Desire checked “hormones” or to study “hormonal balance” – perhaps one of the most haunting ideas as gynaecologists and women themselves. Throughout my work in gynecology, I shudder every time a woman wants to pass tests for hormones, as I understand that now I have to explain for a long time why this should not be done. Often my arguments are unconvincing, and the next time the patient still brings the results of tests and asks for their comments. In the work of most gynecologists tests for hormones and smear infection-probably the main components of their work. Such actions can be compared to the ritual throwing cards fortune teller and studying the coffee grounds – something will show, and from this it is already possible to dance on. The main idea that I will try to convey to you is: “If you have a more or less regular menstrual cycle – you do not have a violation in hormones, and it is not necessary to investigate them.” Immediately make a reservation that hormone tests routinely take in clinics reproduction for in vitro fertilization program (IVF) – in these cases, it is a perfectly reasonable appointment, it is necessary. Also, hormonal studies are necessary for the formulation of congenital disorders of the reproductive system, but this is a completely separate topic. I will still talk about situations where “the study of hormonal background” accompanies almost any visit to the gynecologist, or the desire of a woman to find out for herself whether everything is fine with her.
Hormone tests are actually taken from almost everyone, no matter what the patient may have addressed, the patients themselves often look for an explanation for their poor health in these tests, not only in the field of gynecology. Let’s understand what these analyses can show, how informative and necessary they really are.
To begin with, let’s list which tests for which hormones are most often prescribed. It’s FSH, LH, estradiol, testosterone, prolactin, DHEAS, progesterone, 17-Oh-progesterone, TSH and T4 free, and AMG.
FSH and LH are pituitary hormones that regulate the menstrual cycle.
FSH and LH are two pituitary hormones that regulate the menstrual cycle, I described their work in detail above. Evaluation of the ratio of these hormones is carried out only at the beginning of the cycle on the 2-3 th day of the cycle. Normally at the beginning of the cycle, as I hope you remember, the main employee is FSH, that is, its number should be greater than LH. If this ratio is present, then the menstrual cycle must pass correctly. If, on the contrary, LH more than FSH – the cycle will proceed properly because of LH in the beginning of the cycle will not be able to start the growth of follicles, and will only accumulate billets (male sex hormones) in the environment of the follicles that will not turn into female hormones, because this process leads FSH. In other words, when FSH exceeds LH, the plant starts and works, everything goes as it should; if LH exceeds FSH, blanks are brought to the plant, but the conveyor does not turn on. As a result, in such a cycle, the follicles will not grow, the dominant follicle is not formed, ovulation will not happen, and the cycle will be very long, that is, there will be a delay. This situation is typical for such a disease as” polycystic ovary syndrome”, in which menstruation comes very rarely (several times a year), and the level of male sex hormones is increased, since LH accumulates them in the follicles, and FSH is lazy to transform them into female hormones. This disease is much more complicated, you can read more about it in my book “the General book for women.”
The ratio of hormones FSH and LH can be broken under stress.
But not only in this disease can be disturbed ratio of FSH and LH at the beginning of the cycle. This can happen normally several times a year, be in any violation of the cycle, for example, caused by stress, sports, weight loss, etc., that is, simply reflect the situation in which a particular menstrual cycle was broken. Now the question to experts: if you have a regular menstrual cycle (with fluctuations in a few days), you need to take tests for FSH and LH? Correctly, it is not necessary, since the fact of regularity of the menstrual cycle already suggests that the ratio of these hormones is normal, otherwise the cycle would be irregular. If you have started to actively engage in sports, especially running, and you have lost your period, which before was like a clock – it is obvious that these are interrelated things, and there is no sense to study these hormones.
Estradiol-the main female sex hormone, which synthesize ovarian follicles during growth by converting male sex hormones; regulates this process FSH. At the beginning of the cycle, when the follicles have not yet begun to grow, the concentration of this hormone is small, but by ovulation its values can grow very significantly. Rules for this hormone in laboratories specified for the first phase of the cycle, for example 68-1269 n/mol per liter. Since hormones are usually passed on the 2-3 th day of the cycle, when ovarian activity is minimal, then the estradiol index should be minimal. Often, interpreting test results, would-be gynecologists indicate that estradiol level on the “low end of normal”, and do terrible conclusion that women lack the female hormones that the ovaries have done the work, and then prescribe replacement therapy with estrogens. I hope you understand the frightening folly of such conclusions. In fact, at the beginning of the cycle, the level of your estradiol should be at the lower limit of the norm, since the ovaries have not yet begun to actively produce it.
Blood on hormones it is necessary to pass on the 2-3 day of the cycle, when ovarian activity is minimal.
