Hormonal imbalances can contribute to reproductive disorders and many non-specific, chronic health symptoms.
Commonly tested female hormones include estrogen, progesterone, testosterone, and thyroid hormones, which can help evaluate for menstrual disorders, fertility issues, and other hormone imbalances.
Blood serum is the gold standard for hormone testing, but 24-hour urine collection, dried blood spot, dried urine, and saliva are alternative testing methods.
These alternative methods may be more effective for cycle mapping, or evaluating hormone levels at multiple points throughout the month.
There’s no perfect test for hormone testing, and it’s best to speak with a healthcare practitioner to determine which method is best for your individual needs.
Hormonal imbalances are becoming a part of everyday life for many women, often to the point of disrupting their well-being and creating many troublesome symptoms. Sleep issues, joint pain, memory loss, fatigue, and mood disturbances are all signs that there may be something off with your hormone levels.
Female hormone testing may provide insight into the source of your chronic symptoms by evaluating various sex hormones, like estrogen, progesterone, testosterone, and prolactin. Measuring these hormones is often useful in screening for reproductive disorders, menstrual irregularities, and fertility issues. This includes common conditions and hormonal patterns like premenstrual syndrome (PMS), estrogen dominance, polycystic ovary syndrome (PCOS), menopause, and heavy menstrual cycles.
However, with so many types of hormone testing now on the market, it can be confusing where to begin when getting your hormones checked. The reality of female hormone testing is that there’s likely no “best” method when it comes to measuring hormone levels. It’s your individual symptoms and needs that will determine the most suitable method for your specific situation.
Our female hormone test list is your in-depth guide to the laboratory tests that are currently available for endocrine testing. Whether it be serum, dried blood-spot, urine, or saliva testing, this article breaks down the research behind these different techniques, so that you and your doctor can decide what the best method is for you.
Why Do Your Hormone Levels Matter?
Hormone tests are commonly used in women’s health to diagnose reproductive conditions, endocrine disorders, and fertility issues. However, hormonal imbalances can be implicated in a surprisingly wide array of conditions and symptoms, such as:
Unfortunately, hormonal imbalances can be easily missed by conventional testing methods, leaving many women at a loss about their symptoms. This is, in part, due to the vast fluctuations in female hormone levels throughout the month, and a lack of standardized reference ranges in laboratory testing [8, 9, 10, 11, 12].
However, many private laboratories are now moving away from single-point hormone testing to account for these fluctuations. Several companies are now offering alternatives to conventional testing methods, and are embracing the concept of cycle mapping.
Cycle mapping measures hormone levels at multiple points throughout the month for a more in-depth and comprehensive look at hormonal status . Several labs now measure for hormone metabolites as well, potentially providing more accurate test results to women who are currently on exogenous hormones, like oral contraceptives or hormone-replacement therapy (HRT) [14, 15].
Along with these recent advancements, the options for undergoing female hormone testing are more complex, and can make it difficult to determine what testing method is best for your specific needs. Prior to analyzing these various test methods, let’s take a further look at what female sex hormones really are.
Your Comprehensive Female Hormone Test List
Most female sex hormones are steroid hormones, meaning that they’re made of lipids (fats) . They’re produced and secreted by many different glands in the body, including the pituitary gland, adrenal glands, thyroid gland, and ovaries .
Some of the most commonly measured female hormones and hormonal markers include :
Estrone, estradiol, and estriol (forms of estrogen): A female sex hormone that regulates sex characteristics and maintains reproductive, bone, and cardiovascular health in women.
Progesterone: A female sex hormones that regulates the menstrual cycle and thickens the uterine lining to prepare for follicle (egg) implantation in women.
Total testosterone and free testosterone: An androgen (male sex hormone) that plays an important role in female reproductive health and libido.
Luteinizing hormone (LH): A pituitary hormone that regulates the production of other sex hormones, like progesterone and estrogen, and induces ovulation in women.
Follicle-stimulating hormone (FSH): A pituitary hormone that causes estrogen levels to rise in women and leads to the development of follicles in the ovaries.
Dehydroepiandrosterone (DHEA) and DHEA-sulfate: An androgen produced by the adrenal glands that’s a precursor to other sex hormones and helps produce testosterone in women.
Sex hormone-binding globulin (SHBG): A protein that helps bind up excess sex hormones, like testosterone and estrogen.
Prolactin: A hormone produced in the pituitary that promotes breast milk production, but can suppress fertility when elevated.
All of these hormones are responsible for our menstrual cycle, fertility, and reproductive health. Female sex hormones can even influence our immune, digestive, and psychological functions, and strongly contribute to our overall feeling of wellness.
Assessing female hormones can be effective for diagnosing certain conditions, like PCOS and infertility, and may give insight into what lies behind symptoms of chronic fatigue, insomnia, cognitive issues, and mood swings.
