Importance of Female Hormone Panel - Follow-up

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Importance of Female Hormone Panel - Follow-up

Key Takeaways

  • The UK's National Health Service (NHS) states that women with a PCOS diagnosis often test positive for several hormonal imbalances, most notably elevated amounts of testosterone as well as luteinizing hormone (LH).
  • Penn Medicine similarly asserts that androgens (such as testosterone) are present in higher-than-normal amounts in women with PCOS, adding that women with the clinical condition generally have higher levels of estrogen as well as lower levels of progesterone (due to the lack of ovulation).
  • The Mayo Clinic states that levels of follicle-stimulating hormone (FSH) increase in women with menopause while levels of estrogen typically decrease, adding that doctors may call for blood tests of both FSH and estrogen to confirm a menopause diagnosis.
  • Similarly, the North American Menopause Society highlights the relevance of FSH blood tests to confirm a menopause diagnosis, adding that FSH levels of 30 mIU/mL or more are widely accepted as a key indicator of menopause.
  • Meanwhile, the International Association for Premenstrual Disorders (IAPMD) states that the female hormone panel is a key part of diagnosing premenstrual dysphoric disorder (PMDD), given that the blood tests can identify or exclude any other conditions with similar symptoms.

Introduction

The research team has curated a set of seven organizations/publications that demonstrate the correlation between key elements of the female hormone panel [estrogen, progesterone, testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH)] and suboptimal clinical conditions [polycystic ovary syndrome (PCOS), menopause, premenstrual dysphoric disorder (PMDD)]. In selecting these outlets, special care was taken to include only the most credible institutions, as well as to provide evidence of the association between a variety of relevant hormones and suboptimal clinical conditions. Additionally, direct excerpts from each of the selected resources were included to provide ready access to the content of interest and avoid potential misrepresentation. The full findings of this research have been presented directly below, organized by clinical condition for ease of review.

Polycystic Ovary Syndrome (PCOS)

#1: United Kingdom National Health Service (NHS)

  • The UK's National Health Service (NHS) currently publishes a detailed overview of polycystic ovary syndrome (PCOS) for public consumption, including details of the known hormone imbalances that characterize the clinical condition.
  • The health authority states that women with a PCOS diagnosis often test positive for several hormonal imbalances, most notably elevated amounts of testosterone as well as luteinizing hormone (LH).
  • Additionally, the NHS notes that PCOS may occur alongside elevated amounts of prolactin as well as reduced levels of sex hormone-binding globulin (SHBG).
  • A link to the full NHS publication is available here, while the relevant report excerpt is as follows: "Many women with PCOS are found to have an imbalance in certain hormones, including:
    • raised levels of testosterone — a hormone often thought of as a male hormone, although all women usually produce small amounts of it
    • raised levels of luteinizing hormone (LH) — this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
    • low levels of sex hormone-binding globulin (SHBG) — a protein in the blood that binds to testosterone and reduces its effect
    • raised levels of prolactin (only in some women with PCOS) — a hormone that stimulates the breast glands to produce milk in pregnancy."

#2: Penn Medicine

  • In a March 2020 article covering common myths about PCOS, Penn Medicine similarly highlights known hormonal imbalances that are believed to correlate with the condition.
  • In particular, the major medical organization asserts that androgens (such as testosterone) are present in higher-than-normal amounts in women with PCOS.
  • Additionally, Penn Medicine reports that women with the clinical condition generally have higher levels of estrogen as well as lower levels of progesterone (due to the lack of ovulation).
  • A direct link to the full details of this Penn Medicine article is available here, while a direct quote from the pieces is available directly below:
    • "While the exact cause of PCOS is unknown, one thing is certain: You are not to blame. However, several factors -- including genetics -- are widely believed to play a role.
    • Androgens, or male hormones, control the development of male traits. “While all women produce small amounts of androgens, those with PCOS have more androgens than normal, which can prevent ovulation and make it difficult to have regular menstrual cycles,” explained Justin Sloane, MD, physician at Penn Ob/Gyn Chester County.
    • The follicles grow and build up fluid, but the eggs do not get released. Ovulation does not occur, and the follicles might turn into cysts. If this happens, your body might fail to make the hormone progesterone, which is needed to keep your cycle regular.
    • “Women with PCOS also produce excess estrogen, or female hormones. While this does not contribute to the symptoms above, long term “unopposed estrogen” can lead to a build-up of the lining of the uterus which is a major risk factor for uterine cancer,” said Dr. Sloane."

