Hormone Testing in Women with Normal Menstrual Cycles
In women with truly normal menstrual cycles (regular 21-35 day intervals with no symptoms), routine hormone level checking is generally not indicated. 1
When Hormone Testing is NOT Needed
Women with regular menstrual cycles and no symptoms do not require routine hormonal evaluation. 1 The presence of a normal menstrual cycle itself indicates adequate hypothalamic-pituitary-ovarian axis function in most cases. 2, 3
When Hormone Testing IS Indicated Despite Normal Cycles
Even with apparently normal menstrual cycles, hormone testing should be performed in specific clinical scenarios:
High-Risk Medical Conditions
Measure testosterone and related hormones in patients with: 1
- History of unexplained anemia
- Bone density loss
- Diabetes
- Exposure to chemotherapy or pelvic radiation
- HIV infection
- Chronic narcotic use
- Infertility (inability to conceive after 12 months of unprotected intercourse)
- Pituitary disorders
- Chronic corticosteroid use
Specific Symptoms Warranting Investigation
Check hormone levels when patients report: 1
- Infertility despite regular cycles
- Galactorrhea (breast milk expression in non-lactating women)
- Hirsutism or male-pattern hair growth
- Unexplained weight gain with truncal obesity (waist-to-hip ratio >0.9)
- Symptoms suggesting thyroid dysfunction
Confirming Ovulation When Clinically Relevant
If you need to confirm ovulation (e.g., fertility evaluation): 1, 4
- Mid-luteal progesterone (day 21 or 7 days post-suspected ovulation) is the single most reliable test
- Progesterone <6 nmol/L indicates anovulation despite apparent regular bleeding
- This distinguishes true ovulatory cycles from anovulatory bleeding that mimics normal menses
Common Clinical Pitfall
The most important caveat: Regular menstrual bleeding does not guarantee ovulation. 1, 5 Women can have predictable withdrawal bleeding patterns without actually ovulating, particularly in:
- Polycystic ovary syndrome (PCOS) phenotype D
- Functional hypothalamic amenorrhea with polycystic ovarian morphology (FHA-PCOM)
- Perimenopausal women with shortened follicular phases
These conditions can present with seemingly "normal" cycles but represent anovulation requiring hormonal assessment. 1
Practical Algorithm
For a woman presenting with "normal cycles":
First, verify true normalcy: 1
- Cycle length 23-35 days consistently
- No symptoms (galactorrhea, hirsutism, infertility, weight changes)
- No high-risk medical conditions listed above
If truly asymptomatic with regular cycles: No hormone testing needed 1
If fertility is a concern: Check mid-luteal progesterone to confirm ovulation 1, 4
If any symptoms or risk factors present: Proceed with targeted hormone evaluation based on clinical presentation 1