Female Hormone Profile Blood Test

Pituitary and ovarian hormones

• FSH (measured): drives follicle growth; rises when ovarian activity declines.
• LH (measured): triggers ovulation; read alongside FSH and cycle day.
• Oestradiol (measured): the main oestrogen from developing follicles; varies through the cycle.
• Prolactin (measured): pituitary hormone that can suppress ovulation when raised.

Androgen markers

• Testosterone (measured): total testosterone, bound and unbound.
• SHBG (measured): binding protein that limits how much testosterone is available.
• Free Androgen Index (calculated from testosterone and SHBG): an estimate of unbound, active testosterone.

Thyroid function

• TSH (measured): the most sensitive single marker of thyroid function.
• Free T4 (measured): the main hormone released by the thyroid.
• Free T3 (measured): the more active thyroid hormone, mostly formed from T4 in tissues.

The laboratory counts this panel as 10 biomarkers: nine measured directly and one (the FAI) calculated. Progesterone, anti-Müllerian hormone (AMH) and thyroid antibodies are not included.

The ovaries are controlled by the hypothalamic–pituitary–ovarian axis. The hypothalamus releases gonadotrophin-releasing hormone (GnRH) in pulses, and the pituitary responds with follicle-stimulating hormone (FSH) and luteinising hormone (LH). FSH stimulates follicles to grow and produce oestradiol; around mid-cycle a surge of LH triggers ovulation, after which progesterone rises. Because these hormones change from day to day, a single result is a snapshot that has to be read against the day of the cycle it was taken.

Androgens and SHBG

Women produce testosterone in the ovaries and adrenal glands, in much smaller amounts than men. Most of it is bound to sex hormone-binding globulin (SHBG), a liver protein, so total testosterone is read alongside SHBG. The Free Androgen Index (FAI) divides testosterone by SHBG (multiplied by 100) to estimate the available fraction. The 2023 international guideline on polycystic ovary syndrome (PCOS) recommends total and calculated free testosterone, such as the FAI, to assess biochemical androgen excess, and notes that direct immunoassays are less accurate at female concentrations than mass spectrometry (LC-MS/MS) methods.

Prolactin

Prolactin, a pituitary hormone that supports milk production, suppresses GnRH when raised and can cause irregular or absent periods. It rises in pregnancy and breastfeeding and can be raised by some medicines, an underactive thyroid, kidney disease, a benign pituitary tumour (prolactinoma) or the stress of a blood test. Endocrine Society guidance describes how clinicians work through these causes.

Thyroid hormones

Thyroid-stimulating hormone (TSH) drives the thyroid to produce T4 and T3. Both under- and overactivity can disturb the cycle, and their symptoms overlap with perimenopause. NICE uses TSH as the usual first test, adding free T4 and free T3 depending on the result; this panel reports all three.

Around the menopause

As follicles decline, FSH rises, but during perimenopause FSH and oestradiol swing from month to month. NICE therefore does not recommend FSH, oestradiol, anti-Müllerian hormone or inhibin to diagnose perimenopause or menopause over 45. FSH is reserved for women aged 40 to 45 with symptoms including a cycle change, and for women under 40 in whom menopause is suspected, where premature ovarian insufficiency is diagnosed on symptoms plus raised FSH on two samples 4 to 6 weeks apart.

Your report shows each result with the laboratory's reference range. For FSH, LH and oestradiol, laboratories usually give separate ranges for each cycle phase and after the menopause, so record the first day of your last period when you book. Ranges differ between laboratories and methods, so compare results from different laboratories with care.

Patterns clinicians look at

• Raised FSH with low oestradiol suggests reduced ovarian activity. Over 45 this usually fits the menopause transition; under 40 it needs a repeat test and medical assessment.
• Low or low-normal FSH and LH with low oestradiol can occur when the hypothalamus is suppressed (for example with low body weight, intensive training or significant illness) and occasionally with pituitary conditions.
• Raised testosterone or FAI may support a clinical picture of androgen excess, but PCOS is never diagnosed on a blood test alone.
• Raised prolactin is often repeated before further investigation, because stress, recent breast stimulation, some medicines and a harmless large form of prolactin (macroprolactin) can all raise the result.
• Abnormal TSH is usually confirmed with a repeat test; NICE advises that repeat thyroid tests are not usually done within 6 weeks of the previous one.

Things that change results without disease

Hormonal contraception and HRT alter FSH, LH, oestradiol and SHBG; oestrogen raises SHBG, which lowers the FAI. Pregnancy and breastfeeding change most results. High-dose biotin can interfere with immunoassays, and recent illness can temporarily change thyroid results.

If any result falls outside the reference range, we recommend discussing it with your GP. With your consent, Juvenology can write to your GP with a copy of your results. Please see your GP promptly regardless of this test if you have bleeding after the menopause, have had no periods for three months and are not pregnant, or have new milky nipple discharge.

Hormone and thyroid problems produce overlapping symptoms: irregular periods, tiredness, mood or weight changes, hot flushes, and hair thinning or excess hair growth. Looking at pituitary, ovarian, androgen and thyroid markers together helps a clinician decide which system to focus on.

The results support a conversation with a clinician. On their own they cannot diagnose PCOS, menopause, thyroid disease or a pituitary disorder.

