How To Test For Female Hormones: A Comprehensive Guide

Hormone imbalances in women, particularly those assigned female at birth, are fairly common and often misunderstood. However, with 20-40% of women experiencing PMS, another 8% experiencing PMDD, 6-12% of women suffering from PCOS, and up to 85% of women experiencing a menopause-related symptom at some point in their lifetime, understanding and testing for potential imbalances in female hormones is of paramount importance to help women regain the ability to understand and support their hormonal health.   

This article will provide a comprehensive overview of the four primary female hormones related to the menstrual cycle as well as ways to test for hormones directly and for associated functional lab markers that can contribute to hormonal imbalances.  

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What Are The Functions Of Female Hormones?

There are four primary hormones to consider when looking at female hormone testing: estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

Estrogen is a steroid hormone that’s responsible for the development of female sexual characteristics, as well as influencing the neuroendocrine, adipose, and cardiovascular systems of the body. There are three main forms of estrogen: estrone, estriol, and estradiol. Estradiol is the most common form of estrogen tested and used for hormone replacement therapies. It directly stimulates the release of luteinizing hormone from the pituitary gland and acts on the uterine lining to help it prepare for a fertilized egg. Estradiol also affects cholesterol synthesis, bone health, vascular health, and brain functions such as memory and mood.

The main role of progesterone is to prepare the lining of the uterus for a fertilized egg to implant and grow. Levels of progesterone continue to rise if conception occurs to support the pregnancy; otherwise, the endometrial lining sheds during a woman’s menstrual period as progesterone levels fall. Progesterone is produced primarily by the corpus luteum, a structure formed from the empty egg follicle that has been released during ovulation. Ovulation, then, is a determining factor for progesterone production - without it, there’s no corpus luteum to produce a progesterone spike. In addition to its aforementioned role, progesterone also helps to improve a woman’s mood, serving as an anxiolytic that provides a sense of calm. This hormone also helps support thyroid function and aids in neuroprotection.

Follicle-stimulating hormone (FSH) is a hormone produced in the pituitary gland in the brain that stimulates the ovaries to make an enzyme called aromatase, leading to a rise in estrogen levels. FSH stimulates follicles in the ovaries to mature, with FSH levels peaking during ovulation before they drop during the luteal phase.

Luteinizing hormone (LH) is another hormone produced in the pituitary gland in the brain that plays an important role in ovulation. LH helps to regulate the length of the menstrual cycle and is an important signal for progesterone production to occur after the release of an egg at ovulation. It’s inhibited by high estrogen levels, and it tends to rise during menopause as a woman’s estrogen and progesterone decline.  

What Are The Impacts Of Hormonal Imbalances On Women's Health?

While female hormones are always fluctuating, levels that rise too high or fall too low can have an array of effects, both physiologically and emotionally, on women. Women are at higher risk than men for mood disorders and depression, and this higher risk has been associated with circulating estrogen levels. Progesterone, too, can contribute to changes in mood - low levels have been linked to a higher risk of anxiety.

Hormone imbalances can also lead to or impact menstrual-cycle-related conditions such as PMS, PMDD, and  PCOS - all of which can seriously impact a woman’s health and quality of life if left untreated. Fertility is also dependent on healthy hormone signaling and communication. High stress, anovulation (as often occurs in PCOS), fibroids (which often occur in a high-estrogen environment), and other hormone-related factors can all negatively impact fertility.

Estrogen is also a key regulator of bone health and turnover in women. As estrogen levels fall during menopause, women become at higher risk for fractures and osteoporosis. Younger women who may have low estrogen levels are also at risk for low bone mineral density, as is seen in cases of RED-S (relative energy deficiency in sports, formerly known as the “female athlete triad”). 

Estrogen, particularly estradiol, is also protective against cardiovascular risk in women, which accounts for lower risk seen in menstruating women (this risk rises after menopause). Hormonal imbalances can lead to high cholesterol and other cardiovascular biomarker changes and may also impact metabolic health and affect weight. Dysfunctional estrogen signaling, in particular, can contribute to the development of obesity, insulin resistance, and diabetes.

Signs & Symptoms of Female Hormone Imbalances

Because the body makes over 50 different hormones, many of which communicate with each other, signs and symptoms of female hormone imbalances can vary from woman to woman. They may include:

• Acne on the face, chest, or upper back
• Hair thinning or loss
• Heavy periods
• Hirsutism (excess body hair)
• Hot flashes
• Infertility
• Irregular menstrual cycles
• Low sex drive
• Vaginal dryness and atrophy
• Bloating and GI upset
• Tender, swollen, or fibrocystic breasts
• Headaches
• Endometriosis
• Anxiety or other mood changes
• FIbroids
• Mood swings
• PCOS (polycystic ovarian syndrome)

Causes of Female Hormone Imbalances

There are many different factors that can contribute to female hormone imbalances, and causative factors may often overlap, making it challenging at times to identify a single root cause.

