What if fsh is higher than lh

Estrogen is the female hormone that is secreted mainly by the ovaries and in small quantities by the adrenal glands.

The most active estrogen in the body is called estradiol. A sufficient amount of estrogen is needed to work with progesterone to promote menstruation. This may be due to the fact that the high levels of insulin and testosterone found in women with PCOS are sometimes converted to estrogen.

TSH stands for Thyroid Stimulating Hormone and is produced by the thyroid, a gland found in the neck. TSH is checked to rule out other problems, such as an underactive or overactive thyroid, which often cause irregular or lack of periods and anovulation.

Due to the recent research that PCOS is probably caused by insulin resistance, physicians are beginning to check glucose levels as a factor when diagnosing PCOS. Most women with polycystic ovary syndrome should have an Fasting Plasma Glucose Test and a Glucose Tolerance Test at diagnosis and periodically thereafter, depending on risk factors.

A high glucose level can indicate insulin resistance, a diabetes-related condition that contributes to PCOS. Researchers are also beginning to notice a connection between PCOS and heart disease; therefore, some physicians may want to look at your cholesterol levels when diagnosing and treating PCOS.

Women with PCOS have a greater tendency to have high cholesterol, a major risk factor for developing heart disease. Cholesterol is a fat-like substance normally used by the body for form cell membranes and certain hormones.

A high cholesterol level is considered greater than Too much bad cholesterol tends to increase the risk for plaque to build up in the arteries which can lead to a heart attack. Too much good cholesterol is believed to remove the cholesterol from building up in the arteries. Women with PCOS tend to have less good cholesterol and more bad cholesterol. In addition, triglyceride levels, another component of cholesterol, tend to be high in women with PCOS which further contributes to the risk of heart disease.

Even if your physician does not check your cholesterol levels when diagnosing PCOS, it is a good idea to have these levels checked periodically since women with PCOS have a greater chance of developing high cholesterol which can lead to heart disease. It is important to remember that with all women, hormone levels can very greatly. Unfortunately, many physicians are not familiar enough with PCOS to understand that even small changes in hormone levels can cause PCOS-related symptoms.

This is because your ovarian reserve is so low that no matter how much your ovaries are stimulated, they are not going to be able to produce eggs. But there is some hope and good news, here; while IVF with your own eggs may not be an option, many women have great success with donor eggs. Ask your doctor to have your estrogen levels tested at the same time your FSH levels are tested, to see if this is the case.

FSH levels can technically be lowered with medications including estrogen and the birth control pill, but lowering the FSH level does not actually change the ovarian reserve, or the chances of becoming pregnant. Always talk to your fertility doctor before trying herbs or supplements, engaging in any experimental treatments, or undergoing any major lifestyle changes.

Alan Copperman is a board-certified reproductive endocrinologist and infertility specialist with a long history of success in treating infertility and applying fertility preservation technologies.

Register to use all the features of this website, including selecting clinical areas of interest, taking part in quizzes and much more. This item is 8 years and 9 months old; some content may no longer be current. Understanding the physiology of reproductive hormones, recognising pathology and knowing what tests to order, when to order them and how to interpret the results can be daunting.

Hormone tests provide important information when applied appropriately, but often they are used without a clearly thought out diagnostic pathway, or in response to patient demand, rather than being tailored to the right patient in the right situation.

In such situations, hormone tests will, at best, be of no clinical use, and at worst, lead to anxiety and uncertainty. We look at some of the more common applications of hormone tests in the general practice setting. Luteinising hormone LH and follicle stimulating hormone FSH are important pituitary hormones, required for reproductive processes in both males and females. LH and FSH are released by the anterior pituitary in response to pulsatile gonadotropin-releasing hormone GnRH stimulation by the hypothalamus, and the negative feedback of oestrogen or testosterone.

In females, the combined action of FSH and LH stimulates growth of ovarian follicles and steroidogenesis, with the production of androgens, which are then converted to oestrogens by the action of the enzyme aromatase. A mid-cycle surge in LH also triggers ovulation. FSH levels usually increase during menopause, because the ovaries become less responsive to FSH, which causes the pituitary gland to increase FSH production.

However, fluctuating ovarian activity, especially early in perimenopause, means that FSH and oestradiol levels are not reliable predictors of menopause, as they are sometimes at pre-menopausal levels.

In males, FSH stimulates the Sertoli cells resulting in spermatogenesis and LH causes the interstitial Leydig cells of the testes to produce testosterone. Oestradiol is the principal oestrogen in females who are ovulating and the dominant ovarian hormone during the follicular first phase of the menstrual cycle.

The concentration of oestradiol varies throughout the menstrual cycle. Oestradiol is released in parallel to follicular growth and is highest when the follicle matures prior to ovulation. Oestradiol production gradually reduces if the oocyte released by the follicle is unfertilised. Laboratory testing routinely measures E2 forms of oestradiol, most of which is bound to sex hormone-binding globulin SHBG. Oestradiol levels decrease significantly during menopause. In males, oestrogen is an essential part of the reproductive system, and is required for maturation of sperm.

Primary hypogonadism impaired response to gonadotropins including LH and FSH can result in increased testicular secretion of oestradiol and increased conversion of testosterone to oestradiol. Obesity may also increase oestrogen levels in males. Reference range The adult female reference range for oestradiol is: 1. Oestradiol levels are usually undetectable in females using oestrogen-containing oral contraception as this suppresses oestradiol production from the ovary.