#3: Endocrine Society

  • More recently, in January 2022, the Endocrine Society released a patient resource centered around the endocrine (or hormone) underpinning of PCOS.
  • While highlighting both the diagnosis and signs of the clinical condition, the global medical organization validated the statements of the two preceding organizations/articles by stating that excess testosterone levels are generally present in women with PCOS.
  • As such, the Endocrine Society added that blood hormone panels that include testosterone are generally performed by medical providers to diagnose the condition.
  • While a link to the publication is available here, the relevant excerpts have been included directly below:
    • "Diagnosis and Prevention: In addition to assessing signs and symptoms of PCOS, medical providers take a medical history, perform a physical exam, and check blood hormone levels (including testosterone). They may also perform an ovarian ultrasound. Other tests looking for complication of PCOS may also be done, such as glucose tolerance test or a mental health screening survey."
    • Symptoms and Risk Factors: Signs of PCOS include: Male hormone (androgen) excess — Elevated testosterone levels in blood, Clinical signs of androgen excess such as acne, hair on face and in male pattern on the body, and thinning hair on the scalp."

Menopause

#4: Mayo Clinic

  • The Mayo Clinic currently publishes a detailed overview of the symptoms, causes, diagnosis and treatment of menopause as part of its larger library of health information on diseases and conditions.
  • Within the diagnosis section of this resource, the nonprofit academic medical center states that levels of follicle-stimulating hormone (FSH) increase in women with menopause while levels of estrogen typically decrease.
  • Consistent with this generally understood hormonal connection, Mayo Clinic adds that doctors may call for blood tests of both FSH and estrogen to confirm a menopause diagnosis.
  • A link to the Mayo Clinic publication is available here, while the relevant excerpt is as follows: "Tests typically aren't needed to diagnose menopause. But under certain circumstances, your doctor may recommend blood tests to check your level of: Follicle-stimulating hormone (FSH) and estrogen (estradiol), because your FSH levels increase and estradiol levels decrease as menopause occurs."

#5: Mount Sinai

  • In a similar fashion, Mount Sinai currently hosts an overview of the condition of menopause within its online health library.
  • Within this broad discussion of the clinical condition, the American health system reports that menopause is characterized by several key hormonal changes, including the reduced production of estrogen and progesterone.
  • Mount Sinai adds that while the female body continues to generate small amounts of testosterone and androstenedione, which are converted to estrone and estradiol (forms of estrogen), total levels of estrogen remain much lower in women with menopause.
  • A direct link to the full details of this Mount Sinai piece is available here, while a direct quote is available as follows: "Menopause is marked by the following hormonal changes:
    • Ovarian secretion of estrogen and progesterone ends.
    • Although the ovaries stop producing estrogen, they still continue to produce small amounts of the male hormone testosterone, which can be converted to estrogen (estradiol) by an enzyme found in body fat.
    • The adrenal gland continues to produce androstenedione (a male hormone), which is converted to estrone and estradiol in the body fat.
    • The total estrogen produced after menopause is, however, far less than that produced during a woman's reproductive years."

#6: The North American Menopause Society

  • The North American Menopause Society currently hosts a Q&A piece related to the symptoms of menopause in women as part of its larger Menopause Flashes publication.
  • Within the article, the nonprofit organization highlights the relevance of FSH blood tests to confirm a menopause diagnosis.
  • Specifically, the North American Menopause Society states that FSH levels of 30 mIU/mL or more are widely accepted as a key indicator of menopause.
  • A link to the full Q&A piece is available here, while the relevant excerpt from this article is as follows: "Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause. When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause."


Premenstrual Dysphoric Disorder (PMDD)

#7: International Association for Premenstrual Disorders (IAPMD)

  • While the preponderance of reputable organizations/publications that cover premenstrual syndrome (PMS) and/or premenstrual dysphoric disorder (PMDD) report that any correlation between hormones and these clinical conditions is currently unknown, the International Association for Premenstrual Disorders (IAPMD) highlights the importance of the female hormone panel in diagnosing such conditions.
  • Specifically, the international resource center currently publishes a generally referenced overview of PMDD, which confirms that most women with the condition have relatively normal hormone levels, adding that PMDD appears to be a negative response to such normal changes in the female body.
  • However, given that hormonal imbalances do not typically characterize (or cause) PMDD, IAPMD states that the female hormone panel is a key part of diagnosing the condition, given that the blood tests can identify or exclude any other conditions with similar symptoms.
  • While a link to the publication is available here, the relevant excerpts are as follows: "The vast majority of women/AFAB with PMDD have normal hormone levels. PMDD appears to be a negative response to the normal fluctuations in female reproductive hormone levels. There are instances where an individual with PMDD is also suffering from a hormone imbalance, but for most hormone imbalance is not the cause of PMDD symptoms. A person exploring a PMDD diagnosis will want a Comprehensive Female Panel blood test to rule out any underlying disorders that may be causing symptoms."


Research Strategy

For this research on the correlation between hormones measured within the female hormone panel and suboptimal clinical conditions, the research team leveraged the most reputable sources available in the public domain, including the United Kingdom National Health Service, the Endocrine Society, and Mayo Clinic.

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