First, female hormones naturally fluctuate throughout reproductive years, followed by some unpredictability during perimenopause and menopause as estrogen and progesterone ultimately decline.  

PCOS can be caused by hormone imbalances (particularly insulin and androgens), and it can also lead to further hormone imbalances of the female sex hormones, as it can cause anovulation and impact both estrogen and progesterone levels.  

Thyroid disorders (hypothyroidism or hyperthyroidism) can affect levels of estrogen, sex hormone-binding globulin, and testosterone in women, leading to imbalances across the sex hormones.

Endocrine-disrupting chemicals (EDCs), such as pesticides, flame retardants, fragrances, and industrial and household chemicals, can affect sex hormone levels as well. Some EDCs may “mimic” hormones, leading the body to think hormone levels are different than what they actually are, while others block hormones from doing their job.  

Last, the health of the gut microbiome may also impact hormones and lead to imbalances. The gut plays a role in estrogen metabolism and detoxification. In cases of dysbiosis, a lack of beneficial gut bacteria may lead to high levels of beta-glucuronidase being produced, which can recycle estrogen back into circulation and lead to hormone imbalances if left unchecked. 

Functional Medicine Labs to Test Female Hormones

There are several ways to test directly for female sex hormones, including blood (serum) testing, salivary testing, and urine testing.  

Blood (Serum) Testing

Regular blood draws can assess levels of estrogen, progesterone, LH, and FSH; however, it’s important to note that it’s essential to understand where a patient is at in their menstrual cycle to properly interpret the results. Estradiol and FSH are often tested on day 3 of the menstrual cycle, whereas LH may be tested during the ovulation window (roughly days 13-15). Estradiol may also be tested in the ovulation window, as high estrogen may inhibit ovulation. To see peak progesterone levels, a blood test would have to be administered post-ovulation in the luteal phase, usually days 19-22 (assuming an average 28-day cycle). It can be helpful to evaluate estrogen levels in the post-ovulation window as well, particularly in cases of suspected hormone imbalance due to excess estrogen.

Salivary Testing

Female hormones may also be tested using a saliva sample, which is often more convenient and less invasive than frequent venous blood draws. Saliva testing for female hormones has been shown to be accurate in evaluating both estrogen and progesterone levels. This test also includes a morning cortisol marker, which is the hormone most responsible for our stress response.

Urine Testing

Urinary hormone testing, such as DUTCH Cycle Mapping,  offers a unique view of hormone evaluation, as it assesses hormone metabolites as well, which can show how the body is breaking down and metabolizing key female hormones like estrogen and progesterone. Urine testing has been proven to be as accurate as serum testing for estradiol and progesterone in particular, making it a useful tool for suspected hormone imbalances.  

Other Functional Medicine Labs To Test For The Root Cause of Hormone Imbalances 

There are many other physiological systems in the body that can impact hormone levels and contribute to hormone imbalances, making testing across other systems valuable to help identify a root cause. Some of the most common functional medicine labs to consider in the etiology of hormone imbalances are listed below.  

Comprehensive Digestive Stool Test

A healthy gut microbiome is necessary for the proper elimination of excess estrogen from the body. Testing the health of the gut through a functional test like the GI-MAP can provide insight into the health of the microbiome as well as evaluate levels of beta-glucuronidase.

Genomic Testing

Several genes impact the metabolism of estrogen and can be assessed with functional genomic testing. Estrogen is metabolized in the liver to prepare it for elimination from the body in a process involving enzymes known as cytochromes, like CY1B1 (Cytochrome P450 1B1).   

Additionally, a process referred to as methylation involving MTHFR and COMT is also relevant to estrogen metabolism. When these steps work well, estrogen that isn’t needed can be excreted into the gut to be removed from the body; however, if they aren’t working well, estrogen may build up and recirculate throughout the body.  

Complete Thyroid Panel

Testing a full thyroid panel is important to assess for hypo- or hyperthyroidism in cases of hormone imbalances, as thyroid disorders can lead to sex hormone imbalances if left untreated.  

Toxin Panel/Endocrine Panel

EDCs can be problematic for some women who are experiencing hormonal imbalances. Assessing for toxic load can bring to light any major exposures that need to be addressed to support overall hormone health.  

