Comprehensive Hormone Panel for a 37-Year-Old Female
For a 37-year-old woman, a comprehensive hormone panel should include thyroid function tests (TSH, free T4), reproductive hormones (LH, FSH, estradiol, progesterone), prolactin, and testosterone, with additional testing guided by clinical presentation.
Core Hormone Panel Components
Thyroid Function
- TSH and free T4 should be measured as baseline thyroid assessment 1
- Free T3 can be added if thyroid dysfunction is suspected, though it provides less diagnostic value in routine screening 1
- Thyroid dysfunction directly impacts reproductive hormone levels and menstrual regularity 1, 2
Reproductive Hormones
- LH and FSH should be measured on days 3-6 of the menstrual cycle (ideally calculated from an average of three measurements taken 20 minutes apart) 1
- Estradiol measured during the early follicular phase (days 3-6) provides baseline ovarian function assessment 1
- Progesterone should be measured during the mid-luteal phase to assess ovulation; levels <6 nmol/L indicate anovulation 1
Additional Hormones
- Prolactin should be measured as morning resting levels (not post-stress or postictal); levels >20 μg/L are abnormal and warrant further evaluation 1
- Testosterone measured on days 3-6 of the cycle; levels >2.5 nmol/L suggest hyperandrogenism 1
Conditional Testing Based on Clinical Features
If Menstrual Irregularity Present
- Add androstenedione (abnormal if >10.0 nmol/L) to rule out adrenal/ovarian tumors 1
- Add DHEAS (age 30-39: abnormal if >2700 ng/ml) to rule out non-classical congenital adrenal hyperplasia 1
- Consider fasting glucose and insulin with glucose/insulin ratio calculation if obesity or PCOS suspected 1
If Signs of Hyperandrogenism
- Include testosterone, androstenedione, and DHEAS as above 1
- Consider pelvic ultrasound if hormonal abnormalities detected 1
If Galactorrhea or Suspected Pituitary Dysfunction
- Prolactin measurement is essential 1
- If prolactin elevated, repeat testing to confirm and rule out pituitary adenoma 1
- Consider additional pituitary hormones (ACTH, morning cortisol) if central dysfunction suspected 1
Important Clinical Considerations
Timing is critical: Most reproductive hormones must be drawn during specific phases of the menstrual cycle for accurate interpretation 1. Early follicular phase (days 3-6) is optimal for LH, FSH, estradiol, and testosterone, while mid-luteal phase is required for progesterone assessment.
Common pitfalls to avoid:
- Measuring prolactin after stress, exercise, or breast examination can yield falsely elevated results 1
- Single measurements of LH and FSH may be unreliable; averaging three samples 20 minutes apart improves accuracy 1
- TSH varies seasonally, with lower levels in summer/autumn and higher in winter/spring 3
Referral thresholds: Abnormal results warrant endocrinology or gynecology consultation, particularly for LH/FSH ratio >2, FSH >35 IU/L, persistently elevated prolactin, or clinical signs of PCOS 1.
The panel should be interpreted in context of menstrual history, fertility concerns, and clinical symptoms rather than as isolated values 1. Women with regular cycles and no symptoms may not require the full expanded panel, while those with oligomenorrhea, amenorrhea, hirsutism, or infertility need comprehensive evaluation 1.