Blood test for six hormones during menstruation

For our body, if we want to know where the disease occurs, we need to conduct relevant examinations. The six hormone tests are a method of testing whether the endocrine hormones in the body are normal by drawing blood. Generally speaking, women can have blood drawn during menstruation to check six hormone levels. So, how do you check sex hormones? Let us introduce it to you below. I hope this helps you all.

The first step is to check the common sense of sex hormones

Sex hormone drugs (including progesterone and estrogen) should not be used at least one month before checking basic sex hormones, otherwise the results will be unreliable (except when sex hormones need to be rechecked after treatment). Sex hormones can be checked at any time during menstruation, as the normal values ​​for each period are different. However, when diagnosing and treating infertility, it is necessary to understand the basic hormone level. First of all, the test should be done on the 2nd to 5th day of menstruation, which is called the basic hormone level. It is best to measure it on the 3rd day. To confirm that it is the third day of menstruation, it is sufficient to check 5 sex hormones. Progesterone can be omitted, as it should be checked during the luteal phase (21 days after menstruation or 7 days after ovulation). However, it is not certain whether vaginal bleeding is menstruation. 6 items should be checked to prevent misdiagnosis (the menstrual cycle period can be roughly determined based on the P data). For patients with infrequent menstruation or amenorrhea, if the urine pregnancy test is negative, vaginal B-ultrasound examination shows no follicles ≥10mm in both ovaries, and EM thickness ﹤5mm, it can also be used as the basic status.

The basic sex hormone test report should be read as follows: the normal values ​​of basic LH and FSH are 5-10IU/L, the normal value of basic E2 is 25-50pg/ml (these 3 results cannot be compared with the reference values ​​on the test report, but must be based on this standard); PRL and T can be compared with the reference values ​​on the hospital's test report, and the normal value of P is shown below.

Step 2: Clinical significance of sex hormone testing

(I) FSH and LH: basic value is 5～10IU/L

In a normal menstrual cycle, blood FSH and LH are maintained at low levels in the early follicular phase (2-3 days after menstruation), and rise rapidly before ovulation. LH is as high as 3-8 times the basal value, reaching 160 IU/L or even higher, while FSH is only about 2 times the basal value, rarely >30 IU/L. After ovulation, FSH and LH quickly return to follicular phase levels. Monitoring the FSH and LH levels in the early follicular phase can provide a preliminary estimate of the function of the gonad axis. FSH is more valuable than LH in judging ovarian potential.

1. Ovarian failure: Basic FSH>40IU/L, LH increased or>40IU/L, it is high gonadotropin (Gn) amenorrhea, that is, ovarian failure; if it occurs before the age of 40, it is called premature ovarian failure (POF).

2. Basal FSH and LH are both less than 5IU/L, which is low Gn amenorrhea, indicating hypothalamic or pituitary dysfunction. The distinction between the two requires the use of gonadotropin-releasing hormone (GnRH) test. 3. Poor ovarian reserve (DOR): Basal FSH/LH>2~3.6 indicates DOR (FSH can be within the normal range), which is an early manifestation of ovarian dysfunction. It often indicates that the patient responds poorly to superovulation (COH). The COH regimen and Gn dose should be adjusted in time to improve ovarian responsiveness and obtain an ideal pregnancy rate. Because the increase in FSH/LH only reflects DOR rather than a decrease in fertility, an ideal pregnancy rate can still be achieved once the ovulation period is reached.

4. Basic FSH>12IU/L, recheck in the next cycle, continuous>12IU/L indicates DOR

5. Polycystic ovary syndrome (PCOS): Basal LH/FSH>2-3, which can be used as the main indicator for diagnosing PCOS (basal LH level>10IU/L is considered elevated, or LH maintains a normal level while the basal FSH is relatively low, resulting in an increased LH to FSH ratio).

6. If the basal FSH level is >20IU/L in two examinations, it can be considered as the latent stage of premature ovarian failure, indicating that amenorrhea may occur after one year.

(ii) P: Basic value is generally <1ng/ml

Under normal circumstances, blood P levels remain at a low level during the follicular phase, averaging 0.6~1.9nmol/L, generally <10nmol/L (3.15ng/ml); when the LH peak appears before ovulation, P secretion begins to increase, and after ovulation, the corpus luteum of the ovary produces a large amount of P, and the blood P concentration rises rapidly; when the corpus luteum matures (6~8 days after the LH peak), the blood P concentration reaches a peak, reaching 47.7~102.4nmol/L (15~32.2ng/ml) or higher, and then continues to decline, reaching the lowest level in the early stages of menstruation. The P content in peripheral blood changes in a parabolic pattern throughout the corpus luteum.

