Female Hormone Panel
A comprehensive female hormone panel should include FSH, LH, estradiol, progesterone, testosterone, prolactin, and TSH as core tests, with additional androgens (androstenedione, DHEA-S) and SHBG added based on clinical presentation.
Core Hormones to Measure
Essential Tests for All Female Hormone Panels
- Follicle-Stimulating Hormone (FSH): Critical for assessing ovarian reserve, menopausal status, and pituitary function 1, 2
- Luteinizing Hormone (LH): Essential for evaluating ovulation, polycystic ovary syndrome, and pituitary disorders 1, 3
- Estradiol (E2): Primary estrogen marker for ovarian function, menopausal status, and femininity 4, 2
- Progesterone: Indicates ovulation and luteal phase adequacy; measure in mid-luteal phase (day 21-24 of cycle) for cycling women 4, 2
- Prolactin (PRL): Screens for hyperprolactinemia causing amenorrhea or galactorrhea 5, 3
- Thyroid-Stimulating Hormone (TSH): Rules out thyroid dysfunction affecting menstrual cycles and fertility 6, 3
Additional Androgens (Context-Dependent)
- Total Testosterone: Most sensitive single marker for PCOS (abnormal in 70% of cases); essential when evaluating hirsutism or hyperandrogenism 1
- Androstenedione (A4): Elevated in 53% of PCOS cases; useful adjunct to testosterone 1, 2
- DHEA-Sulfate (DHEA-S): Screens for adrenal androgen excess; less useful for PCOS diagnosis alone 1, 2
- Sex Hormone Binding Globulin (SHBG): Inversely correlates with body mass index; helps contextualize total testosterone but calculating free testosterone adds limited diagnostic value 1, 2
Timing Considerations
For menstruating women: Draw FSH, LH, estradiol, testosterone, androstenedione, and SHBG during the early follicular phase (days 2-5) to establish baseline values 1
For progesterone: Measure during the mid-luteal phase (days 21-24 or 7 days post-ovulation) to confirm ovulation 2
For amenorrheic or menopausal women: Timing is less critical; draw at any time 3
Clinical Context Modifications
For Suspected PCOS
Prioritize testosterone (most sensitive), androstenedione, and LH 1. The combination of testosterone, androstenedione, or LH identifies 86% of PCOS cases 1. Avoid using LH/FSH ratio as it has poor sensitivity (abnormal in only 41-44% of cases) despite being frequently cited 1.
For Amenorrhea Evaluation
Include FSH, LH, prolactin, TSH, and estradiol as first-line tests 3. Add pregnancy test (hCG) universally before proceeding 6, 3.
For Menopausal Assessment
Measure FSH and estradiol; FSH >25-40 IU/L with low estradiol confirms menopause 2, 5. Include estrone (E1) if on oral hormone replacement therapy, as it rises significantly with oral estrogen 2.
For Fertility Evaluation
Core panel plus progesterone on day 21 to document ovulation 4. Consider anti-Müllerian hormone (AMH) for ovarian reserve (not mentioned in provided evidence but standard practice).
Critical Pitfalls to Avoid
- Never rely on a single hormone measurement for diagnosis; patterns and ratios matter more than isolated values 1
- Ensure the same laboratory performs serial measurements, as different assays have varying sensitivities and reference ranges 1
- Define normal ranges precisely using early follicular phase values from regularly ovulating women for your specific laboratory assay 1
- Do not calculate free testosterone from SHBG and total testosterone; it adds minimal diagnostic value over total testosterone alone 1
- Always obtain blood type and Rh status when evaluating pregnancy-related conditions to determine need for Rho(D) immunoglobulin 6