In General, we need estradiol only in conjunction with FSH, when it is necessary to assess the state of the ovaries in women with suspected premature ovarian depletion or to include them in the stimulation cycle in the IVF program. Since FSH production depends on the ovarian response, we can assess whether the ovary is still able to produce enough estradiol in response to FSH stimuli. For example, if in the analysis we see that the FSH index is 40 (at a rate of 10), and estradiol – 110, in this case we see that FSH is repeatedly increased in attempts to get a response from the ovary, and the ovary can not “squeeze” out of itself enough hormones to FSH “calmed down”. Here is this “fork” between these two hormones and will allow us suspect, that in ovaries remained little follicles and they depleted. Ultrasound examination and analysis on AMH, as a rule, confirm this. Thus, the indication for testing for estradiol is only a suspicion of premature ovarian depletion or confirmation of the onset of menopause in older women, when they happen to delay menstruation. It is also important to remember that estradiol, like all hormones in the body, does not have constant indicators. It can vary from cycle to cycle, and it depends on a variety of reasons that are within the physiological fluctuations. Therefore, it is not necessary to compare your tests and be afraid of the fact that a year ago your estradiol level was higher than this year.
Indications for testing for estradiol is only a suspicion of premature ovarian depletion.
Testosterone-male sex hormone, without which it is impossible to create female sex hormones, that is, female sex hormones are obtained only by converting from male. Testosterone is synthesized in the ovaries and adrenal glands and is extremely necessary for a woman. At the beginning of the cycle, under the influence of FSH, it begins to turn into estradiol. So if you didn’t have male sex hormones, you wouldn’t have female hormones. In addition, male sex hormones are responsible for your libido and temperament in General. In other words, male sex hormones are very important for women, but only in moderation. As soon as their number becomes more than necessary, the ovaries are disrupted, hateful pimples and excessive hair growth appear.
Testosterone is responsible for a woman’s libido and temperament.
If you do not use male sex hormones in drugs (anabolic steroids), the increase in male sex hormones in your body can only occur because of just a few conditions. There are congenital diseases associated with a violation of the adrenal glands (more below), you would know about it or from birth, or from the beginning of menstruation. In the event of hormone-producing tumors, the level of hormones is so high that women’s voice changes, the clitoris begins to increase in size, the menstrual cycle stops and extremely excessive hair growth is noted. An increase in the level of male sex hormones occurs in polycystic ovary syndrome, in this case it is due to their excessive production by the follicle membrane and the disturbed mechanism of their transformation into estrogens. In this case, the testosterone level will be increased moderately, not as in tumors. And the last reason-the level of male sex hormones can be slightly increased with any menstrual cycle disorder caused by external causes such as stress, sports, weight changes, etc. Here everything is obvious: against the background of suspended, for example because of stress, the reproductive system “procurement of estrogens” male sex hormones accumulate in the ovary and do not turn into female.
Now let’s analyze the most common situation – you do not have polycystic ovary syndrome, tumors and menstruation in General go regularly. Recently, against the background of stress or active sports began to break the regularity of the cycle. The doctor takes tests and sees a slight increase in testosterone levels in the blood. This increase is called the cause of all the troubles, and prescribed drugs (usually contraceptives) with antiandrogenic effect. In fact, this increase in testosterone is not a cause, but a consequence of menstrual cycle disorders, that is, as soon as the external cause is eliminated (stress will pass, for example), this testosterone will be used to turn into female sex hormones – and the problem will be solved. I hope you get the point.
Hair growth is affected by an overabundance of testosterone and the activity of the enzyme 5-alpha-reductase.
Now the main question: does the level of male sex hormones in the blood on the fact that you have pimples and increased hair growth? Affects, but not directly. Very important is the sensitivity of tissues to sex hormones, or rather, the activity of a special enzyme-5-alpha-reductase, which from testosterone creates a more active hormone. Thus, if the activity of this hormone is increased, even the normal level of male sex hormones in the blood can lead to hair growth or enhance the production of sebum, which is the basis for the appearance of acne. This is a fairly simplified scheme, but I brought it here to explain that not everything depends on the blood hormone levels. Often cosmetologists send their patients to the gynecologist, in the first place to exclude hormonal problems. In fact, the fact that there is a regular cycle in itself indicates that the ratio of hormones is normal, so in this case, it makes no sense to take tests. The presence of acne and increased hair growth on the body with a regular cycle will be largely due to ethnic reasons, or increased sensitivity of tissues to male sex hormones, which requires appropriate correction.
To take a blood test for 17-Oh-progesterone and DHEAS does not make sense to women, who already had a separate pregnancy.
