I believe that girls who have gone to the hospital to see gynecology have had such an experience: go to the hospital for treatment, and always listen to the doctor say to prescribe a "sex hormone six" examination.
Watching menstrual irregularities? Let's have a "sex hormone six"!
Failed pregnancy preparation? Let's have a "sex hormone six"!
So what exactly is the sex hormone six? How do you feel that you can check everything?
Revelation!
The six items are: follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (PROG), testosterone (TEST), and pituitary prolactin (PRL)[1].
These six hormones can determine whether our reproductive and endocrine systems are functioning normally.
First of all, let's get out of a misunderstanding, "sex hormone six" is not a female exclusive examination! Both men and women can perform the "sex hormone six" test whenever an abnormality in the reproductive and endocrine systems is suspected.
In particular, in the following cases, it is necessary to go to the hospital in time to check the "sex hormone six items":
Girls: menstrual cycle disorders, amenorrhea, abnormal bleeding of the genital tract, gynecological-related tumors, etc
Boys: abnormal semen (oligospermia, weak sperm, dead sperm, etc.), impotence, hormone-related tumors, etc
Image source: Stand Cool Helo
To understand this, we must start with the physiological effects of each hormone.
1. Follicle-producing hormone (FSH) and luteinizing hormone (LH)
FSH: Follicle maturation, estrogen secretion.
LH: ovulation induction, luteal production, indirect estrogen stimulation, progesterone secretion.
When these two hormones are abnormal, they may indicate ovarian failure and can also assist in the diagnosis of POLYOS and precocious puberty.
2. Estradiol (E2)
Estradiol is the most active substance in estrogen, but also one of the main hormones produced by the ovaries, estradiol plays an important role in maintaining female reproductive function and secondary sexual characteristics, can diagnose whether there is ovulation, and can also find the cause of amenorrhea through estradiol:
If E2 is within the normal level range, indicating that the follicle is developing normally, consider that the cause of amenorrhea comes from the uterus;
If E2 levels are low, the cause of amenorrhea is likely to originate from the ovaries. For example, primary/secondary ovarian dysfunction or taking hormone drugs to inhibit ovarian function can lead to amenorrhea in women.
3. Progesterone(P)
The role of progesterone is mainly exerted in women's pregnancy, with progesterone, the embryo implantation is smoother, and the mother's milk is more full. Progesterone deficiency predisposes early miscarriage.
Therefore, monitoring progesterone is to monitor a series of safety of the mother during pregnancy and ensure the smooth birth of the fetus.
Understand the function of the luteal body: the luteal body can secrete progesterone, and conversely, the level of progesterone can indicate whether there is insufficient luteinization or incomplete luteal atrophy.
Differentiating ectopic pregnancy: patients with ectopic pregnancy have low progesterone values and normal intrauterine pregnancies have higher progesterone values, and the two can be differentiated.
4. Testosterone (TEST) determination
Assists in the diagnosis of ovarian virilization: a short-term progressive androgen exacerbation suggests virilization of the ovaries.
Adrenal hyperplasia or tumors: abnormally elevated serum androgens may be considered for this disorder.
Female hirsutism: When female serum testosterone levels are normal, female hirsutism is considered to be due to the sensitivity of hair follicles to androgens.
Hyperprolactinemia: signs and symptoms of hyperandrogenism are present, while androgen measurements are within the normal range, blood prolactin levels should be checked [3].
Testosterone is an important hormone for maintaining secondary sex characteristics in men.
5. Prolactin (PRL) assay
Too much prolactin can inhibit the secretion of FSH and LH, indirectly inhibit ovarian function, and affect ovulation. In the presence of amenorrhea, menstrual irregularities, and infertility, patients should have PRL measured regardless of lactation or not to exclude hyperprolactinemia.
Pituitary prolactinomas are considered in patients with abnormally elevated PRL.
1. Check the underlying endocrine: the third day of menstruation
The third day of menstruation is early follicle, which can be used to view the basic functional status of the ovaries.
Tips:
Do not take birth control pills for at least one month before checking for basal sex hormones! Contraceptives are sex hormone drugs and are easy to interfere with examination. In addition, common sex hormone drugs are: tamoxifen, clomiphene, ethinyl estradiol, ethinyne estrone and so on.
2. Ovulation check
The main purpose of this period of examination is to see if there is a peak luteinizing hormone during this period to determine whether it is close to/or ovulated. Can be used in conjunction with ultrasound follicle monitoring to diagnose the condition.
3. Luteal phase examination
After the follicle is released, the corpus luteum forms, and if it is not pregnant, the corpus luteum will automatically atrophy and usher in menstruation; if it is pregnant, the corpus luteum will continue to develop, secreting progesterone to support the needs of pregnancy. Therefore, the luteal phase examination is a critical period to check whether there is ovulation, whether it is pregnant, and to diagnose repeated miscarriages.
Remember, the week before menstruation is the best time for examination, you still want to know what kind of gynecological examination, welcome to leave a comment in the comment area.
Reviewer: Pan Yongyuan | Chief Physician, Department of Endocrinology, Xuanwu Hospital, Capital Medical University
bibliography
HU Jianhua. The application value of six index determination of female sex hormones in the auxiliary diagnosis of infertility[J]. Journal of Practical Medicine in China, 2013, 40(14):90-92.
[2] Scheres LJJ, van Hylckama Vlieg A, Ballieux BEPB, Fauser BCJM, Rosendaal FR, Middeldorp S, Cannegieter SC; CREW consortium. Endogenous sex hormones and risk of venous thromboembolism in young women. J Thromb Haemost. 2019 Aug;17(8):1297-1304. doi: 10.1111/jth.14474. Epub 2019 Jun 4. PMID: 31054196; PMCID: PMC6852478.
Wang Zhou, Sa Yinglong, Ye Xuxiao, et al. Clinical diagnosis and treatment of androgen insensitivity syndrome (with 6 case reports)[J]. Journal of Clinical Urology, 2013(4):287-291.
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