Oestradiol levels in females taking some forms of HRT e. The adult male reference range for oestradiol is assay dependent, so it is recommended to consult the local laboratory. Progesterone is the dominant ovarian hormone secreted during the luteal second phase of the menstrual cycle. Its main function is to prepare the uterus for implantation of an embryo, in the event that fertilisation occurs during that cycle.

If pregnancy occurs, human chorionic gonadotropin hCG is released which maintains the corpus luteum, which in turn allows progesterone levels to remain raised. At approximately twelve weeks gestation, the placenta begins to produce progesterone in place of the corpus luteum. Progesterone levels decrease after delivery and during breastfeeding. Progesterone levels are low in women after menopause. In males almost all progesterone is converted to testosterone in the testes.

There are no indications, other than fertility investigation in females in some circumstances , which requires progesterone measurement in a general practice setting. Reference range Detecting ovulation — measured on day 20 — 23 of a normal 28 day cycle: The reference range for progesterone in adult males is 1. In females, prolactin stimulates the breasts to produce milk, after oestrogen priming.

During pregnancy, prolactin concentrations begin to increase at approximately six weeks gestation, peaking during late pregnancy. In males and non-pregnant females, the secretion of prolactin from the pituitary gland is inhibited by the hypothalamic release of dopamine. Tumours or masses that result in compression of the pituitary stalk or drugs that block dopamine receptors, e. Hypothyroidism can also be associated with hyperprolactinaemia if levels of thyrotropin-releasing hormone TRH are raised, which stimulates prolactin production.

Hyperprolactinaemia is the most common endocrine disorder of the hypothalamic-pituitary axis and causes infertility in both sexes. Prolactin-secreting tumours prolactinomas are the most common type of pituitary tumour. These are usually small tumours microprolactinomas and are characterised by anovulation or other menstrual disturbances, galactorrhoea milk secretion from the breast and sexual dysfunction.

Rarely, tumours may be large macroprolactinomas and present with symptoms such as headaches and bitemporal hemianopia missing vision in the outer halves of the visual field. Galactorrhoea can occur in males, but is a much less common symptom of high prolactin in males. Reference range There is a diurnal variation in prolactin levels and serum levels are lowest approximately three hours after waking. Samples are best collected in the afternoon. Reference ranges are assay-specific so it is recommended to consult the local laboratory for their reference range.

Laboratories usually test for this possibility in new patients presenting with unexplained hyperprolactinaemia. Increased prolactin levels are usually associated with decreased oestrogen or testosterone levels. Testosterone is the primary androgen responsible for the development and maintenance of male sexual characteristics.

It also stimulates anabolic processes in non-sexual tissues. In males, LH stimulates the Leydig cells in the testes to produce testosterone. A small amount of testosterone in males is produced by the adrenal glands. In females, the majority of testosterone is produced by peripheral conversion of androgen precursor steroids to testosterone, with the remainder produced in the ovaries and adrenal glands.

Circulating levels of testosterone fluctuate with the menstrual cycle, and increase during pregnancy. Serum levels of testosterone remain relatively stable during and after menopause. Reference range The reference range for total testosterone in adult males differs between laboratories. If a single early morning testosterone level is clearly within the reference range e.

If a low or borderline result is obtained, a confirmatory early morning test when the patient is well should be conducted. Testosterone reference ranges for females are also assay-specific.

An example of an adult female reference range for total testosterone is 0. Free testosterone can be calculated from total testosterone and sex hormone-binding globulin SHBG. However, SHBG testing is only ever rarely required, such as when abnormalities of sex hormone binding e. Discussion with an endocrinologist or chemical pathologist is recommended before requesting SHBG. These cells form the outer layer of the developing blastocyst following conception and embryonic implantation.

It is detectable approximately three days after implantation of the embryo, which occurs approximately six to twelve days following ovulation and fertilisation. During a normal pregnancy hCG levels usually double approximately every two days, then plateau and begin to decrease at eight to ten weeks, but will remain elevated throughout pregnancy.

Urine or serum hCG measurement can be used to confirm early pregnancy urine hCG is adequate in most cases. Serum hCG can also be useful as an initial investigation in women who have symptoms that may suggest ectopic pregnancy, miscarriage or trophoblastic disease.

A non-viable pregnancy may be indicated by a decrease or plateau in hCG levels in early pregnancy remembering that hCG decreases in normal pregnancies after approximately nine to ten weeks gestation. However hCG alone is not a reliable predictor of ectopic pregnancy as there is no particular pattern of decrease or increase. In males, hCG is produced by some testicular tumours, and it is therefore used as a serum tumour marker for some forms of testicular cancer.

Reference range There is a wide range of variability of hCG levels during early pregnancy. The rate of increase, i. Serum hCG 1. Excessively high hCG levels, e. There are multiple indications for measuring reproductive hormone levels, however, in a general practice setting, the most common reasons are for investigating primary or secondary amenorrhoea or oligomenorrhoea in females, investigating hypogonadism in males, confirming pregnancy and some aspects of investigating fertility.

Measuring hormone levels in women with typical symptoms of menopause is usually not necessary. Table 1 summarises the recommended hormone tests for some of the more common endocrine-related clinical scenarios seen in general practice.

General Practitioners are not expected to investigate and diagnose every endocrine dysfunction. The role of the General Practitioner is often to identify the patients who require referral for further assessment and diagnosis in secondary care. In most cases, reassurance and watchful waiting is all that is required. However, if there is no sign of breast development the first demonstrable sign of puberty in girls by age 12 — 14 years, or menstruation has not begun by age 16 years in a female with otherwise normal pubertal development, investigation needs to be started.

A common cause of primary amenorrhoea is weight loss, dieting or excessive exercise known as hypothalamic amenorrhoea.