The Comprehensive Female Profile II by ZRT Laboratory is designed to provide a comprehensive assessment of female hormonal health. This profile, which requires saliva and blood spot samples, evaluates key hormones such as estradiol, progesterone, testosterone, DHEA-S, and cortisol, providing insights into the menstrual cycle, reproductive health, adrenal function, and overall hormonal balance. Additionally, it assesses thyroid function by measuring levels of TSH, free T3, and free T4, and anti-TPO, an anti-thyroid antibody, offering a comprehensive overview of thyroid health.
This test allows healthcare providers to identify hormonal imbalances, screen for menstrual cycle irregularities, assess adrenal function, and evaluate thyroid health, guiding clinical decision-making and the development of personalized treatment plans.
The Comprehensive Female Profile II differs from the Comprehensive Female Profile I in its use of blood spot testing rather than saliva testing for steroid sex hormones. This difference makes this test ideal for patients who use sublingual or troche hormone replacement: in this setting it is difficult to know how much of the supplemented hormone directly saturates oral mucosa, which could result in falsely elevated hormone levels. The Comprehensive Female Profile II may be more appropriate for patients who do not produce much saliva, and/or are resistant to venipuncture.
Overall, the Comprehensive Female Profile II by ZRT Laboratory empowers healthcare providers to make informed clinical decisions regarding hormone replacement therapy, fertility treatments, adrenal support, thyroid management, and overall wellness interventions. By identifying hormonal imbalances or deficiencies, healthcare providers can tailor treatment strategies to address specific hormonal concerns, alleviate symptoms, and optimize overall health and well-being in women. [18., 19., 22.]
Regular monitoring of hormone levels through this comprehensive profile enables healthcare providers to track progress, adjust treatment plans as needed, and ensure optimal hormonal balance and health outcomes for their patients.
The Comprehensive Female Profile II by ZRT Laboratory includes several key components that are clinically relevant for assessing female hormonal health:
Estradiol: Estradiol is the primary estrogen hormone responsible for regulating the menstrual cycle, reproductive health, and bone density in women. It is essential for maintaining reproductive function and overall hormonal balance. Both estrogen excess and estrogen deficiency can both cause clinical symptoms and increase the risk of certain chronic illnesses.
For example, excess estrogen can cause a clinical picture of estrogen dominance, with symptoms including include fibrocystic, tender breasts and/or breast cysts; heavy menstrual bleeding, and menstrual cycle irregularity; headaches; mood swings; weight gain; and fibroids. Long-term elevated estrogen levels increase a person’s risk of gallbladder and thyroid disease, estrogen receptor-positive cancers, endometriosis, blood clots and stroke. [5.]
In contrast, estrogen deficiency causes a clinical picture typically seen in menopause: hot flashes, night sweats, insomnia, heart palpitations, loss of libido, vaginal dryness, rapidly aging skin, mood swings and irritability, and others. A woman with chronically low estrogen levels may be at increased risk for osteoporosis, cardiovascular disease, early cognitive decline, and sexual and urogenital concerns. [25.]
Progesterone: Progesterone plays a crucial role in regulating the menstrual cycle, supporting pregnancy, and maintaining hormonal balance. It helps prepare the uterus for implantation of a fertilized egg and is essential for maintaining pregnancy. High progesterone levels are most often seen with progesterone supplementation. Through complex negative feedback loops, progesterone excess symptoms often mimic an estrogen dominance presentation. [4.]
Low progesterone levels are more common in the clinical setting and may be related to infertility and/or recurrent miscarriages and sleep problems. In addition, symptoms of estrogen excess are common in the setting of progesterone deficiency. [4.]
The Progesterone/Estradiol Ratio: this ratio can provide clinical insight when both progesterone and estradiol, or E2, are within range for premenopausal women and women using hormone therapy. ZRT Laboratory reports an optimal range of 100-500 pg/mL. When either progesterone or E2 are outside their normal range, the ratio cannot be relied upon to provide an accurate representation of progesterone/estradiol balance. Normally, the effects of progesterone and estrogen balance each other out. When both progesterone and E2 are within range, a low progesterone/E2 ratio ratio signals functional estrogen dominance.
