Female Hormone blood tests explained - from periods to pregnancy to menopause

There are lots of reasons why women check their hormones, from curiosity to fertility, from irregular periods to menopause, and even specific conditions like polycystic ovarian syndrome. Blood tests paint the picture, but it's only part of the picture, and blood tests need to be put into a wider clinical narrative involving your symptoms, your lifestyle, and sometimes even a hands-on check-up as well.

At Dr. Kamini Rao Hospitals, blood tests related to hormones are viewed as just one part of a woman’s overall health. Our doctors understand that hormone levels can change with age, stress, lifestyle, and different phases of the menstrual cycle, which is why results are always interpreted alongside symptoms, ultrasound findings, medical history, and clinical examination. From concerns like irregular periods and PCOS to fertility evaluation, IVF planning, pregnancy care, and menopause management, the focus is on personalised and compassionate care. Recognised by many patients as one of the best IVF centres in Bangalore, the hospital combines experienced specialists, advanced fertility treatments, and counselling to help women clearly understand their reports and confidently move forward in their reproductive journey.

So let us take you through female hormones today, from puberty to fertility to menopause.

Let's start with the two main female hormones:

Estrogen
Progesterone

These hormones are produced mainly by the ovaries, with some contribution from the adrenal glands as well. Estrogen is responsible for the regulation of the female reproductive system. It's involved in the growth of breast tissue, the menstrual cycle, and the development of secondary sexual characteristics like wider hips and pubic hair. When you get a blood test, we tend to look at one of the main estrogens called estradiol. During the menstrual cycle, estrogen levels rise, stimulating the release of an egg from the ovary. It also helps to thicken the lining of your uterus, preparing it for a potential pregnancy.

Progesterone is primarily produced by the ovaries after ovulation occurs. Progesterone is another important hormone that has important roles in, again, females' reproduction and menstrual cycle. Progesterone also has important roles in preparing the lining of the uterus, the endometrial lining for implantation of an embryo. It has important roles in early pregnancy and helps maintain the pregnancy early on. The hormone prepares the uterus for egg implantation if fertilization happens, and maintains a healthy lining should pregnancy occur. If pregnancy doesn't occur, then estrogen and progesterone levels drop, causing the lining to be shed and be released from your body, and that's known as menstruation or a period. And for most women, that lasts a few days to a week.

Now let's introduce two more hormones before we dig into what we look for in the hormone blood test.

Follicle Stimulating Hormone, or FSH, and
Luteinizing Hormone, or LH.

Both these hormones are released from the pituitary gland in your brain.

FSH promotes the growth and development of the ovarian follicles, which contain your eggs. FSH stands for follicle stimulating hormone. This is a hormone that is secreted by our pituitary gland, which is a small gland underneath the brain. And as the name suggests, FSH or follicle stimulating hormone stimulates growth of an ovarian follicle.

So, in the first half of a woman's menstrual cycle, there is a secretion of FSH from the pituitary hormone, which can result in growth of an ovarian follicle containing an egg. Estradiol or estrogen is a hormone that is secreted by a woman's ovaries. And so, as the follicle is growing in response to follicle stimulating hormone, it starts secreting estrogen. And by measuring the level of estrogen in the blood, we can determine if the follicle is mature. So we can determine the maturity of an ovarian follicle. In an IVF cycle or in vitro fertilization cycle, we continuously monitor serum estradiol levels that kind of helps us determine if the ovaries have developed mature follicles. So we use it as a marker of ovarian follicular growth and development.

LH stands for luteinizing hormone. LH triggers ovulation, which is the release of an egg from your ovary. All of your hormones work together in this delicate and beautiful way to orchestrate your menstrual cycle and to ensure proper reproductive function. This is also another hormone that is secreted by the pituitary gland and has very important roles in sexual development and a woman's reproductive function and also regulating a woman's menstrual cycle. It is also an important hormone determining ovulation and the timing of ovulation. So typically LH levels increase right before a woman ovulates. And we use this increase or surge in LH levels to determine when a woman is going to be ovulating.

When a girl is born, she has all of her eggs in her ovaries, millions of them. By the time you reach puberty, it's more like 300 to 500,000, which is still quite a lot. And once you start having periods during each menstrual cycle, a group of eggs begin to mature, but only one reaches full maturity and is released in ovulation. The other eggs degenerate and are absorbed by the body.

For the first few years of periods, they might be a bit irregular, but by your mid-twenties, most women's periods and cycles are pretty regular, normally lasting about 28 to 35 days on average, unless you get pregnant, of course. Your periods then get more irregular again as you then approach the menopause. Now, it's really important to know that all your hormones vary over your cycle.

In order to interpret blood test results properly, it's vital to know what day of the cycle you took your test. The first day of your cycle being the first day that you start bleeding. Let's say someone is entirely textbook normal. Your menstrual cycle hormones look a little bit like this, but if you're having irregular periods, it's worth looking at whether there's any disruption here. Ideally, you take your test on day 4-6 of your cycle, and that's because you're most likely to be in the follicular phase. That's one of the two main phases of your menstrual cycle and is the first half of the cycle.

After you ovulate, you're in the second phase, which is called the luteal phase. Things which can disrupt hormones at this stage are things like contraception, especially the pill, conditions like polycystic ovarian syndrome, and high stress levels, including those women who might have a low body weight or are high-level athletes. High stress can stop your periods.

So, looking at your hormones is important. You may have a low estradiol level, which could be an indication of something like ovarian failure or those high stress levels we spoke about.

We can also add in another hormone at this stage, testosterone.

