This is something that happens a lot in the clinic… a patient walks in with results from hormone testing they’ve managed to get done through their doctor, but there’s some really important information missing.
No one has told her at which point in her cycle to have the tests done.
This makes it very difficult to see anomalies in your hormones, because your hormones fluctuate a lot throughout the menstrual cycle, and a result may only be considered abnormal if it appears at that range at a certain time in your cycle when it’s not expected to be elevated or decreased. For example, it’s normal for progesterone to be at a 1 or 2 or 3 in the first half of your cycle, but if it’s that low in the second half of your cycle then we have big problems!
Your hormone tests are only helpful if we can put them in context of where you were at in your menstrual cycle.
So, I thought I’d share this super important information about when to get your hormones tested so that they can be interpreted properly and as useful as possible for you.
I’d also just like to preface this by saying that I send my patients to have some of these hormones (plus some other important screening pathology) tested through blood… but I prefer to have estrogen, progesterone, androstenedione, testosterone and DHT all tested via saliva. I prefer this because saliva picks up the free hormone, and blood is reflecting bound hormone.
Either way, I still use these guidelines to ensure that the tests, whether they be blood or saliva, are done at the right time.
First things first, if you don’t have a regular period, then this can all be a bit tricky to begin with. If you regularly miss cycles, or have cycles that seem to go as long or as short as they please, then trying to guess when you are a week out from your period in order to get accurate hormone testing done can be next to impossible.
If you’re tracking your period with an app (which I highly recommend you do!) then just note when you have had certain hormone tests done so that your practitioner can put the results into context of what day of your cycle you would have been at once you get your period again.
If you do have a regular cycle, then these tests are a lot easier to have done.
The Ones That Are Easy To Test At The Right Time
Probably a good place to start is knowing how to count your cycle.
Day 1 of your cycle is the first day that you start menstruating or bleeding. It’s not light spotting or very faintly coloured discharge… it’s bleeding. So, start counting day 1 from the first day you bleed.
These hormones are best tested on day 2 or 3 of your cycle.
Estrogen
Prolactin
FSH (Follicle Stimulating Hormone)
LH (Luteinising Hormone)
These hormones will increase throughout the first half of your cycle, peaking around ovulation, which should be midway through your cycle. Having these things tested on ovulation is honestly pretty pointless! We see a much better picture of your ovarian function having these hormones tested at the start of the cycle, no later than day 3. We can see through these results if you are having trouble ovulating, if period irregularity is due to ovarian dysfunction, if the thyroid is struggling, and potentially why there might be premenstrual symptoms like acne and heavy periods occurring. These hormones can also reveal answers to dysfunctional uterine bleeding (AKA spotting or bleeding happening outside of your period) and potential PCOS.
The One That’s Harder To Get Right
Progesterone is the only hormone that’s imperative to have tested later in the cycle - and this is the one that can be tricky to get the timing right if you have an irregular cycle.
The key point to getting progesterone tested is that we want it tested 7 days prior to your next expected bleed. In a textbook 28 day cycle, this would mean that testing be done on day 21 of the cycle… but if you have an irregular period, day 21 might mean sweet FA to you! Day 21 could even be closer to your ovulation window if you have a cycle that’s 35+ days long!
So, this is the tricky one. Here’s a few tips I give my patients when we can’t be 100% sure of when the next expected bleed is:
If you get premenstrual symptoms, use these as a sign of when to test progesterone. For example, if you get sore breasts a week or two before your period, then use this as your major indicator to get your progesterone tested. You might have to track these symptoms in a period tracker for a month or two or three before you can see your premenstrual pattern, and signs that your period is coming. I usually have patients track their period for 3 months at least before we start making assumptions about their period patterns and their cycle length.
Use your period tracker app to see what sort of cycle length you are averaging. If you have a 35 day cycle one month, and a 40 day cycle the next month, then I would recommend having progesterone tested around day 30 of your next cycle, because this will get us as close to the 7-days-before window as possible. A clever practitioner will be able to help guide you if this feels overwhelming to do yourself.
The reason we want to test progesterone 7 days prior to your period is because this is when progesterone should be at its peak. I always use this result and then do some quick maths to compare your progesterone level with your estrogen level to get a ration of estrogen to progesterone. This is how I can tell if there is estrogen dominance occurring, by putting it in context with how high your progesterone gets.
Progesterone mainly tells us if you are ovulating or not, and this is very frequently a problem in hormonal acne, so it’s important to have it tested… but at the right time! Having progesterone tested in the first half of the cycle is honestly one of the most pointless tests ever!
The Ones That Don’t Really Matter
And I don’t mean they don’t matter in the presentation of acne because they are major hormonal players in acne!
These ones can be tested at any point of your cycle, because they don’t fluctuate throughout the menstrual cycle like our other hormones, which are directly involved in ovulation and menstruation.
Testosterone (this is a major androgenic hormone, often responsible for acne)
DHT (dihydrotestosterone… this is a much more potent metabolite of testosterone, which can be a problem in acne)
Androstenedione (an androgenic hormone produced by the adrenals, not the ovaries… this is more related to your adrenal function and stress, and it’s elevated in about 90% of my acne patients)
SHBG (Sex Hormone Binding Globulin… this neat little protein from the liver helps to… you guessed it… bind sex hormones and get them out of the body. If this is low, then there will be issues detoxifying sex hormones, which in turn causes elevation in sex hormones like testosterone that contribute to acne)
I always have hormones extensively investigated before putting together treatment programs for my patients.
This is something you can already be looking at if you know what to ask for and when to get it tested, so I hope this is helpful in giving you some guidance to getting your hormones tested.
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Remember, it is in your uniqueness that you will find your answers.
