Hormone Testing in Females

Indications for Hormone Testing

The American College of Obstetricians and Gynecologists recommends hormone testing in females with specific clinical indications of hormonal dysfunction, such as menstrual irregularities, symptoms of premature ovarian insufficiency, or signs of androgen excess, rather than as routine screening 1, 2
Failure to initiate puberty by age 13 years requires laboratory evaluation of FSH and estradiol levels, as recommended by the American Academy of Pediatrics 3, 4
The Endocrine Society suggests that prepubertal females age ≥11 years with delayed puberty should undergo laboratory evaluation 5, 4
Early-onset body odor, axillary or pubic hair, accelerated growth, advanced bone age, and genital maturation in prepubertal children may indicate hormonal abnormalities requiring testing, according to the American Academy of Dermatology 6

The American College of Obstetricians and Gynecologists recommends that primary amenorrhea (no menses by age 16 years) in the presence of other evidence of puberty should be evaluated with hormone testing 3, 4
Secondary amenorrhea (absence of menses for ≥4 months) should be evaluated with hormone testing, as recommended by the American College of Obstetricians and Gynecologists 3, 4
Oligomenorrhea (irregular cycles or cycle length >35 days) should be evaluated with hormone testing, according to the American College of Obstetricians and Gynecologists 1, 2

The Endocrine Society recommends that follicle-stimulating hormone (FSH) and estradiol should be measured during the early follicular phase (days 2-5) of the menstrual cycle in women with oligomenorrhea 3, 4
Luteinizing hormone (LH) is useful for evaluating hypothalamic-pituitary-gonadal axis, as recommended by the American College of Obstetricians and Gynecologists 7
Thyroid-stimulating hormone (TSH) and free T4 should be measured to rule out thyroid dysfunction, according to the American Thyroid Association 7, 8

Cancer survivors treated with alkylating agents and/or radiotherapy that potentially exposed the ovaries should undergo hormone testing, as recommended by the American Society of Clinical Oncology 9, 3, 1
Women with suspected premature ovarian insufficiency (POI) should undergo hormone testing, according to the American College of Obstetricians and Gynecologists 3, 2
Patients receiving immune checkpoint inhibitor therapy who develop symptoms of hypophysitis should undergo hormone testing, as recommended by the Society for Immunotherapy of Cancer 7, 8

FSH and estradiol should be measured during the early follicular phase (days 2-5) of the menstrual cycle in women with oligomenorrhea, as recommended by the Endocrine Society 3, 4
For women with amenorrhea, FSH and estradiol can be measured randomly, according to the American College of Obstetricians and Gynecologists 3, 4

Fluctuations in hormone levels, particularly AMH, may fluctuate throughout the menstrual cycle, especially in young women under 25 years, as noted by the American Society for Reproductive Medicine 9, 3
Interpretation of hormone tests should consider the patient's age, as normal ranges vary throughout the lifespan, according to the Endocrine Society 9
Routine microbiologic or endocrinologic testing is not recommended for the majority of patients without specific symptoms, as recommended by the American Academy of Dermatology 6

Refer to endocrinology/gynecology when prepubertal females have no signs of puberty by age 13 years with elevated FSH levels, as recommended by the American Academy of Pediatrics 3, 4
Refer to gynecology, endocrinology, and/or reproductive endocrinology for postpubertal females with menstrual dysfunction suggestive of POI, according to the American College of Obstetricians and Gynecologists 3, 4
Consider referral for all patients diagnosed with POI for consideration of hormone replacement therapy, as recommended by the Endocrine Society 3, 4

Clinical signs of estrogen deficiency, such as hot flashes and vaginal dryness, in reproductive-age women require estradiol testing, as recommended by the American Society of Clinical Oncology 10
Cancer survivors treated with alkylating agents or pelvic radiotherapy should undergo hormone testing, including estradiol, as suggested by the American Society of Clinical Oncology 10
Women with persistently abnormal gonadotropin levels need estradiol correlation, according to the American Society of Clinical Oncology 10