Virtual Clinic for Women's Hormonal Health & Digestion in Ontario

Maximizing Hormone Testing Efficacy

Optimal Time For Testing Women's Hormones

Know when to test in your cycle when you're measuring hormones

When To Test Women's Hormones?

Knowing when to test women’s hormones can be a very valuable when it comes to women’s health. Hormonal symptoms can be important signals from the body, but often getting some objective data when it comes to hormonal levels can shed future light on the underlying health situation and therefore better guide us in creating an effective treatment plan for a woman’s hormonal health. However, proper testing timing is crucial to making sure these test results are clinically useful.

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Understanding the Menstrual Cycle And When To Test Hormones

Phases of the Menstrual Cycle

The Follicular Phase

Women are born with all of their eggs already formed and housed within their ovaries. Each egg is held within a follicle. The follicle is triggered to develop by Follicle Stimulating Hormone (FSH). In a regularly cycling female, FSH levels start to rise a few days after her period starts, and causes the follicle to mature. As the follicle matures, it secretes estrogen. Estrogen levels rise day by day, until (around mid-cycle) the levels are high enough that they signal to the brain that the follicle is ripe enough to be able to ovulate (to release the egg). 

 

The Luteal Phase

The brain then releases Lutenizing Hormone (LH), which triggers the follicle to rupture and release the egg. Once the egg is out, the follicle morphs into a Corpus Luteum, which then releases both estrogen and progesterone. Note! This means that progesterone is only increased in the blood AFTER ovulation has occurred. The Corpus Luteum usually only lasts for about 2 weeks, and then without a signal from Human Chorionic Gonadotropin (HCG, which is what is tested for in urine pregnancy tests), it dies off, estrogen and progesterone levels drop off (which triggers a period), and then cycle starts again.

 

Best Time for Hormone Testing

Follicular Phase Testing

  • During the Follicular Phase we usually test at day 3 of the cycle. We’re testing at this time to best assess the brain-ovary communication, as well as ovarian function. Typical tests include:
    • FSH
    • LH
    • Estradiol (E2)

 

Ovulation Phase Testing (Day 14)

To narrow down the ovulation window, a woman can do at-home ovulation predictor urine test strips which measure LH levels. This does not confirm that ovulation has occurred, but it confirms the timing of when the brain is asking the ovary to ovulate.

 

Luteal Phase Testing (Days 15-28)

During the luteal phase we want to test at the peak of progesterone, so 1 week before menstruation is scheduled to begin. If a woman has a regular 28 cycle, this testing day is easy to determine (test on day 21). If a woman has an irregular cycle, it’s best to use ovulation predictor urine test strip to gauge ovulation, then go for luteal phase blood or urine testing for progesterone 1 week later. We will also often add in estradiol to see the ratio of estrogen to progesterone (whereas when we test estradiol on day 3 of the cycle it’s to see if estrogen levels come down cyclically as they do in a system with proper estrogen metabolism and elimination).

 

Tests That Are Not Phase Sensitive

Other hormonal assessments to be considered are prolactin, testosterone, DHEA, other estrogens (like estriol and estrone) and thyroid hormones.

 

Basal Body Temperature Testing

Basal body temperature charting is the serial testing of one’s temperature first thing in the morning, ongoing. The time of day needs to be consistent, as does the temperature testing device  (oral, vaginal, rectal or topical). Progesterone increases the basal body temperature, like turning on the incubator in case a baby is inside. By testing all month long, we can determine when a woman has ovulated by seeing a temperature increase a couple weeks before her period. By cross referencing the number of days that the temperature is up, with the blood or urine levels of progesterone, it gives us a pretty good idea of the woman’s ability to both ovulate and sustain cyclically high levels of progesterone (which can be beneficial to her health in many ways). 

Best Time To Test Hormones

The take home message is that USUALLY it is best to test progesterone levels 1 week before your period, and possibly peak estrogen as well. Whereas day 3 testing is best for measuring FSH, LH, and trough estrogen levels. Timing for other hormones are not as crucial.

 

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Sarah Goulding naturopathic doctor

Your Doctor: Meet Dr. Sarah

Dr. Sarah Goulding is a licensed naturopathic doctor in Ontario and has a BSc in neuroscience and biology from Dalhousie University (2004), and did her 4-year naturopathic training at the Canadian College of Naturopathic Medicine (2010). She’s since accumulated over a decade of clinical experience, and refined her practice to focus on women’s health and digestion. She is licensed and registered as a Naturopathic Doctor in Ontario by The College of Naturopaths of Ontario (CONO) and is a member of the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).

Dr. Sarah Goulding blends science and compassion, and acts as a personal health researcher to help you navigate your health. Tools that she uses include nutrition, supplements and botanicals, bioidentical hormones, and lifestyle modifications. The closer you get to the root cause, the gentler the therapies needed to resolve the issue.

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