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hormonal and blood tests in gynecology

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Hormonal and Blood Tests in Gynecology - Overview

This is a broad topic covering many distinct tests used in reproductive endocrinology, infertility workup, menstrual disorders, and gynecologic oncology. Here's the map of what it covers, based on Berek & Novak's Gynecology and related physiology/lab medicine texts in the library:
  1. Gonadotropins (FSH, LH) - used to evaluate ovarian reserve, menopause, PCOS (LH:FSH ratio), hypothalamic-pituitary-ovarian axis dysfunction
  2. Estradiol and Progesterone - assess ovarian function, confirm ovulation (midluteal progesterone), monitor menstrual cycle disorders
  3. Prolactin - key test in amenorrhea/galactorrhea workup, pituitary adenoma screening
  4. Androgens (testosterone, free testosterone, DHEAS, 17-hydroxyprogesterone) - hirsutism, PCOS, virilization workup
  5. Thyroid function (TSH, free T4) - routine screen in menstrual irregularity and infertility evaluation
  6. Beta-hCG - pregnancy confirmation, ectopic pregnancy, gestational trophoblastic disease monitoring
  7. AMH (Anti-Mullerian Hormone) - ovarian reserve testing, PCOS marker
  8. Tumor markers (CA-125, CA 19-9, AFP, LDH, inhibin, HE4) - gynecologic oncology diagnosis and surveillance
  9. Other supportive blood tests - fasting glucose/insulin (PCOS metabolic workup), SHBG, coagulation studies, CBC
Brief overview: Gynecologic hormonal testing is generally organized around the clinical question being asked. Menstrual/ovulatory disorders (amenorrhea, oligomenorrhea, PCOS) are worked up with FSH, LH, prolactin, TSH, and androgens, often drawn on cycle day 2-5. Fertility and ovarian reserve assessment relies on day-3 FSH/estradiol and AMH. Suspected pregnancy or its complications are evaluated with serial beta-hCG. Suspected pituitary or thyroid disease affecting the reproductive axis is screened with prolactin and TSH. Gynecologic oncology uses tumor markers (CA-125 for epithelial ovarian cancer, AFP/hCG/LDH for germ cell tumors) alongside imaging, never as a sole diagnostic test given limited specificity.
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