Prolactin, estradiol, progesterone and why you need to be tested for hormones.
With the permission of the Eksmo publishing house, we publish an excerpt from Dmitry Lubnin’s book “Project Woman. The subtleties of tuning the female body: find out how your body works. “
– The desire to be tested “for hormones” or to study the “hormonal background” is perhaps one of the most obsessive ideas of both gynecologists and women themselves. Throughout my work in gynecology, every time I shudder from a woman’s desire to be tested for hormones, as I understand that now I will have to explain for a long time why this is not necessary. Often my arguments are unconvincing, and at the next appointment, the patient still brings the test results and asks for comments. In the work of most gynecologists, hormone tests and smear tests for infections are probably the main components of their work.
The main idea that I will try to convey to you is: “If you have a more or less regular menstrual cycle, you do not have a hormonal disorder, and you do not need to research them.”
Tests for hormones are actually taken from almost everyone, no matter what the patient turns to, the patients themselves often look for an explanation of their poor health in these analyzes, and not only in the field of gynecology. What can these analyzes show, how informative and necessary they really are, let’s figure it out.
FSH and LH – two hormones of the pituitary gland that regulate the work of the menstrual cycle. The assessment of the ratio of these hormones is carried out only at the beginning of the cycle on the 2-3rd day of the cycle. Normally, at the beginning of the cycle, as you hopefully remember, FSH is the main worker, that is, its amount should be greater than L. G. If this ratio is present, then the menstrual cycle should go right. If the opposite is true – there is more LH than FSH, such a cycle will not proceed correctly, since LH at the beginning of the cycle will not be able to start the growth of follicles, but will only accumulate preparations (male sex hormones) surrounded by follicles that will not turn into female sex hormones , since this process is led by the FSG.
Estradiol – the main female sex hormone, which is synthesized by ovarian follicles in the process of growth by converting male sex hormones; regulates this process FSH. At the beginning of the cycle, when the follicles have not yet begun to grow, the concentration of this hormone is small, but by ovulation its values can increase very significantly. The norms for this hormone in laboratories are indicated for the entire first phase of the cycle, for example, 68-1269 p / mol per liter.
Since hormones are usually donated on the 2-3rd day of the cycle, when the activity of the ovaries is minimal, then the estradiol indicator should be minimal. Often, interpreting the test results, would-be gynecologists point out that the level of estradiol is at the “lower limit of the norm”, and make a terrible conclusion that the woman has a lack of female hormones, that is, the ovaries are finishing their work, after which estrogen replacement therapy is prescribed. I hope you understand the frightening stupidity of such conclusions.
In fact, at the beginning of your cycle, your estradiol level should be near the lower limit of normal, since the ovaries have not yet begun to actively produce it.
Progesterone – Another female sex hormone that is produced by the corpus luteum during the second phase of the cycle. Its main task is to prepare the body for the onset of pregnancy and, if pregnancy has occurred, to support it until the very birth. It is completely pointless to evaluate the indicators of this hormone in the first phase of the cycle, since progesterone at this time is in minimal concentrations and does nothing. It makes sense to estimate the amount of progesterone only in the second phase of the cycle, when the corpus luteum is actively working. The only task of this analysis is to confirm the fact of ovulation, that is, to prove that the egg left the follicle and the corpus luteum was formed.
Prolactin – pituitary hormone, the main task of which is to organize the lactation process (milk production by the mammary glands). In parallel with this, prolactin should temporarily turn off the reproductive function so that the mother can safely feed the baby and until she becomes pregnant. Yes, in some women, even during feeding, the menstrual cycle is restored, but this once again shows that there are no clear rules in the body and there are many individual characteristics. Prolactin levels can also rise outside the lactation period. One of the most common causes is a pituitary adenoma, a small, benign tumor that produces a lot of prolactin. In the overwhelming majority of cases, they are not dangerous, do not require removal, and the treatment of this condition is carried out with medication. In response to an increase in prolactin levels in a woman, the regularity of the menstrual cycle is disrupted, so a blood test for prolactin is included in the list of tests that we prescribe to find out the cause.
TTG and T4 free assess the function of the thyroid gland, but since the work of this gland can affect the reproductive system, gynecologists often prescribe tests for these hormones. TSH (thyroid stimulating hormone) essentially works the same way as FSH for the ovaries: it stimulates the thyroid gland and depends on how much of these hormones the thyroid gland produces. The main thyroid hormone is thyroxine (T4), so if the thyroid gland produces few hormones, the level of TSH increases, and T4 decreases, and vice versa. Endocrinologists are engaged in the treatment of thyroid pathology, the gynecologist can only suspect the presence of a problem, but then send it to a specialized specialist. Any disruption of the thyroid gland can lead to a disruption in the regularity of the menstrual cycle, and also indirectly affect the possibility of the onset and bearing of pregnancy.
Tests for hormones are needed to find out the reasons for the violation of the regularity of the menstrual cycle., moreover, mainly in those cases when violations arose from the very beginning, that is, from the first menstruation. A study of the level of hormones is necessary when examining an infertile couple, if a woman has an irregular menstrual cycle, as well as in an IVF program. During the premenopausal period, hormone indicators will help determine the cause of the delay in menstruation, that is, to understand whether menopause has happened. And in some other situations. In all other cases, hormone tests are unnecessary research that does not carry any useful information. Let me remind you the rule again: if you have a relatively regular menstrual cycle, your hormones are normal.