Though not traditionally considered to be female sex hormones, thyroid hormones can play a significant role in women’s health too. Checking for thyroid disease typically involves measuring several hormonal and other markers of thyroid health, such as:
Impaired thyroid function, such as in hyperthyroidism and hypothyroidism, can frequently contribute to female hormonal disorders and symptoms.
Female Hormone Testing Methods
Now that we understand the importance of having balanced hormone levels, let’s take a dive into the various laboratory testing methods in order to determine the most accurate and effective method for evaluating your symptoms.
Serum blood tests are the most conventional method of endocrine testing and are considered the gold standard for evaluating hormone levels. In serum testing, a blood sample is taken via blood draw at a laboratory and sent off for analysis.
Since serum blood tests are the oldest form of hormone testing, there are established reference ranges for female and male hormones, which helps when interpreting test results. This type of testing is also often covered by insurance companies.
However, serum lab tests are somewhat invasive (as they require a blood draw) and the collection method can make it difficult and time-consuming to measure hormone levels at several points throughout the month. However, a single blood draw is often all that’s necessary in screening for certain conditions, like menopause and PCOS, which makes serum blood tests a viable option in cases such as these.
Some research has found no significant differences between the concentrations of estrogen metabolites found in serum and urine samples analyzed by modern, high-tech mass spectrometry . However, the Endocrine Society, the American Association for Clinical Chemistry, and the Partnership for Accurate Testing of Hormones have complained about the lack of standardization for accurately measuring hormone metabolites . This is especially true for metabolites that occur in very low concentrations .
Researchers who work for Precision Analytics, the company that produces DUTCH testing, claim that serum tests can’t detect hormone metabolites, but that their dried urine tests can [14, 19]. However, more publicly funded research is necessary to determine the differences between modern serum testing and dried urine testing.
Meanwhile, conventional testing that uses mass spectrometry methods to analyze serum or 24-hour urine samples is probably sufficient for most women to get a good sense for their reproductive hormone levels, and it’s more likely to be covered by insurance. However, DUTCH testing can provide a picture of hormonal fluctuations throughout a full menstrual cycle, which may be useful for people with chronic hormonal imbalances or who suspect infertility.
Serum blood testing might be the best method for you if:
You’re using health insurance to pay for your labs
You’re not on HRT
You’re not interested in cycle mapping
Dried Blood Spot
Dried blood-spot test kits require you to prick your finger and dry a small amount of blood on a card. The card is then mailed in for analysis, therefore making it a suitable method for home testing. Dried blood-spot testing measures hormone levels in your small blood vessels (capillaries). This is slightly different to serum testing, which evaluates venous blood levels. It’s a small — but important — distinction, as there are likely variances in hormone levels throughout the circulatory system.
Research shows that dried blood-spot tests may even be more accurate than serum, 24-hour urine, and saliva testing. Additionally, it differs from serum testing, as it can measure hormonal metabolites, and thus is more useful for women on HRT . It’s important to note that these findings were reported by a private laboratory that offers dried blood-spot testing.
Despite this, blood-spot testing is likely an effective method for cycle mapping and assessing several hormones throughout the menstrual cycle, including FSH, LH, and progesterone . This can be useful in detecting ovulation in women who are trying to conceive, and when assessing the cause of menstrual abnormalities like irregular cycles and heavy bleeding .
While it’s still a relatively invasive form of hormone testing, it’s more convenient than serum blood tests, and is useful in collecting multiple blood samples for cycle mapping.
Dried blood-spot testing may be the preferred method for you if:
You experience abnormal menstrual cycles (heavy, painful, or irregular cycles)
You struggle with fertility issues
You suspect a hormonal imbalance is at the root of your chronic symptoms
24-Hour Urine Collection
Second to serum blood testing, collecting urine over a 24-hour period is one of the oldest methods for analyzing hormone levels. This test accounts for variances in hormone levels throughout the day, and gives a better look at total daily hormone production. It’s also less invasive than serum blood testing, and is an accurate alternative for those who have a fear of needles.
However, like serum blood tests, it doesn’t look at hormonal fluctuations over the course of a month. This makes it ineffective for cycle mapping, and likely more difficult to assess for menstrual disorders and other hormonal imbalances that can lead to non-specific health symptoms.
It may not be effective for assessing hormone metabolites, rendering it irrelevant for women on HRT . Furthermore, having to collect an entire day’s worth of urine can be cumbersome and time-consuming.
Twenty-four hour urine testing is likely best for women who:
Are not interested in cycle mapping
Are not currently on hormone therapy
Are hesitant to undergo a blood draw
Dried Urine Testing
The dried urine testing method differs from urine collection in that only small samples of urine are collected and dried on filter paper. This process is completed at home, and is useful for testing hormones over the course of a day or several weeks. After all samples are collected, the card is mailed back to the lab for evaluation.
