Understand which hormone tests to ask for, how to interpret your results and what imbalances like oestrogen dominance or low progesterone actually mean for your health.
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Hormone testing is one of the most powerful tools available for understanding your health. Whether you’re experiencing unexplained fatigue, irregular periods, mood changes, weight gain, low libido or difficulty sleeping, a comprehensive hormone assessment can provide crucial insights into what’s happening inside your body. Yet many South African women are either not offered appropriate testing by their healthcare providers, or are given results without adequate explanation. This guide covers everything you need to know about hormone testing — from which tests to ask for to how to interpret what your results actually mean.
The most commonly tested hormones in women include oestrogen (specifically oestradiol, E2), progesterone, testosterone (total and free), FSH (follicle-stimulating hormone), LH (luteinising hormone), DHEA-S, cortisol and thyroid hormones (TSH, free T3, free T4). A full thyroid panel should always include not just TSH but also free T3, free T4 and thyroid antibodies (anti-TPO and anti-TG), since TSH alone can miss early thyroid dysfunction. Fasting insulin and HbA1c are also important for assessing metabolic health and its interaction with hormones. The right panel for you depends on your symptoms, age and health goals — an experienced endocrinologist or integrative GP can help you identify the most relevant tests.
Oestrogen dominance is one of the most commonly discussed hormonal imbalances in women, yet it is frequently misunderstood. It refers not necessarily to absolute high oestrogen, but to a state where oestrogen is high relative to progesterone — a ratio that becomes increasingly common during perimenopause as progesterone declines faster than oestrogen. Symptoms include heavy or irregular periods, breast tenderness, bloating, mood swings, weight gain around the hips and difficulty sleeping. Testing oestradiol alongside progesterone, ideally on day 21 of the menstrual cycle, provides the most informative snapshot of this ratio.
Low progesterone is particularly common in the years leading up to menopause and in women with irregular ovulation. Since progesterone is produced after ovulation, anovulatory cycles (where ovulation doesn’t occur) result in low progesterone and its associated symptoms: anxiety, poor sleep, PMS, spotting before periods and short luteal phases. Low testosterone in women — which affects libido, energy, muscle tone and mood — is often overlooked because reference ranges used in many South African labs are based on male values and don’t reflect appropriate thresholds for women.
Timing is critical when it comes to hormone testing. Oestrogen and LH are best measured on days 2–5 of the menstrual cycle (the follicular phase), while progesterone should be tested on day 21 (or 7 days after ovulation in those with longer cycles). Testosterone can be measured at any point in the cycle. Cortisol is ideally tested first thing in the morning, as levels follow a diurnal pattern and decline throughout the day. A four-point salivary cortisol test across the day can provide a more detailed picture of adrenal function than a single morning blood draw.
A comprehensive hormonal health assessment goes beyond blood tests. It includes a thorough review of your symptoms, menstrual history, sleep quality, stress levels, diet, exercise habits and family history. Some practitioners also use DUTCH testing (Dried Urine Test for Comprehensive Hormones), which assesses hormone metabolites and provides information on how the body is processing and clearing hormones — particularly oestrogen, which can be metabolised via more or less protective pathways. HealthLab connects South African women with specialists who offer thorough, personalised hormonal assessments that go beyond a basic TSH or oestrogen check.
Understanding your hormone levels is the first step to reclaiming your wellbeing. Whether you’re investigating symptoms for the first time or seeking a second opinion on existing results, the information in this section is designed to help you ask better questions, understand your options and work collaboratively with qualified healthcare professionals to achieve genuine hormonal balance.