In contrast, a high progesterone/E2 ratio commonly occurs with progesterone supplementation.
Testosterone: Testosterone is an important hormone in women, contributing to libido, muscle mass, bone density, and overall sense of well-being. Low testosterone levels in women can lead to symptoms such as low libido, fatigue, and mood disturbances. In contrast, high testosterone levels are associated with androgenic hair loss, acne, depression, insulin resistance and PCOS, or polycystic ovarian syndrome, and infertility in women. [20., 22., 24., 27.]
DHEA-S: Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands (and in smaller amounts in the ovaries and testes); a sulfate group is added to DHEA in the adrenal glands and the liver, forming DHEA-S. DHEA-S can be converted into other hormones, including estrogen and testosterone. It plays a role in regulating mood, energy levels, and overall hormonal balance. It can be used as a marker for adrenal function. [2.]
Cortisol: Cortisol is a stress hormone produced by the adrenal glands that plays a critical role in the body's stress response and regulation of metabolism, immune function, and energy levels. Dysregulation of cortisol levels can lead to adrenal dysfunction and contribute to symptoms such as fatigue, insomnia, and mood disturbances [16.]. By testing salivary levels of cortisol at 4 time points in a 24 hour period, this test maps out the individual’s diurnal cortisol rhythm and may provide insight into chronic stress, sleep disturbances, immune or digestive dysfunction, and more. [1.]
Sex Hormone Binding Globulin (SHBG): SHBG levels play a crucial role in regulating the bioavailability of sex hormones such as testosterone and estrogen; additionally it has effects on, and its levels are affected by, other hormones present in the blood. [21.] By assessing SHBG levels through blood spot testing, clinicians can identify abnormalities in hormone binding and distribution, providing valuable information to understand hormone imbalance symptoms. This approach allows for targeted interventions to rebalance hormone levels and improve overall health outcomes.
Thyroid Hormones (TSH, Free T3, Free T4, anti-TPO antibodies): Thyroid hormones, T3 and T4, are essential for regulating metabolism, energy production, and overall body functions. TSH, thyroid stimulating hormone, is a hormone made in the pituitary gland which stimulates thyroid hormone production and release in the thyroid gland. Abnormalities in thyroid hormone levels can lead to symptoms such as fatigue, weight changes, and mood disturbances. [GARBER] Assessing an individual’s level of anti-TPO antibodies is an important step to rule out Hashimoto’s thyroiditis, an autoimmune thyroid condition that causes eventual hypothyroidism. [10.]
As mentioned above, blood spot testing for hormone assessment is ideal for patients who use sublingual or troche hormone replacement: in this setting salivary testing could result in falsely elevated hormone levels. Additionally, the Comprehensive Female Profile II may be more appropriate for patients who do not produce much saliva, and are resistant to venipuncture.
As with saliva testing, blood spot testing can be done from home, avoiding the stress and inconvenience of a trip to a lab or phlebotomist’s office. It also avoids the potential aversion to venipuncture.
Blood spot testing has been shown to correlate well with serum hormone levels. [6., 23., 26.]
Women experiencing menstrual irregularities: Hormonal imbalances can lead to irregular menstrual cycles, irregular periods, excessive or light bleeding, or absence of menstruation. Testing hormone levels can help identify the underlying cause of menstrual irregularities and guide appropriate treatment strategies. [14., 15., 19.]
Women with fertility concerns: Hormonal imbalances can impact fertility by affecting ovulation, egg quality, and implantation. Assessing hormone levels can help identify factors contributing to infertility and guide interventions to improve fertility outcomes. [17.]
Women experiencing menopausal or perimenopausal symptoms: Hormonal changes during menopause can lead to symptoms such as hot flashes, night sweats, mood changes, urogenital concerns and vaginal dryness. Prior to this,women may experience perimenopausal symptoms including menstrual irregularities which may be accompanied by heavy bleeding. Testing hormone levels can help assess menopausal or perimenopausal status and guide hormone replacement therapy decisions. [18., 19.]
