Laboratory Testing for Female Hormone Panel in Endometriosis with Suspected Autoimmune Issues
For a patient with known endometriosis and suspected autoimmune issues, order a comprehensive hormone panel including FSH, LH, estradiol, AMH (anti-Müllerian hormone), and TSH with anti-TPO antibodies, along with targeted autoimmune screening including ANA, anti-dsDNA, RF, anti-CCP, and tissue transglutaminase antibodies. 1, 2, 3
Hormone Panel Components
Ovarian Reserve Assessment
- Anti-Müllerian Hormone (AMH) is critical because women with endometriosis frequently have reduced ovarian reserve markers, including decreased antral follicle counts 4
- FSH and LH on cycle day 2-3 to assess baseline ovarian function and reserve 4
- Estradiol (baseline day 2-3) to evaluate ovarian function and rule out premature ovarian insufficiency 4
- Women with endometriosis may experience progressive ovarian damage, with up to 44% experiencing symptom recurrence within the first year after surgery 4
Thyroid Function
- TSH with anti-thyroid peroxidase (anti-TPO) antibodies is essential because autoimmune thyroid disorders are significantly associated with endometriosis 2, 3
- Anti-TPO may be particularly beneficial in endometriosis patients with concurrent polycystic ovary syndrome (PCOS) 3
- The association between endometriosis and autoimmune thyroid disease is well-established in population-based studies 2
Autoimmune Screening Panel
First-Line Autoimmune Tests
- Antinuclear antibodies (ANA) as a broad screening tool, since women with endometriosis demonstrate autoimmunity to nuclear antigens 1, 5
- Anti-double stranded DNA (anti-dsDNA) if ANA is positive, to evaluate for systemic lupus erythematosus (SLE), which shows significant association with endometriosis 2
- Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) to screen for rheumatoid arthritis, another autoimmune disease significantly associated with endometriosis 2
Additional Targeted Autoimmune Tests
- Tissue transglutaminase IgA antibodies (tTG-IgA) with total IgA to screen for celiac disease, which demonstrates significant association with endometriosis 2
- Anti-Sjögren's syndrome A (anti-SSA/Ro) and anti-Sjögren's syndrome B (anti-SSB/La) if dry eyes or dry mouth symptoms are present, as Sjögren's syndrome is associated with endometriosis 2
Endometriosis-Specific Autoantibodies (Optional Advanced Testing)
Diagnostic Autoantibodies
- Anti-endometrial antibodies including anti-transferrin and anti-alpha 2-HS glycoprotein are specifically elevated in women with endometriosis and represent important candidates for non-invasive diagnosis 1, 3
- Anti-SLP2, anti-TMOD3, anti-TPM3, and anti-PDIK1L are particularly useful for early diagnosis in minimal to mild endometriosis 3
- These specialized tests may not be widely available but can provide additional diagnostic value when standard imaging is inconclusive 3
Clinical Context and Pitfalls
Important Considerations
- CA-125 has limited utility as a diagnostic marker, especially for minimal or mild endometriosis, and should not be relied upon for diagnosis 6
- The presence of autoantibodies in endometriosis patients reflects both a chronic local inflammatory process and systemic autoimmune dysregulation 1, 5
- Endometriosis shares similarities with autoimmune diseases including elevated cytokines, decreased apoptosis, and cell-mediated abnormalities 5
Timing of Testing
- Hormone testing (FSH, LH, estradiol) should be performed on cycle days 2-3 for accurate baseline assessment 4
- Autoimmune testing can be performed at any time but should be done before initiating immunosuppressive therapies if being considered 2
Follow-Up Strategy
- If autoimmune screening is positive, refer to rheumatology for further evaluation and management 2
- If ovarian reserve markers are diminished, consider fertility preservation counseling before surgical intervention 4
- Clinicians must be aware of the potential coexistence of endometriosis and autoimmune diseases when either is diagnosed 2