Proven Methods for Female Hormone Assessment
BioHealth offers specialty profiling for women and their unique hormone balancing concerns.
Using reliable and proven salivary assays (and thermal protection of your patients’ valuable samples), we produce critical data for women in every stage of life.
Premenopause, perimenopause, and menopausal dynamics are evaluated to help with common health concerns, including:
- Irregular menstruation
- Inconsistent menstrual cycles
- Mood swings
- Weight gain/loss
Assessing Female Hormones: Which Test to Run?
BioHealth provides the following test panels:
Choosing the Right Tests
To determine which sex hormone test is most appropriate for your female patients, you have to know some basic information regarding their cycles. You will need to know if they are perimenopausal or in menopause, if they have regular or irregular cycles, what the typical cycle length is each month and what symptoms they may have during their cycle.
It is important not to get the “cycle length” confused with the “duration of menses.” The cycle length is the number of days between the first day of menses in one cycle and the first day of menses in the next cycle. The duration of menses is the number of days there is a menstrual flow. Day one of the cycle is the first day of menses so any test that requires the patient to collect samples on specific days of their cycle will need to know when to start counting.
Premenopause Hormone Profile #208
Up to 17 salivary samples are taken every other day starting on day two of the cycle giving a total of 17 measurements of estradiol and progesterone. Two measurements of testosterone are taken on days 10 and 18 of the cycle. The extended profile is appropriate for women who are premenopausal or perimenopausal. This test is appropriate for perimenopausal women who are still having regular cycles but present with signs and symptoms of progesterone deficiency likely due to anovulatory (without ovulation) cycles. This test would be appropriate for women who have fertility issues, PMS, heavy menses, symptoms of progesterone deficiency and perimenopause and other associated symptoms that recur with each cycle.
Irregular cycles – If a woman has irregular cycles, the onset of menses is difficult to predict so the collecting salivary samples at any time in the extended cycle may be the best option. The timing of events within the cycle may not correlate on the graph on the lab result but we can still identify where key events are occurring within the cycle. If the irregular cycles tend to be very long, doing two Premenopause Hormone Profiles, one after the other, would allow the clinician to see if cycles are occurring within a broader time frame.
Female Hormone Profile #209 and #209E (w/Estrone)
The #209 includes a single salivary measurement of estradiol, estriol, DHEA-S, testosterone, and progesterone. The #209E includes an additional measurement of estrone. This test can be used to do a single measurement of each of these hormones in one day. Hormones fluctuate in both premenopause and perimenopause. These fluctuations are part of a normal cycle in the premenopausal woman. In perimenopause, hormone fluctuations can be more erratic with estrogen reaching highs and lows in no predictable pattern and progesterone dropping off significantly as a woman approaches menopause.
If doing a single measurement of hormones, it is best to choose the day of the cycle that will give the most information regarding output, timing and distribution. In the premenopausal woman, collections should be done on day 19, 20 or 21 of the cycle. This time frame correlates with the middle of the luteal phase of the cycle when progesterone should be peaking. Estrogen should also be rising after the post-ovulatory drop.
Taking a single salivary sample to measure hormones within a fluctuating cycle is like taking a snapshot of a moving picture. We need to pick the day that will give us the best information about hormone output. One of the most important aspects of the premenopausal and perimenopausal cycle is the progesterone to estrogen ratio. Many of the complaints that women have regarding their menstrual cycle are related to an imbalance between these two hormones. Taking samples during the mid-luteal phase (day 19, 20 or 21) will give us the best feedback regarding the ratio of estrogen and progesterone.
The #209 without the estrone can also be used to assess sex hormones in males. Both men and women produce all sex hormones and male and female reference ranges are provided on the test results.