Though dried urine doesn’t account for total daily hormone production, such as with 24-hour urine collection, the ability to collect multiple samples throughout the day can provide a close estimate. In fact, research supports that taking four dried-urine spots throughout the day is an effective alternative to 24-hour urine collection .
It’s also a less-cumbersome method than 24-hour urine collection, and research shows that it’s likely equally accurate in detecting hormone levels .
Dried urine testing is accurate in measuring LH, estrogen, and progesterone, making it helpful for predicting ovulation in women trying to conceive. This shows that it may be useful for cycle mapping as well, which has been determined to be one of the best diagnostic tools for measuring fertility [13, 24]. It can also be used to assess hormonal imbalances contributing to irregular, heavy, or painful menstrual cycles, along with PMS and PMDD.
The dried urine test assesses for hormone metabolites and is useful for measuring hormone levels in premenopausal and postmenopausal women, especially those on HRT [25, 26].
Dried urine testing is currently offered by two popular private labs, Precision Analytics and ZRT. While Precision Analytics only offers dried urine testing (the DUTCH Test), ZRT offers saliva and dried blood spot as well, and has successfully qualified for the CDC’s hormone standardization program .
While both are viable options for alternative forms of hormone testing, there’s currently a lack of research that shows how these test results can be used in a clinical setting for screening and diagnosis. Additionally, these private laboratories can be expensive, with some of these tests running $300-$700 each.
Dried urine testing may be a good option for you if:
You’re interested in cycle mapping
You want to detect ovulation for pregnancy planning
You’re taking HRT and want to monitor your hormone levels
You’re not seeking insurance coverage for your test
Saliva testing is a non-invasive hormone test that’s easily completed at home by collecting saliva in a test tube. Because of its accessibility, it’s a good option for women interested in cycle mapping to assess for menstrual disorders and other hormonal imbalances.
It may be particularly beneficial in assessing for menopause, as research shows that saliva testing can accurately evaluate estrogen and follicle-stimulating hormone (FSH) levels . FSH rises as a woman enters menopause, due to the natural decline in estrogen, and is the most common marker for indicating menopause.
It’s important to note that laboratory testing isn’t necessary in the diagnosis of menopause , but can be an effective method for menopausal screening if you’re experiencing symptoms, such as:
Memory loss and cognitive issues
Joint pain and low bone density
Testing salivary hormones may be more accurate than serum or 24-hour urine testing in women who are taking hormones, making it even more useful for menopausal women who are considering HRT .
Additionally, saliva testing may be effective for women who are addressing fertility issues, as it’s an accurate indicator of anti-Mullerian hormone (the hormone that shows how many eggs a woman has left) .
Unfortunately, research shows that saliva hormone levels often do not reflect serum blood levels for many other female hormones, likely causing it to be a less accurate test overall . Additionally, testing saliva is not a preferred method for assessing hormones in young women with menstrual irregularities, as adolescent females have naturally low levels of hormones in their saliva .
While it may not be the most accurate form of measuring hormones, and shouldn’t be used in young women, saliva testing may be beneficial for you if:
You have a fertility disorders
You suspect you may be entering menopause
You want a non-invasive method of cycle mapping
A Comparison of Female Hormone Test Methods
Looking over the female hormone test list and deciding which one is right for you can be complicated and confusing. While it’s best to work with a medical practitioner who is knowledgeable in the various hormone testing methods, this table can help direct you on where to start.
24-Hr. Urine Collection
Dried Blood Spot
Keep in mind that there are no hard and fast rules when it comes to assessing your hormone levels, and this female hormone test list is meant to help guide your decision — not determine it.
Your Female Hormone Test List: The Results Are In
There’s likely no “best” method when it comes to evaluating your hormone levels. Dried blood-spot and dried urine testing are likely the preferred methods when you want multiple measurements of your hormone levels, such as in cycle mapping. This can be useful in evaluating menstrual abnormalities and non-specific symptoms of a hormonal imbalance.
These are also the preferred methods for women on hormone-replacement therapy, as they can measure hormone metabolites. However, these tests can be expensive and time-consuming, and aren’t necessarily indicated in all situations.
If you’re looking for a quick, inexpensive, and accurate way to diagnose an endocrine or reproductive disorder, serum blood testing is likely a safe bet. Furthermore, certain methods — like saliva testing — aren’t suitable for young women, but can be very helpful in diagnosing infertility.
In short, there is no “one size fits all” option when it comes to hormone testing, and it’s best to speak with your healthcare provider about which method is best for you. If you’re considering hormone testing, and would like assistance in addressing the root cause of your chronic health symptoms, reach out to our functional medicine clinic today.
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