Yes, it's not just for men. Women have it as well in far lower levels. However, one condition where it's higher than it should be is polycystic ovarian syndrome or PCOS. PCOS is quite common and can lead to a range of symptoms, including irregular periods, excess hair growth, acne, weight gain, and so on. It can cause issues with sugar and cholesterol regulation and with fertility. So, a high testosterone might point towards something like that, which you can then follow up with your doctor, who can do an ultrasound scan to confirm it and take things further.

Now, what about fertility? Well, once again, we want to look at your FSH, LH and estradiol to make sure they're all doing what they should. But we might also want to throw in a couple of hormone tests here as well. If you want to check that you've ovulated, then a progesterone test seven days before the end of your cycle, i.e., before you start bleeding again, can be a good indicator of that. If an egg is released, progesterone levels tend to rise until you have your period.

There's also another hormone called Anti Mullerian Hormone (AMH), which is a good surrogate marker for how many eggs you have left. It basically drops as you get older and if you did an ultrasound scan at various points, you'd likely see fewer and fewer eggs over time. But blood tests are easier than ultrasound scans, that's why we do them. If your AMH is lower than it should be and you're interested in having children, then it might be worth speaking to a fertility doctor to discuss things like egg harvesting and other options. When you get pregnant, your hormones undergo massive shifts. This is a glycoprotein type of hormone that is secreted by granulosa cells or support cells of antral follicles, small follicles in the ovary. And so we use AMH as a marker for egg quantity or a woman's ovarian reserve.

From the ones we talked about already, you'll see your FSH and LH get suppressed, your estradiol and progesterone rise.

Another hormone which often gets tested to confirm pregnancy is beta-HCG. This hormone doubles every two to three days during pregnancy, so it's quite a good indicator if things are progressing normally.

And if you take more than one test, you can see it trending upwards. It's pretty useful for the first 10 weeks or so, but it becomes more unreliable after that stage and that's when ultrasound scans are more important.

Other hormones which kick off during pregnancy and just after include relaxin, which helps relax the ligaments around your pelvis during birth, prolactin, which stimulates the production of milk from your breasts, and oxytocin or the love hormone, which triggers contraction during labour and promotes bonding between mother and baby and triggers milk let down during breastfeeding.
Prolactin - This is another type of hormone, also known as lactotroph, that is secreted by the anterior part of the pituitary gland, the same gland that is underneath the brain. And so, prolactin is important in breast development, is also important in a woman's lactation and ability to breastfeed, but is also important in regulating a woman's menstrual cycle and a woman's fertility. So, when we are working, when we are evaluating a woman's fertility, we measure serum prolactin levels because elevated levels of serum prolactin can inhibit or prevent from ovulation, resulting in anovulation, which can then result in subfertility or infertility.
Androgens - these are male-type hormones, hormones including testosterone and DHEAS, and these hormones are typically produced and secreted by a woman's body, by a woman's ovaries and also adrenal gland, and sometimes elevated levels of these hormones can result in symptoms of hair growth or acne, skin breaking out, and this is something that we sometimes can see in women diagnosed with a condition called PCOS or polycystic ovarian syndrome.

When you go through the menopause, your ovaries have basically run out of steam and they stop producing estradiol. That's because your eggs have depleted to a level which doesn't support a menstrual cycle. What will you see on the blood test? Well, as your estradiol levels drop, your FH and LH, they both go up to try and stimulate the ovaries, but to no success.

Menopause itself can take several years and can cause a number of really bothersome symptoms, and I want to touch on this for a moment because I don't think there's a great deal of education around it. Like most things we do in health, we focus everything on men over history and we kind of forgot about women. I see a lot of women in their 40s and 50s who are convinced something is wrong with either their thyroid or their general health because they're suffering symptoms which are really affecting the quality of their life.

The reality is they're going through the and it hadn't really occurred to them because no one had told them about it. Now, I'm not saying it will make the symptoms better, but at least you'll know and you'll know what's happening to you is entirely normal and it's a normal part of female aging. Symptoms of menopause include irregular and eventually absent periods. In fact, menopause is typically classified as when you've had no periods for over 12 months. Hot flashes, flushing, sweating, rapid heartbeats and night sweats and poor sleep, vaginal dryness which is due to a lack of oestrogen, mood changes, irritability, mood swings, anxiety or even depression, lower libido, weight gain, hair thinning and hair loss and of course any of these symptoms if they're impacting your quality of life, you can always speak to your Gynaecologist or family doctor to discuss options like hormone replacement therapy which can help you feel better. Most people go through the menopause after the age of 45 but it can happen earlier and if it does especially if it's much earlier it's called premature menopause.

For some women this is genetic and others it's surgically induced with a hysterectomy. If this happens and you're under the age of 45 then it's really important to speak to your doctor. Not only will this draw a line under your fertility but it can also lead to things like bone weakness and a few other conditions down the line which will benefit from hormone replacement therapy and closer monitoring.

And there we go female hormones all wrapped up in a bow. As you've probably seen it's quite complicated and if you have a blood test you should have a clear reason for doing it and you should interpret it ideally with a health professional who can put it into context with your wider health.

When it comes to a woman's fertility, blood testing is important because it can help us physicians determine many aspects of their reproductive potential and reproductive options. Blood tests, including hormonal testing, can help us determine a woman's ovarian reserve or a quantity and just help us guide them better in their reproductive and fertility journey.

Along with patient care, continuous medical education plays a key role in improving women’s health outcomes. Medline Academics’ Fellowship in Reproductive Medicine and IVF training courses is dedicated to training doctors and healthcare professionals in a hybrid setup or full-time placements as per the students requirements. Through structured academic syllabus, clinical exposure, and expert-led sessions, Medline Academics helps clinicians better understand hormone evaluation, fertility testing, and evidence-based treatment approaches. This focus on education ensures that doctors stay updated with current practices, leading to more accurate diagnosis, better counselling, and improved care for women across all stages of reproductive life.