To finish the topic with male sex hormones, it is worth briefly describing another hormone that is often studied in conjunction with testosterone – dehydroepiandrostenedione sulfate (dgeas). This hormone is produced by the adrenal glands, then in the peripheral tissues it turns out testosterone. The study of this hormone is shown only in the diagnosis of such a disease as adrenogenital syndrome – a congenital defect of enzymes in the adrenal glands. As a result of this defect in the adrenal glands disrupted hormone synthesis, and they begin to produce excess male sex hormones. This disease has two variants of development: symptoms appear at birth, with girls there is a violation of the structure of the external genitals; and the second option-when the disease manifests itself only during puberty in the form of menstrual irregularity. I accidentally brought up this quite complex information. The fact that to exclude or confirm the presence of this disease is quite simple – a blood test for 17-ON-progesterone and dgeas. If these indicators are increased within certain limits, the diagnosis is confirmed; if not-then this disease is absent. That is, these tests are given only once in the life of women with serious menstrual irregularities or as part of the examination of infertile couples. In practice, I constantly meet in patients of different ages tests for these two hormones, which is especially funny-in patients who have had more than one independent pregnancy, which is almost impossible in the presence of this disease. In other words, the diagnosis “congenital adrenal hyperplasia” is most often in adolescence in the process of ascertaining the causes of menstrual irregularities, and to explore the 17-Oh-progesterone and DHEAS routine in adult women with a regular menstrual cycle is ridiculous.
Insufficient production of progesterone in the second phase of the cycle we are treated with antiseptic and utrozhestane. But most of the time it is absolutely meaningless.
Progesterone is another female sex hormone that is produced by the yellow body during the second phase of the cycle. Its main task is to prepare the body for the beginning of pregnancy and, if pregnancy has occurred, to maintain it until the birth. To evaluate the performance of this hormone in the first phase of the cycle is completely meaningless, since progesterone at this time is in minimal concentrations and does nothing. It makes sense to estimate the amount of progesterone only in the second phase of the cycle, when the yellow body is actively working. The only task of this analysis is to confirm the fact of ovulation, that is, to prove that the egg came out of the follicle and formed a yellow body.
Progesterone deficiency is typical for women of late reproductive age.
In our country like to assess the level of progesterone in the second phase of the cycle, as firmly believe in the same “insufficiency of the second phase of the cycle,” explaining this diagnosis difficulties in pregnancy. As treatment is widely prescribed an antiseptic or cough medicine (analogues of progesterone) in order to fill the alleged deficiency. In fact, the second phase of the cycle is extremely rare and predominantly in women of late reproductive age. “Fix” this condition in the future is simply impossible. The fact is that in each cycle a completely new yellow body is formed, and what it will be and how it will produce progesterone depends on which follicle was chosen dominant and how ovulation occurred. If the follicle was defective, and in the process of ovulation there was an excessive hemorrhage in the cavity of the corpus luteum, in fact, progesterone production may be impaired. Luteum – a temporary gland, it exists only 12-14 days (if no pregnancy) and then disappear forever. Obviously, if you study progesterone in one menstrual cycle and, for example, see that it is low, you can not extrapolate this result to the next cycle, because it will be a completely new yellow body, and a reduced rate of this hormone in this cycle does not indicate that it will repeat again. Now, I hope, it becomes clear how stupid on a single indicator of progesterone in one cycle to diagnose “insufficiency of the second phase of the cycle” and prescribe dufaston from the 16th to the 25th day of the cycle for the next 3-6 months. The meaning of this assignment no. Then in what situation do we need this analysis? In fact, only for laboratory confirmation of ovulation, if during ultrasound there is no convincing evidence of the presence of the yellow body. This is required for examination as part of infertility treatment. If you have a regular cycle, it does not make sense to take this analysis.
To test for progesterone if regular cycle is meaningless.
Prolactin is a pituitary hormone, the main task of which is to organize the lactation process (milk production by the mammary glands). In parallel, prolactin should temporarily turn off reproductive function, so that the mother can safely feed the child and not yet become pregnant. Yes, some women even on the background of feeding the menstrual cycle is restored, but this once again shows that there are no clear rules in the body and there are many individual characteristics. Prolactin levels can rise and outside of lactation. One of the most common causes is pituitary adenoma, a small benign tumor that produces a lot of prolactin. In the vast majority of cases, they are not dangerous, do not require removal, and treatment of this condition is carried out medicamentally. In response to an increase in prolactin levels, a woman’s menstrual cycle is disrupted, so a blood test for prolactin is on the list of tests we prescribe to find out the cause.
