Female Hormone Check – How Are Hormone Levels Monitored?

By BSc, MSc (embryologist), MD (gynecologist), BSc, MSc (embryologist) and BA, MA (fertility counselor).
Last Update: 01/17/2019

Getting your hormones tested through blood test is very useful to assess the levels of female hormones, which are responsible for regulating the female ovarian cycle and help us to determine a woman’s fertility potential.

The main hormones checked in women are: FSH, LH, estradiol, progesterone, AMH, prolactin, and TSH.

Along with a transvaginal ultrasound scan, a female hormone check allows us to predict the status of a woman’s ovarian reserve. This makes hormone checks a highly useful tool when it comes to determining the egg count of a woman as well as if the woman is ovulating adequately.

Female sex hormones

A woman’s menstrual cycle is regulated by the hypothalamic-pituitary-ovarian axis.

The hypothalamus and the pituitary gland are two structures located in the brain. One of their functions is to regulate most of the hormones found in blood.

On the other hand, the ovaries are responsible for releasing sexual hormones, which develop their function over the uterus. Moreover, they are responsible for the appearance of the secondary female characteristics in women.

Thus, any abnormality that affects the release of hormones by this axis can lead to menstrual irregularities and, as a result, infertility.

This is the reason why getting your hormones tested with a simple hormone analysis is a crucial female fertility test.

The regulation process of the menstrual cycle can be split into two different functions: the hypothalamic-pituitary function and the ovarian function. The following sections will provide you with more information on the hormones involved in each:

Hormones produced by the pituitary gland

The main Hormones produced by the pituitary gland, also called gonadotropins, are the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Both are released on the ovary and trigger the production of estrogen and progesterone.

Simultaneously, estrogen and progesterone stimulate the pituitary gland by blocking the effect of hormones produced by the pituitary gland, closing the cycle. This process is known as feedback regulation.

TSH and prolactin are also released by the pituitary gland under the influence of the ovarian cycle.

Let’s see what is the function of each one of these hormones in detail:

FSH
This gonadotropin affects the ovary by favoring the development and maturation of ovarian follicles, a series of sac-like structures where eggs grown and mature.
LH
It is responsible for triggering the follicle maturation process and ovulation (egg release), which leads to the formation of the corpus luteum (empty follicle after ovulation) and the release of progesterone.
TSH
The thyroid-stimulating hormone is released by the pituitary gland and regulates the activity of the thyroid gland.
Prolactin
This hormone is especially important during pregnancy, since it stimulates milk production by the mammary glands as well as progesterone synthesis in the corpus luteum.

You may also enjoy some further information reading this: Gonadotropins & Their Use in Assisted Reproduction.

Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

Hormones produced by the ovaries

Also, hormones released by the ovary thanks to the function of gonadotropins are sex hormones, including:

Estradiol (E2)
This estrogenic hormone is released by growing ovarian follicles, whose function is to activate the release of LH, thereby inducing ovulation. Along with progesterone, E2 plays a role in the endometrial preparation process for embryo implantation.
Progesterone (P4)
This steroid hormone is released mainly by the corpus luteum and the placenta in case the woman is pregnant. Its function if especially important during the second phase of the menstrual cycle (luteal phase), preparing the endometrium for embryo implantation, too. If implantation does not occur, progesterone levels decrease, causing the endometrial lining to shed during a process called menstruation.
Anti-Müllerian hormone (AMH)
It is released b the granulosa cells of the antral and preantral follicles during the reproductive years of women. It plays a major role in follicle formation and development. Moreover, AMH is an indirect marker of the ovarian reserve.

To get more info on how the female menstrual cycle works, we recommend that you continue reading here: The Different Phases of the Menstrual Cycle.

When and how to test hormone levels for women

A fertility hormone test involves just the removal of a blood sample to determine the levels of all the reproductive hormones described above.

It should be noted that the blood test should be done between the third and fifth day of the menstrual cycle, that is, within 3-5 days after the start of your menstruation, since your hormones are in basal levels and can be compared with the reference values.

