal range depends on age)
   • What results mean:
     • High levels: polycystic ovarian syndrome, stress
     • Low levels:  levels decline in women over age 40. Contribute to perimenopause and menopause symptoms including fatigue, brain fog, muscle aches and pains.
   • NOTE: make sure DHEA-S  is tested, not DHEA. these are 2 different tests and DHEA is not a good measure.
6. Prolactin
   • When to test: day 2 or 3 of menses, in the morning, fasting for at least 8 hours, between 8 and 10am. No exercise the morning of testing
   • Why test: trouble conceiving/infertility, irregular periods, missed periods or no periods, short menstrual cycles, premature menopause symptoms
   • Optimal lab range: < 14 ng/mL
   • What  results mean:
     • Levels >14 indicate an error in how the pituitary in the brain is communicating with the ovaries. Mild elevations can often be addressed with natural treatments.  If levels are very high,  some women will need medication.
     • Very high levels over 80-100 could indicate a benign pituitary tumor and warrants further workup.
7. Anti-Mullerian Hormone (AMH)
   • When to test:  Day 2-3 of menses is best
   • Why test: Trouble conceiving/infertility, premature symptoms of menopause, suspicion of PCOS
   • Optimal Lab range: Between 2.0 and 4.0 indicates good ovarian reserve and has best outcomes for fertility and successful pregnancy
   • What results mean:
     • > 4.0 could indicate polycystic ovarian syndrome
     • < 1.0  associated  with ovarian insufficiency,  poor egg reserve and poorer prognosis for achieving pregnancy naturally.
8. Progesterone
   • When to test: 2^nd half of the menstrual cycle, ideally 1 week before you expect your period. This is Day 19-21 of the typical length cycle of 27-28 days.
   • Why test: Infertility/trouble conceiving, irregular periods, skipping periods, short  or long menstrual cycles, PMS , heavy or prolonged menses, premenstrual spotting, history or miscarriage
   • Optimal lab range:
     • > 15 ng/mL is ideal and has best outcomes for achieving pregnancy.
   • What results mean:
     • If levels are < 5ng/mL  this indicates that you have NOT ovulated. Anovulation (lack of ovulation) is a common cause of infertility and is also common in PCOS.

Note: when testing hormones, do not test while you are on birth control. Testing levels of hormones is not useful when on birth control.

It’s important to remember that testing hormones is only a one day snapshot and your hormones are fluctuating all month long. In order to fully understand what’s going on with your hormones, lab results need to be interpreted over time while observing your menstrual cycle and your symptom picture.

In Health,
Dr. Joanne Aponte

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.