In order for the result of the analysis for prolactin to be objective, it is necessary to follow several rules. The analysis is given in the morning after at least eight hours of restful sleep, the day before it is important to refrain from sexual activity, orgasms, stress, do not touch the nipples and do not wear a tight bra. All of the above can lead to an increase in prolactin, which will affect the result. Interpretation of the analysis also has nuances. Often you get only one result from the laboratory, for example, that your prolactin is elevated. However, prolactin in the blood exists in two forms: macroprolactin – inactive prolactin and macroprolactin – just active prolactin. The General rise in prolactin may be due to the increase in both macro-and macroprolactin. Because the increase in the level of macroprolactin has no value for the organism, as it has no effect on the tissue, it is important to always in the General level of prolactin to perform additional analysis on macroprolactin. If there is an increased level of macroprolactin, only in this case, treatment is required. Modern lab immediately isolate the rate of macroprolactin if the level of total prolactin increased. Thus, the analysis for prolactin is necessary only in violation of the regularity of the menstrual cycle.
When testing for prolactin levels should be borne in mind that the increase in macroprolactin does not matter, the important data on macroprolactin!
TSH and T4 free evaluate thyroid function, but since the work of this gland can affect the reproductive system, gynecologists often prescribe tests for these hormones. TSH (thyroid stimulating hormone) essentially works the same way as FSH for the ovaries: it stimulates the thyroid gland and depends on how much of these hormones the thyroid gland produces. The main thyroid hormone is thyroxine (T4), so if the thyroid gland produces few hormones, the level of TSH increases, and T4 – decreases, and Vice versa. Endocrinologists are engaged in the treatment of thyroid pathology, the gynecologist can only suspect the presence of a problem, but after all send to a profile specialist. Any disorders of the thyroid gland can lead to a violation of the regularity of the menstrual cycle, as well as indirectly affect the possibility of pregnancy and gestation. At the initial stages of dysfunction of this gland, bright clinical manifestations may not be, but since thyroid hormones regulate almost all metabolic processes in the body, it is important to detect these disorders in time. In this regard, the analysis of TSH and T4-perhaps the only ones that are advisable to take to assess their “hormonal background”.
Treatment of thyroid pathology is the responsibility of the endocrinologist. But in the competence of the gynecologist to suspect the presence of a problem.
AMH is an anti-Muller hormone, it allows you to evaluate the so-called” ovarian reserve”, in other words, the time of the ovary. This indicator is determined by the number of remaining in the ovary immature follicles, without which the ovary can not perform its function-to synthesize hormones and produce an egg. Currently, this hormone is most often used in reproductive medicine to assess the possibility of ovulation stimulation in the IVF program. Read more about AMH in the paragraph “About menopause”. In this Chapter, I can say that a decrease in AMH, combined with an increase in FSH and a decrease in the number of follicles in the ovaries during ultrasound may indicate that your reproductive period is coming to an end, but it is impossible to say exactly when this will happen on the basis of such a survey. The results of such studies should not sow panic, they can only indicate that if you delayed the birth of children, and this is in your plans, it is necessary to accelerate their implementation.
A decrease in AMH and an increase in FSH may indicate a decrease in reproductive potential.
Now there is a logical question: what, in fact, hormonal background all the time we are talking about? What is the doctor studying or do you want to know, considering the result of tests for hormones? If you have a regular menstrual cycle, you do not need any tests for hormones. None of the gynecological diseases is associated with a violation of the “hormonal background”, except for the menopause, when ovarian failure causes a deficiency of female sex hormones. Neither uterine fibroids nor endometriosis, polyps, cysts or endometrial hyperplasia require an assessment of hormone levels, as this does not affect the choice of treatment. Yes, with simple endometrial hyperplasia, the level of estradiol will be increased due to the formation of a functional ovarian cyst (more in the relevant chapters), but it is so obvious during ultrasound, it is not necessary to confirm this analysis.
A separate issue analyzes on hormones before prescribing hormonal contraceptives. In fact, these tests are not necessary at all, since there are no recommendations that would determine what kind of contraceptive you prescribe for certain indicators of hormones. Thus, when the doctor intelligently examines your tests and on the basis of this “selects” you a drug – it’s nothing more than a show, in which, perhaps, the doctor believes himself. Read about the selection of contraceptives in the paragraph “about contraceptives”.
Tests for hormones (if the cycle is regular) when prescribing contraceptives are not needed!
Then in what cases it is necessary to take tests for hormones? Hormone tests are needed to determine the causes of irregularities in the menstrual cycle, while mainly in cases where the violations occurred from the very beginning, that is, from the first period. The study of hormone levels is necessary in the examination of a infertile couple, if a woman has an irregular menstrual cycle, as well as in the IVF program. During premenopause, hormone indicators will help determine the cause of menstruation delay, that is, to understand whether menopause has occurred. And in some situations. In all other cases, tests for hormones-an extra study, not carrying any useful information. Once again, let me remind you the rule: if you have a relatively regular menstrual cycle – your hormones are normal.