The first day of the menstrual cycle is considered the first day when a woman has a heavy bleeding, marking the start of the menstrual period. The previous days, even if mild spotting occurs, are not considered the beginning of menstruation.

Nevertheless, the hormone progesterone should be checked on day 21 of the cycle to determine if ovulation has happened or not.

Finally, AMH testing can be done anytime during the cycle, since its value does not fluctuate through it.

Normal hormone levels

For a woman’s menstrual cycle to allow ovulation and therefore egg fertilization and embryo implantation into the womb, it is crucial that the female hormone system is well regulated.

The method used to check that there exists no irregularity is by measuring the levels of sex hormones in blood and comparing them with normal or reference values, which you can find in the following table:

What follows are the normal reference values for female sex hormones and the usefulness of measuring them:

FSH
It helps to check the ovarian reserve. Levels between 3 to 9 mIU/ml indicate a good ovarian reserve. Levels below 6 indicate that the ovarian reserve is excellent, from 6 to 9 good, between 9 to 10 moderate, and 10-13 indicate a diminished egg count. Values above 13 mIU/ml show a very low ovarian reserve, and typically occurs when menopause starts.
LH
LH levels must range between 2 and 10 mIU/ml. Too high levels (above 20) show that ovulation is about to happen. Along with progesterone, LH helps to determine if the woman is ovulating normally. Too elevated levels can indicate the presence of certain disorders, including PCOS (Polycystic Ovary Syndrome).
TSH
Its levels should range between 0.2 and 4.7 mIU/ml on day 3 of the cycle. Higher or lower levels can indicate hyperthyroidism or hypothyroidism, respectively. Both alterations can have a negative impact on ovulation and subsequently affect fertility.
Estradiol (E2)
Its levels at the beginning of the cycle range between 27 pg/ml to 161 pg/ml approximately. Ideally, a fertile woman’s levels should be below 50 pg/ml. Abnormally elevated levels may indicate the presence of cysts or poor ovarian reserve.
Progesterone (P4)
Normal progesterone levels on day 21 of the cycle must range between 5 and 20 ng/ml (ideally 10 ng/ml or below) to confirm that ovulation has happened. On day 3, they must be lower than 1.5 ng/ml.
Prolactin
In non-pregnant women, prolactin level are 0-20 ng/ml, whilst in pregnant women they range between 10 and 300 ng/ml. When they are higher than 30 ng/ml, it indicates the presence of hyperprolactinemia. In other words, that hormone regulation is altered and subsequently ovulation. Moreover, if prolactin levels in a non-pregnant women are above 80 ng/ml, it suggests that the pituitary gland is not working as is should, most likely due to the presence of a tumor or PCOS.
AMH
The normal values are 0.7-1 and 3.5 ng/ml. AMH levels below 0.7-1 indicate a diminished ovarian reserve, while levels above 3.5 ng/ml indicate an excessive ovarian development. In the latter case, your doctor must take special care of your ovarian stimulation protocol during a fertility treatment.

If you want to get more info on ovarian reserve tests to find out more details about your fertility levels, click here: Can a Woman’s Egg Count Be Measured with a Blood Test?

Other hormone levels

Although the following list is composed of hormones that are rarely checked, sometimes they can be helpful when it comes to diagnosing a fertility problem. Hence the importance of taking them into consideration as well.

Free triiodothyronine (FT3)
It helps to assess the function of the thyroid gland. Its value on day 3 should range between 1.4 and 4.4 pg/ml approximately.
Free thyroxine (FT4)
Its levels must be between 0.8 and 2 ng/dl. Too low levels can indicate thyroid gland insufficiency or pituitary gland disorders.
Total testosterone (T)
Normal T levels in women lie between 24 and 47 ng/dl. Too elevated levels are usually an indicator of PCOS.
Inhibin B
When its levels are lower than 45 pg/ml, it indicates ovarian reserve abnormalities or a poor response to stimulation drugs.