1. Determine ovulation: In the mid-luteal phase (the 21st day of menstruation for women with a 28-day menstrual cycle), P>16nmol/L (5ng/ml) indicates ovulation, and <16nmol/L (5ng/ml) indicates anovulation.

2. Diagnosis of luteal phase insufficiency (LPD): P < 32nmol/L (10ng/ml) in the mid-luteal phase, or P measured three times on the 5th, 7th and 9th days after ovulation, the total P < 95.4nmol/L (30ng/ml) is LPD; or P < 47.7nmol/L (15ng/ml) before 10 weeks of pregnancy is the standard for diagnosing LPD.

3. Determine the prognosis of in vitro fertilization-embryo transfer (IVF-ET): The P level before ovulation can estimate the prognosis of IVF-ET. On the day of intramuscular injection of HCG, P ≥ 3.18 nmol/L (1.0 ng/ml) should be considered elevated, and both the implantation rate and clinical pregnancy rate will decrease. P > 4.77 nmol/L (1.5 ng/ml) indicates premature luteinization.

In the long-term IVF-ET ovulation induction protocol, even if there is no increase in LH concentration on the day of intramuscular HCG injection, if P (ng/ml) × 1000/E2 (pg/ml) > 1, it indicates premature luteinization of the follicles, and the clinical pregnancy rate of such patients is significantly reduced. Premature luteinization is also a manifestation of DOR.

4. Identification of ectopic pregnancy: The blood P level of ectopic pregnancy is low, and most patients have blood P﹤47.7nmol/L (15ng/ml). Only 1.5% of patients had levels ≥79.5nmol/L (25ng/ml). In normal intrauterine pregnancy, P90%﹥79.5nmol/L, 10%﹤47.6nmol/L. Blood P levels can be used as a reference in the differential diagnosis of intrauterine and ectopic pregnancy.

(III) E2: Basic value is 25-45 pg/ml

In a normal menstrual cycle, E2 in the early follicular phase is about 183.5 pmol/L (50 pg/ml). It reaches the first peak before ovulation, which can reach 917.5-1835 pmol/L (250-500 pg). It drops rapidly after ovulation and forms a second peak in the luteal phase, about 458.8 pmol/L (124.80 pg). After a period of maintenance, it drops to the level of the early follicular phase when the corpus luteum atrophies, that is, it should be 91.75-183.5 pmol/ml (25-50 pg/ml) on the third day of menstruation. 1. Basic E2>165.2~293.6pmol/L (45~80pg/ml), regardless of age and FSH, indicates decreased fertility.

2. When basal E2 ≥ 367pmol/L (100pg/ml), the ovarian response is worse, and pregnancy is impossible even if FSH is ﹤15IU/L.

3. Monitoring indicators of follicle maturation and ovarian hyperstimulation syndrome (OHSS)

① Stimulate follicle discharge: During superovulation treatment, when the follicle is ≥18mm and the blood E2 reaches 1100pmol/L (300pg/ml), stop using HMG and inject HCG 10000IU on the same day or 24 to 36 hours after the last injection of HMG.

②E2﹤3670pmol/L (1000pg/ml), OHSS generally does not occur.

③E2﹥9175pmol/L (2500pg/ml) is a high-risk factor for OHSS. Timely discontinuation or reduction of HMG dosage and disabling of HCG to support luteal function can avoid or reduce the occurrence of OHSS.

④When E2﹥14800pmol/L (4000pg/ml), nearly 100% of patients will develop OHSS, which can rapidly develop into severe OHSS.

(IV) PRL

PRL is synthesized and secreted by eosinophilic PRL cells in the pituitary. The secretion of PRL is unstable. Emotions, exercise, sexual intercourse, hunger and eating can all affect its secretion state. It also fluctuates slightly with the menstrual cycle and has a rhythmicity related to sleep. PRL secretion increases in the short term after falling asleep, and is higher in the afternoon than in the morning. Therefore, according to the characteristics of this rhythmic secretion, blood should be drawn on an empty stomach between 9 and 10 am. For those with significantly elevated PRL, a single test can confirm the diagnosis; for those with mildly elevated PRL, a second test should be performed. Do not easily diagnose hyperprolactinemia (HPRL) and abuse bromocriptine for treatment.

PRL ≥ 25ng/ml or higher than the normal value of HPRL tested by this unit.

PRL>50ng/ml, about 20% have prolactinoma.

If PRL>100ng/ml, about 50% have prolactinoma, and pituitary CT or MRI can be performed selectively.

If PRL>200ng/ml, microadenoma is often present and pituitary CT or MRI must be performed.

Decreased PRL: Sheehan syndrome, use of anti-PRL drugs such as bromocriptine, levodopa, VitB6, etc.

(V) Testosterone: PCOS patients have mild to moderate elevation of T. T is elevated in patients with androgen-secreting tumors of the ovaries or adrenal glands or hirsutism.