Overview of hormones for women’s health:

The most common hormones I test for when looking at women’s health are progesterone, estradiol, testosterone, DHEA, TSH, and cortisol. I mostly just test estrone and estriol when using the DUTCH test to get a better look at how your body uses and converts estrogens.

Hormone: Progesterone

Where it is made: progesterone is primarily produced in the ovary by the corpus luteum (follicle remnant) after ovulation. The hormone is very low during the menstrual cycle through ovulation then increases and is typically at its highest level between days 20 and 22 of the menstrual cycle (this is usually when we test for the hormone). A small amount of progesterone is produced in the adrenal glands and a small amount is stored in fat cells.

Quick list of what it does in the body:

  1. Promotes thickening of uterine lining to prepare for pregnancy.

  2. Drop in progesterone levels signal the shedding of the uterine lining and initiates your period.

  3. Reduces risk of endometrial cancer - progesterone is used in combination with most estrogen prescriptions to help prevent endometrial cancer.

  4. Vasodilating effects that may improve circulation and cardiovascular health

  5. Promotes relaxation and reduces feelings of anxiety

More on how it is used and when a prescription for progesterone is considered:

  1. Progesterone prepares the uterus for pregnancy - it promotes the healthy growth of the uterine lining to get it ready to accept a fertilized egg and is needed for the pregnancy to progress. If there is not a fertilized egg, progesterone levels will drop and this will signal the uterine lining to shed and start your period. When a fertilized egg implants into the uterine lining, Hcg (Human chorionic gonadotropin) is released and signals the corpus luteum to continue making progesterone so that the uterine lining remains intact.  At 8-10 weeks the placenta starts taking over the majority of your progesterone production needed for the rest of the pregnancy. For some women, low progesterone may make it more difficult to get successful implantation and gestation therefore progesterone supplementation may be considered in early pregnancy.

  2. Progesterone promotes calm feelings and improves sleep quality.

  3. Progesterone is sometimes prescribed for menstrual related physical and emotional symptoms - progesterone taken for days 14-28 of the menstrual cycle can be helpful for some women who experience strong emotional and/or physical symptoms prior to their period. 

  4. Progesterone levels after menopause are much lower and for some this is associated with insomnia and poor sleep quality.

  5. Progesterone is prescribed in combination with estrogen to help reduce the risk of endometrial cancer. Estrogen and progesterone combinations are used for family planning during reproductive years and for hormone replacement therapy in menopause.

  6. Progesterone only pills are also available for family planning though estrogen + progesterone is more commonly prescribed.

Hormone: Estrone (E1) -

This is the first of the 3 estrogens I will be discussing

Where it is made: E1 is made in the ovaries, adrenal gland, and some is stored in reserve in our fat cells. 

What it does in the body: During reproductive years, E1 is made in smaller amounts than estradiol (E2) and estriol (E3) and is considered less significant. After menopause, E1 becomes the more predominant estrogen in circulation. Although E1 is considered less potent than the other estrogen forms, understanding how it is broken down in your body can help shed light on risk factors for breast cancer as some metabolites can lead to DNA damage.

Here are the 3 main breakdown pathways:

  1. Estrone is converted to 2-OH-E1 which is a protective pathway

  2. Estrone is converted to 4-OH-E1 which can either be detoxed through methylation or glutathione or it can become reactive and bind to DNA causing potential DNA damage

  3. Estrone is converted to 16-OH-E1 - this can be converted to estriol (E3).

Why does this matter? - You can use the DUTCH test to see if metabolites are imbalanced to get more insight into whether or not you could benefit from taking methylation support or glutathione.

Hormone: Estradiol (E2)

Where it is made: primarily the ovaries during reproductive years. 

It is also produced in smaller amounts in fat tissue of the breast, osteoblasts and chondrocytes of bone, in blood vessels and smooth muscle cells of the heart, and numerous sites in the brain - these sites become more important after menopause.

What it does in the body: 

Responsible for our so-called feminine features <3 - Responsible for healthy development in puberty - development of breast tissue, widened hips, etc.

Helps mature and signal release of an egg at ovulation

Helps thicken the uterine lining to help with proper implantation

Keeps vaginal tissue healthy and promotes healthy vaginal fluids

Important role in mental health - to much or too little is associated with depression and anxiety

Too much or imbalanced E2 is associated with hormone related acne, depression, constipation, bloating, breast tenderness, and a slew of other PMS related symptoms.

