If you’re like most of the reproductive-age women we work with, you may have wanted to know what’s up with your hormone levels. You may even have asked your doctor to test your hormones, and they either denied your request or complied only to come back and tell you “everything is fine.” Or even worse, your doctor may have tested your hormones and then made a sweeping life-sentence statement such as “you have poor egg quality” or “you’re infertile” without explaining why.
These are scenarios we see all the time. Smart and curious women of all ages want to test and understand their hormones. Some of them order their own tests from an online service but then are not able to interpret the results properly. Kudos to these women who take their health investigation into their own hands! Do not apologize for this. I am sorry that your doctor didn’t do this for you so that you could use your health insurance and then have your test results explained by a medical expert.
Here I describe what tests to request on the third day of your cycle (arguably the most useful day of your cycle to test hormones), and what results to look for. Since you’re on a functional medicine blog you may already be aware that conventional blood lab ranges typically encompass a wide range of what is considered “normal” and that simply falling inside the lab reference range does not mean your levels are optimal. Nor do out of range levels mean that you’re doomed. It’s important to look at all your hormones, as well as your health struggles and symptoms, to get a clear picture. And hormones fluctuate, so never take a single hormone reading as a forever thing.
Cycle day 3
The first day of your monthly cycle is the first day of active bright red bleeding and flow. Scant or brown spotting does not count. If you start your flow after the sun goes down, day 1 is the following day. Your follicular phase starts on this day, and the third flow day is the optimal time to gauge your hormone levels.
Specifically, on cycle day 3 we look at your pituitary hormones (FSH, LH, and prolactin) and your ovarian hormone (estradiol and AMH)
FSH (follicle-stimulating hormone)
This is made by your pituitary gland in your brain, and it binds to your ovaries so that your follicles (eggs in sacs) start ripening for your new cycle. You want FSH to be nice and low if you are still cycling and especially if you want to conceive. If FSH is high, it means that your pituitary gland is yelling at your ovary and the ovary is not responding, or in the case of PCOS, the ovary is over-responding. Here are the functional ranges for FSH:
- Optimal level: between 4 – 7
- Not bad: between 7 – 10
- In trouble for conceiving but natural medicine can help: 10 – 15
- Heading into menopause: Above 20
- PCOS or adrenal stress: 30 or more
You can’t make judgments on fertility with FSH alone. If FSH is high, retake it on a future cycle day 3. If it’s still high and you want to conceive or you’re too young for menopause, consider seeing a functional fertility specialist for help lowering FSH.
This is your dominant estrogen. It starts building on cycle day 1 and ideally peaks on cycle days 12 – 14. Estradiol’s job during the follicular phase is to signal ovulation. It also suppressed FSH so that follicles stop developing at the right time.
An optimal day 3 estradiol is between 30 – 50. If it’s too low, ovulation may be delayed or not happen at all. Estradiol and FSH have a see-saw relationship – as estrogen rises, FSH lowers.
LH (luteinizing hormone)
As estradiol peaks, it signals your pituitary to make LH, the hormone you check with ovulation predictor sticks and kits. Your LH surge signals ovulation, the release of a mature follicle.
LH is ideally in a 1:1 ratio with FSH, between 4 -7. If LH is twice as high as FSH, suspect PCOS. If LH and FSH are both high (15 or more), it indicates perimenopause.
This pituitary hormone signals lactation and is naturally high while you’re breastfeeding. It blocks FSH – this is why your period is delayed while nursing. It can also be high because of stress or in PCOS.
On cycle day 3 prolactin should be under 12. Other interesting facts about prolactin:
- It is a marker of inflammation and increases with stress.
- Prolactin can be high in PCOS.
- It blocks ovulation, which lowers progesterone.
- Guess what lowers prolactin? Dopamine!
- Guess what increases dopamine? Vitex or Chaste tree! This is exactly why some women benefit from Vitex – in cases of high prolactin, no or delayed ovulation with low progesterone.
AMH (anti-Müllerian hormone)
This hormone is made inside your follicles, and truth be told it causes worry and upset for many women, with inaccurate diagnoses of infertility or poor egg quality. Read more about AMH here. The bottom line is that AMH does not measure egg quality. It can measure egg quantity but is useless for women over 35. It’s best used for women over 35 going through IVF to indicate how a woman may respond to IVF meds. That’s it. Here’s how to understand AMH levels:
- Optimal AMH is 2 – 4.
- A slightly low AMH of 0.3 – 2 does not mean anything for women under 35! And, this number can go up with natural medicine interventions.
- High AMH above 4 is a flag for a PCOS workup.
Cycle day 3 hormones to request and optimal levels in functional medicine:
- Estradiol between 30 and 50 pg/mL
- Prolactin under 12 ng/mL
- FSH between 4 and 7 mIU/mL
- LH approximately the same as FSH mIU/mL
- AMH between 2 and 4 ng/mL but don’t freak out if it’s outside this range!
I hope this guide helps you know what to test and how to make sense of the results. Need help testing your hormones? Please reach out!