Insulin/Blood glucose

Looking at insulin and blood glucose levels can help assess for PCOS and for overall metabolic health status. Particularly for perimenopausal and menopausal women, insulin sensitivity can start to decrease and lead to changes in blood glucose that may contribute to inflammation and other symptoms of hormone imbalances.   

Conventional Treatment For Female Hormone Imbalance

Treatment for female hormone imbalances varies from person to person, and conventional treatments can offer much-needed symptomatic relief and can support individuals who have co-existing health conditions. Hormone replacement therapy (HRT) and bioidentical hormone replacement therapy (BHRT) are both options for women struggling with hormone imbalances that are impacting their quality of life, though both risks and benefits must be considered for each individual patient case before making a decision on the best hormone replacement option for a given person.  

Oral contraceptives (OCP) are often prescribed to “treat” hormone imbalances, though it should be noted that these medications often mask symptoms and may not be the only solution to support hormones. OCP’s can be extremely beneficial for women with severe PMDD, as sensitivities to hormone fluctuations can lead to suicidal thoughts and other severe risks.  

Medications to address low bone density, high blood pressure, other cardiovascular complications, or other co-existing health conditions may be used by a patient’s conventional provider to help minimize any health risks while identifying and supporting hormone imbalances.   

Functional Medicine Treatment for Female Hormone Imbalance

Because female hormones can be influenced by diet, genetics, environmental factors, stress and lifestyle, and even medications, a functional medicine approach for female hormone imbalance often includes a blend of these considerations. Below, we outline specifically nutritional and CIM treatments that can help in addressing female hormone imbalances.  

Nutrition For Female Hormone Imbalances

While bio-individuality should always lead when it comes to nutritional recommendations, studies show that an anti-inflammatory, Mediterranean-type diet with a diverse intake of phytonutrients and fiber from fruits and vegetables is an ideal starting place to support female hormone health. Such an approach supports a healthy gut microbiome and estrabolome to help properly metabolize and eliminate excess estrogens that are so often at the root of female hormone imbalances.  

Including adequate protein, healthy fats, and carbohydrates to meet each women’s needs is also important for female hormone health. Chronic calorie restriction and inadequate macronutrient intake can lead to further exacerbation of hormone imbalances.  

Reducing alcohol and caffeine intake can also be beneficial, as these have been linked to a higher burden on the liver and can disrupt estrogen metabolism in some women.  

Supplements & Herbs That Help With Female Hormone Imbalance

Supplementation for hormone imbalances is dependent on the root causes leading to the imbalance in the first place. Below are a few specific supplements that have been studied for their impact on female hormones and can be helpful in addressing hormone imbalances as part of a bigger-picture functional medicine strategy. Other supplements that address various micronutrient imbalances, support genomic testing results, etc., may also be helpful.

Vitex (Chastetree)

Vitex is a supplement that contains the extract and dried powder of the fruit from the chaste tree plant. It helps to shift the estrogen-progesterone balance in favor of progesterone by increasing LH levels and mildly inhibiting FSH. It also helps to reduce the secretion of prolactin, which, when elevated, can inhibit fertility and regular hormonal rhythm.

Calcium-D-Glucurate

Calcium-D-glucarate can be a helpful supplement to help excrete excess estrogen, particularly in cases where the gut microbiome health may be impacting estrogen levels. Calcium-D-glucarate inhibits beta-glucuronidase, allowing for better estrogen elimination.   

Inositol

Inositol has been linked to improving egg quality, possibly by making the ovaries more responsive to FSH and LH. It may be particularly helpful in women dealing with PCOS.

Complementary and Integrative Medicine

Acupuncture has been studied for various types of hormone imbalances. Sessions have been found to be helpful for alleviating sleep trouble and depression symptoms in perimenopausal women, and acupuncture has been linked to improving postmenopausal symptoms with few adverse effects. Additionally, acupuncture can confer benefits for those on a fertility journey, helping to support overall hormone health as part of a holistic health strategy.  

Herbal therapies have also been studied for support during hormonal transition periods, such as menopause. St. John’s wort, black cohosh, and dong quai have been linked to improvement in vasomotor symptoms, such as hot flashes, insomnia, and irritability, while ginseng has been found helpful in supporting sexual function.

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Summary

Testing for female hormones may include a mix of specific hormone testing methods and other functional labs evaluating physiological systems that can also contribute to changes in female hormones. It’s important to understand that the approach may look different for each case of hormonal imbalance, which is why it’s important to work with a functional medicine provider who can help guide you on the right path.