Women with symptoms of hormonal imbalance: Hormonal imbalances can contribute to a variety of symptoms, including fatigue, weight changes, mood swings, insomnia, and low libido. Testing hormone levels can help identify underlying imbalances and guide treatment strategies to alleviate symptoms and improve quality of life. [14., 15., 19.]
Women with adrenal or thyroid issues: Hormonal imbalances involving the adrenal glands or thyroid can lead to symptoms such as fatigue, weight changes, and mood disturbances, and may alter available and total levels of sex hormones. [11., 13.] Assessing adrenal and thyroid hormone levels can help identify dysfunction and guide appropriate management strategies.
Women struggling with weight loss: these women could benefit from the Comprehensive Female Profile II By ZRT Laboratory as it provides valuable insights into hormone levels that may influence metabolism, appetite regulation, and fat storage. [9., 12.] Hormonal imbalances, such as thyroid dysfunction or insulin resistance commonly seen in PCOS, can contribute to difficulties in losing weight. [3., 7.] By identifying these imbalances, healthcare providers can develop targeted interventions to address underlying hormonal issues and support weight management efforts effectively.
By providing insights into hormone levels and hormonal balance, the Comprehensive Female Profile II can help healthcare providers tailor treatment plans to address specific hormonal concerns and optimize overall health and well-being in women.
Collection can be done any day of the month for children and non-menstruating women. Menstruating women should collect according to specific days of their cycle, as guided by their ordering healthcare provider.
Patients using certain medications including steroids should consult their healthcare provider regarding optimal collection timing. Avoidance of certain medications, 7-keto DHEA supplements and anti-aging facial creams for up to 3 days prior to testing may be necessary.
Patients using hormone replacement therapy should collect samples according to the schedule below, unless otherwise directed by their healthcare provider.
Samples should be shipped as soon as possible after collection to ensure accurate results.
Menstruating women should adhere to specific collection days based on their cycle, while others can collect any day of the month. Unless otherwise specified by the ordering healthcare provider, the recommended collection schedule for menstruating women is:
Regular cycles: Collect on Day 19, 20, or 21 of your cycle.
Day 1 is the first day of your period.
Irregular cycles: Collect 5 days before your period begins.
Unpredictable cycles: Collect any day when you're not bleeding.
Various guidelines exist for those using different forms of hormones or steroids, emphasizing proper timing and avoidance of certain substances before testing. People taking glucocorticoids should consult their healthcare provider before making any changes in their dosing schedule.
The general recommendations for people using hormone replacement is as follows:
If you use topical or oral hormones:
Apply/take any night dosage at least 12 hours prior to your morning collection.
Avoid applying hormones with your bare hands for at least 2 days prior to collection.
Avoid using hormones on your face, lips, and neck.
Change your sheets, pillowcases, and hand towels the night before collection.
Avoid touching any surfaces which may be contaminated with hormones prior to collection; this includes faucets, hand towels, cabinet doors, etc..
If you use hormone patches, vaginal rings, pellets, or injectables,
Test halfway between doses.
Example: 3 days after a once-a-week patch, or 6 weeks after insertion of pellets dosed every 3 months.
If you use sublingual hormones or troches,
Talk to your healthcare provider. It is not recommended that you take this test.
If you are taking steroids (glucocorticoids, prednisone, etc.), talk to your healthcare provider about appropriate timing.
Blood spot collection involves washing hands, pricking the finger, and saturating the filter paper with blood drops.
The blood spot card should be left to air dry for at least 4 hours before packaging.
Saliva collection involves collecting samples at specific times and using provided tubes to pool saliva.
Saliva should be collected in the morning upon waking, before lunch, before dinner, and before bed.
Samples should be shipped back to the lab as soon as possible after collection, ensuring they remain dry and intact during transit.
Proper packaging and labeling are essential to facilitate the shipping process.
Results are typically available 3-5 business days after samples are received at the lab.