May be helpful for

• Women under 45 with irregular periods or menopause-type symptoms
• People being assessed for possible androgen excess
• Anyone asked by their GP or specialist for these particular markers

May not be the right test if

• You are 45 or over with typical menopause symptoms and want a diagnosis: NICE advises this is made from symptoms, and your GP can help
• You use combined hormonal contraception or HRT, as results are difficult to interpret (please do not stop either without advice from your prescriber)
• You might be pregnant: a pregnancy test should come first
• You want to assess fertility: this panel does not confirm ovulation (progesterone) or estimate egg reserve (AMH)
• You have heavy bleeding, severe pain or feel unwell: please contact your GP or NHS 111

Menopause is a natural stage of life, and the hormonal changes around it are expected. NICE's position is that, for women aged 45 or over with typical symptoms, knowing FSH or oestradiol levels does not change management. Decisions about symptom relief, including hormone replacement therapy, are made on symptoms and an individual discussion of benefits and risks, not on hormone levels.

Testing matters more earlier in life: recognising premature ovarian insufficiency before 40 is important for long-term bone and cardiovascular health.

At a population level, low SHBG is associated with insulin resistance. Associations across groups do not mean an individual result predicts disease. There are no evidence-based ‘optimal’ hormone ranges for healthy ageing, and this test does not measure biological age.

• Cycle timing: if you have periods, book for day 2 to 5 of your cycle (day 1 is the first day of bleeding) unless your clinician has asked for a different day. If your periods are irregular or absent, the test can be taken on any day; note the date of your last period.
• Time of day: a morning appointment is preferred, but not immediately after waking, as prolactin can be raised by sleep and stress.
• Food and drink: fasting is not normally required.
• Biotin: if you take biotin or a hair, skin and nails supplement, tell us; the laboratory will advise how long to pause it.
• Hormonal medicines: tell us about any contraception, HRT, fertility treatment or thyroid medicine. Do not stop or change any of these to take the test.
• Illness and exercise: avoid testing during acute illness or straight after very intense exercise.
• Breast stimulation: avoid breast or nipple stimulation shortly before the test, as this can raise prolactin.

Choose how your sample is taken when you book. We confirm the collection option, any collection fee and the expected turnaround time before you book.

• Juvenology Clinic, Maidstone (82 King Street, Maidstone ME14 1BH): Available.
• Partner clinic near you, anywhere in the UK: Available on request. We confirm availability for your postcode before you book.
• Postal home finger-prick kit: Ask before ordering. We offer a home kit only where the laboratory confirms this test is suitable for a finger-prick sample.

Sample: Venous blood sample (serum)

Collection notes: If you have periods, book for day 2 to 5 of your cycle unless your clinician has advised otherwise, and note the first day of your last period. A morning appointment is preferred, not immediately after waking. A home finger-prick kit is offered only if the laboratory confirms that all ten markers can be reported reliably from a capillary sample.

The price of this test covers laboratory analysis and the laboratory's results report. The report lists each result beside the laboratory's reference range.

Beyond the blood test: optional support, priced separately

• Personalised written interpretation report: £50
• General consultation: £50
• Results consultation (results discussion and follow-up advice): £100
• Personalised programme: from £150, after we assess whether a programme suits you

Consultations are with Marina, an NMC-registered nurse. She explains what your results show and how they relate to lifestyle. No prescription service is offered with these tests.

If a result suggests you need medical follow-up, we will recommend that you see your GP and, with your consent, can provide a letter to take with you. A blood test cannot rule out every condition. If you have symptoms, speak to your GP or NHS 111, and call 999 in an emergency.

Can this test tell me whether I am in the menopause?

Over 45, NICE advises diagnosis from symptoms because hormone levels fluctuate too much. FSH has a role between 40 and 45 with a cycle change, and under 40, where a repeat test 4 to 6 weeks later is needed.

Which day of my cycle should I have the test?

With regular periods, day 2 to 5 is usual unless your clinician asks otherwise. If periods are irregular or absent, any day is acceptable. Record the first day of your last period.

I use the combined pill or HRT. Is the test still useful?

Thyroid results remain interpretable, but most ovarian and androgen results are hard to read. The 2023 PCOS guideline notes that if androgen testing is essential, a clinician may advise a three-month break from the pill with other contraception. Never stop contraception or HRT without advice from your prescriber.

Will this test diagnose PCOS?

No blood test diagnoses PCOS on its own. Diagnosis combines cycle history, signs of androgen excess and, in adults, ovarian assessment, after excluding conditions such as thyroid disease and raised prolactin. This panel covers several of the blood tests used in that assessment.

Does this test check my fertility?

Not directly. It does not include progesterone (to confirm ovulation) or AMH (to estimate ovarian reserve). If you are trying to conceive, your GP can advise on fertility investigations.

Is interpretation included in the price?

The price covers laboratory analysis and the laboratory's report, which shows each result with its reference range. You can add a personalised written interpretation report (£50) or book a results consultation (£100) with Marina, our NMC-registered nurse. Where a result needs medical attention, we will advise you to see your GP.

1. Menopause: identification and management (NG23). National Institute for Health and Care Excellence, 2015, updated 2024. https://www.nice.org.uk/guidance/ng23
2. Menopause. Quality standard QS143, statement 1: Diagnosing perimenopause and menopause. National Institute for Health and Care Excellence, 2017. https://www.nice.org.uk/guidance/qs143/chapter/quality-statement-1-diagnosing-perimenopause-and-menopause
3. Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Human Reproduction, 2023;38(9):1655–1679. https://doi.org/10.1093/humrep/dead156
4. Thyroid disease: assessment and management (NG145). National Institute for Health and Care Excellence, 2019. https://www.nice.org.uk/guidance/ng145
5. Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 2011. https://doi.org/10.1210/jc.2010-1692