In short
- Hardly any hormonal complaint is exclusively hormonal, many complaints have other causes too.
- The cycle day determines how a result should be read: FSH, LH and oestradiol early in the cycle, progesterone in the second half.
- With hormonal contraception the cycle hormones mainly reflect the contraception.
- PCOS and the menopause are established by a doctor on the basis of more than one blood value.
When do you think of your hormones?
Hormonal complaints have many faces. Think of:
- An irregular or absent period
- Heavy or very light bleeding
- Strong mood swings around the cycle
- Acne that will not clear
- Increased hair growth on the face or body
- Difficulty getting pregnant
- Hot flushes and night sweats
- A changed libido
- Fatigue that does not seem to belong anywhere
Some women recognise one clear complaint, others a diffuse feeling that their balance is off.
Important to know: hardly any of these complaints is exclusively hormonal. Fatigue can just as easily fit an iron deficiency, mood complaints can fit stress or lack of sleep, and an irregular cycle can be temporary after illness, weight change or intensive exercise.
That is why it makes sense not to look at hormones in isolation, but in the context of your pattern of complaints, your cycle and possibly other blood values. That prevents you from drawing conclusions from one isolated value.
Which hormones can you have measured?
Oestradiol is the most important oestrogen. It directs the build-up of the uterine lining and the maturation of the egg, and moves strongly up and down during the cycle.
Progesterone is released mainly after ovulation and prepares the body for a possible pregnancy. A progesterone measurement at the right moment can therefore give an indication of whether ovulation has taken place, a common question when trying to conceive.
FSH and LH are the controlling hormones from the brain. FSH sets the maturation of eggs in motion and rises as the ovaries respond less, for example approaching the menopause. LH peaks around ovulation and, together with FSH, can provide additional information with an irregular cycle.
Prolactin is the hormone that makes breastfeeding possible, but a raised value outside that period can disrupt the cycle. Stress, certain medicines and other causes can raise prolactin, which is exactly why a doctor always assesses such a result in context.
Testosterone belongs on the list too, because women produce it as well. A relatively high value can be linked to acne, increased hair growth or an irregular cycle. SHBG, the protein that binds sex hormones, helps interpret the testosterone value correctly.
And then there is the thyroid, the silent player: an underactive or overactive thyroid can affect the cycle, weight, mood and energy levels. With hormonal complaints, the thyroid is therefore often included via TSH and free T4.
Have your thyroid tested at Bloodworks
TSH and free T4 as a thyroid test for €109 all-in, including blood draw costs, doctor interpretation and a personal PDF report. No referral required, results typically within 2 working days.
Timing: on which cycle day do you test?
| Hormone | What does it say? | When to test? |
|---|---|---|
| Oestradiol | Directs the build-up of the uterine lining and the maturation of the egg | Cycle day 2 to 5 |
| FSH and LH | Drive egg maturation and change approaching the menopause | Cycle day 2 to 5 |
| Progesterone | Released after ovulation and can say something about ovulation | Second half of the cycle, about a week before the expected period |
| Prolactin | A raised value outside breastfeeding can disrupt the cycle | Morning draw, not tied to a cycle day |
| Testosterone and SHBG | Can be linked to acne, hair growth and an irregular cycle | Morning draw, not tied to a cycle day |
| TSH and free T4 | Show whether the thyroid is underactive or overactive | Morning draw, not tied to a cycle day |
You count the cycle day from the first day of your period. In that early phase the values of FSH, LH and oestradiol are most comparable, and in the second half of the cycle progesterone can say something about ovulation. If your cycle is irregular, make sure the doctor takes that into account in the assessment.
Do you use hormonal contraception, such as the pill, a hormonal coil or an implant? It suppresses or masks your own cycle. Measurements of oestradiol, progesterone, FSH and LH then mainly reflect the contraception, not your natural hormone balance.
Thyroid values and prolactin can still be assessed. If you want a picture of your own cycle hormones, first discuss with your doctor whether and when a measurement makes sense; never simply stop contraception for a test.
The menopause: what does a blood test say?
Around the menopause, hormone levels change gradually. FSH rises as the ovaries respond less, and that can be visible in the blood. Still, a single measurement is of limited use in this phase of life: precisely in the years around the menopause, values fluctuate strongly from cycle to cycle.
Doctors therefore look mainly at the whole picture of age, cycle pattern and complaints such as hot flushes, night sweats and sleep problems. A blood test can support that picture and help rule out other explanations, such as a thyroid problem causing similar complaints.
PCOS: signals in the blood
With a combination of an irregular or absent cycle, acne and increased hair growth, PCOS often comes to mind. In the blood, testosterone, SHBG and the ratio between LH and FSH can give indications that fit this picture.
But be aware: PCOS is a diagnosis made by a doctor based on a combination of criteria, including the cycle pattern and, where needed, an ultrasound of the ovaries. A blood test can support the suspicion or make it less likely, but is never a diagnosis on its own. If you recognise this picture, take the results to your GP.
What can a hormone test do, and what can it not?
What a blood test can do:
- Provide objective values of where you stand now
- Offer clues towards an explanation for your complaints
- Give a starting point for tracking changes
- Help determine whether a visit to your GP is worthwhile
What a blood test cannot do:
- Make a diagnosis on its own
- Predict fertility from a single value
- Replace treatment
Every result at Bloodworks is therefore reviewed by a doctor, who places the values in your context and indicates when follow-up testing or contact with your GP is sensible.
Frequently asked questions
On which cycle day should I have my hormones tested?
FSH, LH and oestradiol are usually measured between cycle day 2 and 5. Progesterone in the second half of the cycle, about a week before the expected period. Prolactin, testosterone and thyroid values are less cycle-dependent; a morning draw is usually enough.
Can I have my hormones tested while on the pill?
You can, but the cycle hormones then mainly reflect the contraception, not your natural hormone balance. Thyroid values and prolactin can still be assessed properly. Never stop contraception on your own initiative for a test; consult your doctor first.
Can a blood test show that I have PCOS?
No, not on its own. Testosterone, SHBG and the LH/FSH ratio can give indications that fit PCOS, but the diagnosis is made by a doctor based on several criteria, including the cycle pattern and, where needed, an ultrasound.
Can a blood test tell me whether I am in the menopause?
A raised FSH can be an indication, but values fluctuate strongly around the menopause. Age, cycle pattern and complaints often weigh more heavily than a single measurement. A test can support the picture and help rule out other causes, such as the thyroid.
How much does hormone testing cost?
The Hormones Female package costs €159, plus €29 blood draw costs, free from €225. Individual tests such as oestradiol, progesterone, FSH or LH cost €69 all-in each; a thyroid test with TSH and free T4 costs €109 all-in.
If you want your hormones measured, you can arrange it at Bloodworks without a referral. You have your blood drawn at one of over 750 affiliated collection points across the Netherlands, a doctor reviews your results and you receive a personal PDF report, typically within 2 working days.
With the Hormones Female package you measure the most important female hormones in one draw, and the thyroid can be tested separately or in addition.