Healthcare providers will notify patients when results are ready and schedule follow-up appointments to discuss them
How to Interpret The Elite Thyroid Profile Blood Spot from ZRT Laboratory: https://www.rupauniversity.com/live-classes/how-to-interpret-the-elite-thyroid-profile-blood-spot-from-zrt-laboratory
Progesterone: Why it’s Important to Perimenopausal and Menopausal Women: https://www.rupauniversity.com/live-classes/progesterone-why-its-important-to-perimenopausal-and-menopausal-women
[1.] Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology. 2017 Sep;83:25-41. doi: 10.1016/j.psyneuen.2017.05.018. Epub 2017 May 24. PMID: 28578301; PMCID: PMC5568897.
[2.] Al-Aridi R, Abdelmannan D, Arafah BM. Biochemical diagnosis of adrenal insufficiency: the added value of dehydroepiandrosterone sulfate measurements. Endocr Pract. 2011 Mar-Apr;17(2):261-70. doi: 10.4158/EP10262.RA. PMID: 21134877.
[3.] Biondi B. Subclinical Hypothyroidism in Patients with Obesity and Metabolic Syndrome: A Narrative Review. Nutrients. 2023 Dec 27;16(1):87. doi: 10.3390/nu16010087. PMID: 38201918; PMCID: PMC10780356.
[4.] Cable JK, Grider MH. Physiology, Progesterone. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558960/
[5.] Delgado BJ, Lopez-Ojeda W. Estrogen. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538260/
[6.] Edelman A, Stouffer R, Zava DT, Jensen JT. A comparison of blood spot vs. plasma analysis of gonadotropin and ovarian steroid hormone levels in reproductive-age women. Fertil Steril. 2007 Nov;88(5):1404-7. doi: 10.1016/j.fertnstert.2006.12.016. Epub 2007 Mar 26. PMID: 17368453; PMCID: PMC2175208.
[7.] Farshchi H, Rane A, Love A, Kennedy RL. Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management. J Obstet Gynaecol. 2007 Nov;27(8):762-73. doi: 10.1080/01443610701667338. PMID: 18097891.
[8.] Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. doi: 10.4158/EP12280.GL. Erratum in: Endocr Pract. 2013 Jan-Feb;19(1):175. PMID: 23246686.
[9.] Hewagalamulage SD, Lee TK, Clarke IJ, Henry BA. Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domest Anim Endocrinol. 2016 Jul;56 Suppl:S112-20. doi: 10.1016/j.domaniend.2016.03.004. Epub 2016 Mar 31. PMID: 27345309.
[10.] Hu X, Chen Y, Shen Y, Tian R, Sheng Y, Que H. Global prevalence and epidemiological trends of Hashimoto's thyroiditis in adults: A systematic review and meta-analysis. Front Public Health. 2022 Oct 13;10:1020709. doi: 10.3389/fpubh.2022.1020709. PMID: 36311599; PMCID: PMC9608544.
[11.] Iob E, Kirschbaum C, Steptoe A. Persistent depressive symptoms, HPA-axis hyperactivity, and inflammation: the role of cognitive-affective and somatic symptoms. Mol Psychiatry. 2020 May;25(5):1130-1140. doi: 10.1038/s41380-019-0501-6. Epub 2019 Aug 21. PMID: 31435001; PMCID: PMC7192852.
[12.] Kapoor E, Collazo-Clavell ML, Faubion SS. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clin Proc. 2017 Oct;92(10):1552-1558. doi: 10.1016/j.mayocp.2017.08.004. PMID: 28982486.
[13.] Kjaergaard AD, Marouli E, Papadopoulou A, Deloukas P, Kuś A, Sterenborg R, Teumer A, Burgess S, Åsvold BO, Chasman DI, Medici M, Ellervik C. Thyroid function, sex hormones and sexual function: a Mendelian randomization study. Eur J Epidemiol. 2021 Mar;36(3):335-344. doi: 10.1007/s10654-021-00721-z. Epub 2021 Feb 6. PMID: 33548002; PMCID: PMC7612952.
[14.] MacLean JA 2nd, Hayashi K. Progesterone Actions and Resistance in Gynecological Disorders. Cells. 2022 Feb 13;11(4):647. doi: 10.3390/cells11040647. PMID: 35203298; PMCID: PMC8870180.