Monitoring Hormone Replacement Therapy
Women – The #209 can be used to monitor hormone replacement therapy in premenopausal, perimenopausal and postmenopausal women. In premenopausal and perimenopausal women doing progesterone augmentation, samples need to be collected on days 19, 20 or 21 of the menstrual cycle. If using topical or sublingual progesterone, it is recommended that the progesterone be stopped 48-72 hours prior to saliva collection to avoid contamination of the sample or falsely elevated readings. If taking oral micronized progesterone, allow 24 hours to pass from the last dosage before doing saliva collections.
In postmenopausal women, samples can be collected any time. However, the rules for collection vary depending on the type of hormones being used. If using a topical or sublingual product, it is recommended to stop the hormones for 48-72 hours prior to saliva collection to avoid contamination or falsely elevated readings. If using and oral micronized version of progesterone, allow 24 hours to pass from the last dosage before collecting saliva sample.
Men – This test can also be used in men who are on testosterone and/or progesterone therapy. Samples can be collected any time as collections are not related to a cycle. If using a topical formula, dosing should be stopped 48-72 hours prior to saliva collection to avoid contamination of the sample or falsely elevated readings. If doing injections, levels tend to peak within 2-7 days after the injection so it is best to test levels between days 10-14 when testosterone levels out.
HPA Stress Profiles with Sex Hormones (#205/205E and CAR Variations)
The #205 and its variations are the most popular tests as they include diurnal cortisol and/or cortisol awakening response (CAR), DHEA-S, estradiol, estriol, progesterone, testosterone and melatonin. This test is an appropriate screening tool for both men and women who need to assess HPA function as well as sex hormones and melatonin. For women, the timing of collections should be the same as in the recommendations for the #209. For men, collections can occur at any time.
Collection Matrix for Female Hormone Testing
|#209/209E||#205/205E (Optional CAR)||#207||#208|
|Test Description||Single measurement of estradiol, progesterone, DHEA-S and testosterone (am), E=Estrone||HPA Stress Profile + Single estradiol, estriol, progesterone, testosterone, melatonin||Estradiol (11)Progesterone (11), Testosterone (2)Cycle length 24 days or less; collection day 2 thru day 22||Estradiol (17) Progesterone (17) Testosterone (2) Cycle length 25-34 days; collection day 2 thru 34|
|Perimenopause||Best measured in the luteal phase; days 19, 20 or 21 of the cycle||Best measured in the luteal phase; days 19, 20 or 21 of the cycle||Short cycle 24 days or less; used to determine ovulation, timing of progesterone supplementation||Regular to longer cycle, determine ovulation and level of progesterone: estrogen ratio|
|Pre-menopause||Best measured in the luteal phase; days 19, 20 or 21 of the cycle for accurate progesterone level||Best measured in the luteal phase: days 19, 20 or 21 of the cycle for accurate progesterone level||Short cycle 24 days or less; determine ovulation, estradiol and progesterone output||Regular to longer cycle, determine ovulation, estradiol and progesterone output|
|Menopause||No cycle; samples can be taken anytime; monitor HRT||No cycle; samples can be taken anytime; monitor HRT||N/A||N/A|
|Irregular Cycles (see above)||Wait for cycle then collect on day 19, 20 or 21 of cycle OR collect anytime||Wait for cycle then collect on day 19, 20 or 21 of cycle OR collect anytime||N/A||Wait for cycle then start collections on day 2 OR collect anytime and complete all collections|
|Short Cycles||Collect on day 19, 20 or 21; need to check progesterone in mid-luteal phase||Collect on day 19,20 or 21; need to check progesterone in mid-luteal phase||Best option to track a short cycle; start collections on day 2 of cycle||N/A|
|Male||Test collections can occur at any time (#209)||Test collections can occur at any time (#205)||N/A||N/A|
|Monitoring Hormone Replacement Therapy – Women||Premenopausal and Perimenopausal woman: Day 19, 20 or 21 of cyclePostmenopausal woman: collect samples any time if dosing of hormones is the same everyday.*||N/A||N/A||N/A|
|Monitoring Hormone Replacement Therapy – Men||Collect samples any time*||N/A||N/A||N/A|
*Refer above to the specifics on saliva collections for those who are supplementing hormones.