Too little estrogen (typically seen in menopause): vaginal dryness, recurrent UTIs, hot flashes, mood swings, depression, fatigue, and mental fog.

Hormone: Estriol (E3)

Where it is made: Estriol in the non pregnant body is very low, it is produced from other circulating estrogens - estradiol (E2) and estrone (E1). In pregnancy E3 rises dramatically and is produced by the placenta.

What it does in the body:

1. Less potent than E 1 and E2 and is created in very low levels except during pregnancy.

2. E3 increases dramatically in pregnancy and can be a useful marker of the health of the fetus. Low levels of E3 during pregnancy may indicate chromosomal or congenital anomalies like Down syndrome or Edward's syndrome. Higher than normal levels prior to the last few weeks of pregnancy may indicate an early labor.

3. Estriol is often used in compounding hormone therapies because it may have a more selective action than E2. As a form of hormone replacement in menopause it is effective at treating menopausal symptoms including hot flashes, insomnia, vaginal dryness, and frequent urinary tract infections.

Hormone: Testosterone

Where it is made: In women, testosterone is produced in the ovaries and adrenal glands. In Men it is produced primarily in the testes. 

What it does in body (for women):

While it is produced in much smaller levels when compared to men, testosterone is still an import hormone for: 

  1. Bone health

  2. Promotes healthy reproductive tissue

  3. Cognitive function and mood

  4. Promotes muscle growth

  5. Promotes libido

Signs of elevated testosterone:

  • Acne

  • Abnormal hair growth such as facial hair

  • Irregular menses

  • Deepened voice

Signs of low testosterone:

  • Thinning hair or hair loss

  • Decreased libido

  • Fatigue

  • Sleep disturbances


Hormone: DHEA - Dehydroepiandrosterone

Where is it made? DHEA is primarily made in the adrenal gland. A very small percentage is made in the ovaries.

What does it do in the body?

DHEA is a precursor to both estrogen and testosterone so its effects are multifactorial. High or low DHEA (measured as DHEA-S) may result in symptoms related to high or low estrogen and/or testosterone. DHEA affects fertility as both estrogen and testosterone are vital to a healthy reproductive system. 

Hormone: Thyroid stimulating hormone (TSH) and free thyroxine (fT4) and triodothyonine (fT3)

The 3 main thyroid labs I run are the TSH (thyroid stimulating hormone), the free T4 (fT4) and free T3 (fT3). There are additional labs that I often run to check for autoimmunity that are not included here.

Thyroid Stimulating Hormone (TSH) - this hormone comes from the pituitary gland to send signals to the thyroid to increase free T4 into the blood stream. When free T4 is high, this will signal back to the brain to decrease the production of TSH. Therefore, if TSH is high, there is not enough circulating free T4 so the brain keeps increasing the level of TSH to try to get the thyroid gland to produce more free T4. A high TSH is seen in hypothyroidism which is associated with fatigue, weight gain, constipation, dry skin, brittle nails, and feeling cold all the time.

Free thyroxine (fT4) - this is the hormone created in the thyroid gland that helps support metabolic processes. T4 is the inactive form of the thyroid hormone and is circulated throughout the body then converted to the active form, free T3, where it is needed in the body. Levels are often low or normal for hypothyroidism.

Triiodothyronine or free T3 (fT3) - This is the active form of the thyroid hormone. It is made in small amounts in the thyroid and most is converted from free T4 in the body where it is needed. Levels can be normal or low in hypothyroidism.

Hormone: Cortisol

Where is it made? The adrenal gland

What does it do?

The Good:

  • Vital for your Stress Response - "Fight or Flight" - sets you up for the challenge!

  • Increases blood sugar so you have the energy you need to fight a stressful situation.

  • Boosts daytime energy and helps regulate sleep/wake cycle (when balanced)

  • Anti-inflammatory - we often prescribe forms of cortisol for inflammatory conditions such as asthma and dermatitis. 

The Bad:

  • Chronic stress leads to chronic cortisol elevation, which means:

  • Chronic elevation of blood sugars -> can lead to type 2 diabetes

  • Weight gain

  • Susceptible to infections/immune suppression

  • Cardiovascular disease - high blood pressure, vascular disease related to BP and high blood sugar.

  • Fatigue

  • Insomnia