[15.] Marquardt RM, Kim TH, Shin JH, Jeong JW. Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis? Int J Mol Sci. 2019 Aug 5;20(15):3822. doi: 10.3390/ijms20153822. PMID: 31387263; PMCID: PMC6695957.
[16.] McEwen BS, Seeman T. Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load. Ann N Y Acad Sci. 1999;896:30-47. doi: 10.1111/j.1749-6632.1999.tb08103.x. PMID: 10681886.
[17.] Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015 Jun;103(6):e44-50. doi: 10.1016/j.fertnstert.2015.03.019. Epub 2015 Apr 30. PMID: 25936238.
[18.] Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, Burger HG, Colditz GA, Davis SR, Gambacciani M, Gower BA, Henderson VW, Jarjour WN, Karas RH, Kleerekoper M, Lobo RA, Manson JE, Marsden J, Martin KA, Martin L, Pinkerton JV, Rubinow DR, Teede H, Thiboutot DM, Utian WH; Endocrine Society. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2010 Jul;95(7 Suppl 1):s1-s66. doi: 10.1210/jc.2009-2509. Epub 2010 Jun 21. PMID: 20566620; PMCID: PMC6287288.
[19.] Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021 Jan 1;106(1):1-15. doi: 10.1210/clinem/dgaa764. PMID: 33095879.
[20.] Schiffer L, Arlt W, O'Reilly MW. Understanding the Role of Androgen Action in Female Adipose Tissue. Front Horm Res. 2019;53:33-49. doi: 10.1159/000494901. Epub 2019 Sep 9. PMID: 31499495.
[21.] Selby C. Sex hormone binding globulin: origin, function and clinical significance. Ann Clin Biochem. 1990 Nov;27 ( Pt 6):532-41. doi: 10.1177/000456329002700603. PMID: 2080856.
[22.] Sharma A, Welt CK. Practical Approach to Hyperandrogenism in Women. Med Clin North Am. 2021 Nov;105(6):1099-1116. doi: 10.1016/j.mcna.2021.06.008. Epub 2021 Sep 8. PMID: 34688417; PMCID: PMC8548673.
[23.] Shirtcliff EA, Reavis R, Overman WH, Granger DA. Measurement of gonadal hormones in dried blood spots versus serum: verification of menstrual cycle phase. Horm Behav. 2001 Jun;39(4):258-66. doi: 10.1006/hbeh.2001.1657. PMID: 11374911.
[24.] Stanikova, D., Zsido, R.G., Luck, T. et al. Testosterone imbalance may link depression and increased body weight in premenopausal women. Transl Psychiatry 9, 160 (2019). https://doi.org/10.1038/s41398-019-0487-5
[25.] Thaung Zaw JJ, Howe PRC, Wong RHX. Postmenopausal health interventions: Time to move on from the Women's Health Initiative? Ageing Res Rev. 2018 Dec;48:79-86. doi: 10.1016/j.arr.2018.10.005. Epub 2018 Oct 21. PMID: 30355506.
[26.] Worthman CM, Stallings JF. Hormone measures in finger-prick blood spot samples: new field methods for reproductive endocrinology. Am J Phys Anthropol. 1997 Sep;104(1):1-21. doi: 10.1002/(SICI)1096-8644(199709)104:1<1::AID-AJPA1>3.0.CO;2-V. PMID: 9331450.
[27.] Zeng LH, Rana S, Hussain L, Asif M, Mehmood MH, Imran I, Younas A, Mahdy A, Al-Joufi FA, Abed SN. Polycystic Ovary Syndrome: A Disorder of Reproductive Age, Its Pathogenesis, and a Discussion on the Emerging Role of Herbal Remedies. Front Pharmacol. 2022 Jul 18;13:874914. doi: 10.3389/fphar.2022.874914. PMID: 35924049; PMCID: PMC9340349.
The Comprehensive Female Profile II provides a broad assessment of sex, adrenal, and thyroid hormone levels. Unlike the Comprehensive Female Profile I, it tests only diurnal cortisol in saliva and tests all sex and thyroid hormones with a dried blood spot sample.
.jpg)