FAQs from users

At what age should AMH be examined?

By Dr. Elena Santiago Romero MD (gynecologist).

Anti-Müllerian hormone is produced by the ovary, and its blood levels are an indicator of a woman’s ovarian reserve.

To ensure everything works as expected, we recommend that the first measurement is done from age 20 and not later than age 30. By doing this, if a woman has a diminished ovarian reserve at a young age, she would have time to decide whether she wants to have a baby now or cryopreserve some eggs to become a mother in the future.

Is having your progesterone levels below the reference value on day 21 too bad?

By Andrea Rodrigo BSc, MSc (embryologist).

Too low progesterone levels on day 21 on the cycle can indicate that ovulation (egg release from the ovary) has not taken place as expected. Without ovulation, a pregnancy cannot occur.

Do low AMH levels equal low ovarian reserve?

By Andrea Rodrigo BSc, MSc (embryologist).

Yes, although it should be confirmed with other tests such as FSH testing or an antral follicle count via transvaginal ultrasound.

Can anxiety affect female hormone levels?

By Andrea Rodrigo BSc, MSc (embryologist).

Yes, stress and anxiety can affect a woman’s hormonal system, and subsequently alter the menstrual cycle.

What is the ideal day to do a blood test to examine female fertility?

By Andrea Rodrigo BSc, MSc (embryologist).

Ideally, it should be done on day 3 of the cycle after the start of the menstrual period in order to obtain an accurate result for FSH, LH and estradiol levels. Progesterone, on the other hand, should be tested on day 21. Finally, AMH levels can be checked at any time during the cycle, as its values are independent from the cycle.

What are injectable female hormones used for?

By Andrea Rodrigo BSc, MSc (embryologist).

Injectable female hormones are used in fertility treatment cycles to control the menstrual cycle artificially. It allows for an optimization of the ovarian stimulation cycle in fertility treatment cycles, thereby increasing the chances of success.

Suggested for you

You can get more information on the function of sex hormones in both males and females by reading this comprehensive guide: Male & Female Sex Hormones – Definition & Functions.

Also, if you are interested in learning more on the different female fertility tests, continue reading here: Female Fertility Tests – How Do You Know if You Can’t Get Pregnant?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Matorras R, Hernández J (eds): Estudio y tratamiento de la pareja estéril: Recomendaciones de la Sociedad Española de Fertilidad, con la colaboración de la Asociación Española para el Estudio de la Biología de la Reproducción, de la Asociación Española de Andrología y de la Sociedad Española de Contracepción. Adalia, Madrid 2007.

National Collaborating Centre for Women´s and Children Health. Fertility: assessment and treatment for people with fertility problems. Clinical Guideline. London: RCOG Press, 2004.

Crosignani PG, Rubin BL. Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group. Hum Reprod 2000.

Rimbach S, Bastert G, Wallwiener D. Technical results of falloposcopy for infertility diagnosis in a large multicentre study. Hum Reprod 2001.

Tufan E, Elter K, Durmusoglu F. Assessment of reproductive ageing patterns by hormonal and ultrasonographic ovarian reserve tests. Hum Reprod 2004.

FAQs from users: 'At what age should AMH be examined?', 'Is having your progesterone levels below the reference value on day 21 too bad?', 'Do low AMH levels equal low ovarian reserve?', 'Can anxiety affect female hormone levels?', 'What is the ideal day to do a blood test to examine female fertility?' and 'What are injectable female hormones used for?'.

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Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
Dr. Elena Santiago Romero
Dr. Elena Santiago Romero
MD
Gynecologist
Bachelor's Degree in Medicine and Surgery from the Autonomous University of Madrid. Master's Degree in Human Reproduction from the King Juan Carlos University and the Valencian Infertility Institute (IVI). Several years of experience as a gynecologist specializing in Reproductive Medicine. More information about Dr. Elena Santiago Romero
License: 282864218
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Sandra Fernández
Sandra Fernández
BA, MA
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

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