What are normal hormone levels for women, and how do you get them tested?
There is no universal standard for hormone levels in women: they depend on age, cycle phase, and measurement method. Always have testing guided by a doctor who takes that context into account, especially for testosterone.
Hormone levels in women depend strongly on age and phase of the menstrual cycle, which means there is no universal 'normal'. LH, FSH, estradiol and progesterone all fluctuate from one day of the cycle to the next. Reference values are only meaningful when they are linked to a specific cycle phase, preferably around the time of ovulation. If you want your cycle hormones tested, discuss with your doctor in advance which day of the cycle the blood draw should be scheduled.
AMH (anti-Mullerian hormone) is the hormone that best indicates how many eggs you still have in reserve. This hormone declines steadily from your twenties onward and the decline accelerates toward forty. Reference values differ considerably by age group: a value of 1 to nearly 10 ng/ml is normal for women aged 20-24, whereas for women aged 48-49 a value as low as 0.01 ng/ml can already be normal. AMH can be measured at any point in the cycle, which makes it a practical measurement.
FSH rises only late in the lead-up to menopause; inhibin B declines earlier, and estradiol does not fall noticeably until roughly two years before the final menstrual period. A single FSH measurement therefore says little about menopausal status, given the large day-to-day variation.
Testosterone in women is a complicated matter. Normal values are poorly defined and vary considerably between laboratories and measurement methods. The most reliable measurement is free testosterone using a specialized technique (equilibrium dialysis), but in practice calculated free testosterone, based on total testosterone plus SHBG (the transport protein that binds testosterone), is a good alternative. The commonly used rapid tests for free testosterone from a fingerprick or direct immunoassay are less reliable. Furthermore, testosterone in women barely declines during menopause itself; symptoms such as reduced libido in that phase are more often linked to the fall in estradiol. Harmonized reference values for testosterone in women do not yet exist: an international process to develop them is under way, but has not yet been completed.
If you want your hormones tested, the first step is a conversation with your general practitioner or gynecologist, who can determine which hormones are worth measuring and at what point in time. Always ask about cycle day, your age, and the measurement method, because these factors determine how the result should be interpreted.
This answer is based on reviews, a large multicenter study in more than a thousand healthy women, and smaller studies on testosterone measurement and hormonal changes during menopause. The AMH reference values are the best supported. The evidence is thinnest for testosterone: international experts acknowledge that reliable reference values for women are still lacking and that harmonized standards are still being developed.
How do you get your hormone levels tested during perimenopause?
Hormone tests during perimenopause are difficult to interpret: AMH is the most practical option, but does not reliably predict your fertility. Always have results interpreted with the guidance of a doctor.
How do your hormone levels change throughout your menstrual cycle?
Your hormone levels follow a recognisable pattern throughout the cycle: oestrogen and progesterone rise and fall at set moments, with a sharp LH peak around ovulation. Bear in mind that there are large differences between women, and that the pill largely suppresses this pattern.
Which hormone levels are tested during menopause?
During menopause, the hormones measured most commonly are FSH, LH, oestradiol, progesterone, testosterone and AMH; elevated FSH combined with reduced oestradiol (below 20 pg/ml) is the most reliable sign that menopause has begun, but always have your results explained by your doctor, as body weight and background influence reference values.
Is testosterone important for women?
Testosterone is a physiologically relevant hormone for women, with the strongest evidence for sexual desire and sexual function. If you have symptoms consistent with low testosterone levels, it is worth discussing this with your doctor, including the choice of skin-based delivery.
Which hormone levels are characteristic of perimenopause and menopause?
Characteristic features are an early decline in AMH and inhibin B, followed by a rise in FSH and a late sharp fall in oestradiol. If you have symptoms, do not rely on a blood test alone, as hormone levels fluctuate considerably during the transition; discuss the pattern of your menstrual cycles and symptoms with your doctor.
Does hormone therapy help women age more healthily?
Hormone therapy relieves menopausal symptoms well and shows positive indications for bones and metabolism, but the effects on the heart and brain are uncertain and highly individual. Whether it is worthwhile for you depends strongly on your symptoms, timing and health history: discuss it with your doctor.