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When you suspect you have endometriosis, make sure you get the right lab tests done to give you a baseline into your health. You want a very comprehensive lab workup in order to give you a picture of you health right now. The first comprehensive lab workup I ever got was after I suspected endometriosis and I went to my first functional medical physician. What I found out was critical to my ability to start doing what I could do improve my health through diet and supplements.
You may be doing all of these things and perhaps you are way down the road from getting all of the right lab tests. If that’s the case this post probably won’t be as helpful as it will be to someone just starting their healing journey. But I have found that endometriosis (and its relationship to infertility) is not always very well understood by mainstream pharma or doctors. Bloodwork and results were not explained to me in a way that empowered me nor did I know to ask certain questions because I didn’t know what I didn’t know.
In this post, I won’t be talking about the Ca-125 test. This is a test doctors sometimes order to see what level of inflammation you have in your woman’s area that could indicate endometriosis. It is a test commonly given to detect ovarian cancer, and detects abnormalities and increases over time in inflammation. It was ordered for me several times and did show a higher than normal level of inflammation. It is considered as a rough measure of detecting endometriosis by blood test. There are no known non-invasive tests to diagnose endometriosis except laproscopy in Western medicine.
This post will be a general guide to what lab work you need and what ideal results will look like for you for maximum health and healing. Don’t be afraid of your lab tests. They are one point in time and are changeable. Your body is amazing and with making tiny or massive changes to the levels for healing your body will adjust over time. While the endometriosis will not disappear over night or ever, you have a lot more leverage than you may realize to help your symptoms. I can’t wave a magic wand and remove your current condition, but I know a thing or two about improving symptoms holistically.
Let’s jump in!
What are the most important lab tests when you have endometriosis?
These lab tests are important because they will give you an overview of the picture of your health and where the trouble spots may fall. When one or more areas are out of the functional range then your health has some deficiencies which can be corrected. Even if you haven’t been diagnosed with endometriosis, these are good lab tests to have done especially if you have irregular cycles, fatigue, pain of any kind, low mood, depression or anxiety. They are important for any chronic health issue, really.
The ideal ranges will depend upon which point in your menstrual cycle you get lab tests done. The ideal results may be indicated on your lab results.
Progesterone is an important hormone in a woman’s body. During the second half of a woman’s cycle known as the luteal phase the basal body temperature rises in anticipation of pregnancy and it helps create a plush environment for a fertilized egg. If the body is not pregnant, progesterone levels will fall and the menstruation will begin.
In many women progesterone will not rise enough or will be dwarfed by excessively high estrogen also known as estrogen dominance. Low progesterone is also called luteal phase defect. Many times premenstrual syndrome (PMS) and premenstrual tension (PMT) arise because of deficiency in second half of the cycle. You want to get your progesterone levels checked ideally in the second half of the cycle. (Yes, there are ideal times to get these levels checked.) If you are low, a doctor may prescribe progesterone. Though, in traditional medicine, not all women benefit from extra progesterone even if they have luteal phase defect. There may be other issues causing low progesterone.
Estradiol is simply the most commonly tested form of estrogen. Endometriosis is considered an estrogen dependent condition meaning estrogen may help endometriosis progress. Lab tests for estrogen are commonly run but important to understand your own level of imbalance. Estrogen can be regulated with the help of cleansing the liver and through diet and lifestyle changes.
Estrone is another form of estrogen. Its ratio with estradiol is a marker for more information. Estrone is indicative of circulating estrogen in post menopausal women and abnormal ranges can cause irregular bleeding and mood swings. If you have never had any lab tests for estrogen, it might only need to be tested once so you know your baseline.
4. Vitamin D
Vitamin D is such an important hormones in the body. Ideally exposure to the sun provides your body with enough vitamin d but many people do not get enough sun exposure. The latest studies from 2022 show in increase in autoimmune disease, depression and cardiovascular issues from vitamin d deficiency. This is one of those lab tests that is helpful because it is easy to treat. A good level is 50 ng/mL and higher. Levels 30-50 ng/mL should be supplemented. Levels under 30 ng/mL are very deficient.
While it’s tempting to self-treat with Vitamin D supplements, the easiest and safest way to get more Vitamin D is via the sun. Your body will regulate the amount it absorbs based on its needs. If you supplement without knowing your levels, you may injest too much which isn’t healthy. Vitamin D3 is the form you body can ingest. Vitamin D2 is often a supplement added to products like orange juice and cereal but it’s not the greatest form for your body.
5. Vitamin B12
Another one of those important lab tests is for B12. B12 helps to alleviate anemia (also related to the iron panel below) and helps certain gut conditions where there is an overgrowth of ‘bad bacteria’ that use up B12 including heliobactor pylori infection.
The demands are also high for B12 in nervous tissue and vitamin B12 deficiency plays a role in cognitive decline. Vitamin B12 is essential for regulated menstruation. There are many B vitamins that are important for you body’s health well being.
The ideal range for vitamin B12 is 650-946 pg/mL for optimal health. Conventional ranges run between 211-946 pg/mL and functional ranges which are just ok range from 350-950 pg/mL.
My absolute favorite brand for supplemental vitamin b12 is by Vimergy. This brand produces an organic formula with the most bioavailable forms of B12 for your body to metabolize, a blend of Methylcobalalmin and Adenosylcobalamin. This is especially important if your B12 levels are low, you are a vegetarian or vegan and you don’t each much red meat. Also, you can’t get too much of the b-vitamins. Since they are water soluble you will excrete any excess amounts in your urine.
6. Folic Acid (B9)
You may hear a lot about folic acid especially if you are TTC, even though folate is the more absorbable natural form for the body to metabolize. What’s the deal with folic acid? The simplest way I can describe the importance is that folic acid goes through DNA and RNA synthesis to help form red blood cells and plays a role in avoiding anemia.
Folate is especially important during pregnancy to help avoid any neural tube birth defects. The best sources are from food and include leafy green vegetables, fruits and vegetables. Plus, a study showed that vitamin b12 plus adequate levels of folate lead to cognitive enhancement. Sign me up!
Optimal levels include 3-20 ng/mL in women. Conventional ranges include 2.2-20 ng/mL and functional / ok ranges include 2.2-20 ng/mL. I opt to supplement with a pure methylated folate since it is easier for absorption as well as eat an array of leafy greens daily in my endometriosis smoothie.
Gimme some sugar! Who doesn’t love this stuff? Well, until it shuts down your immune system, harms your reproductive function and gives you a drug like addiction. If you’re trying to break up with sugar check out my post on the topic. It is possible.
When you get lab tests for glucose, you’re most likely getting a blood glucose test and not a glucose challenge test. They are slightly different. You probably won’t need a glucose tolerance test unless it is suspected you have diabetes of some form.
A glucose test simply measures the amount of sugar in the blood. Straight up sugar makes the blood more sticky and more likely creates clots. If you have endo, the last thing you want is sticky blood but you do want some glucose for energy. It can also put you at risk for diabetes.
Optimal ranges are 74-84 mg/dL. Conventional ranges run around 65-99 mg/dL and functional ok ranges run 84-90 mg/dL usually.
This test is similar to the glucose blood test but measures sugar in the blood over time. People with endometriosis need to be careful about blood sugar dysregulation and getting these blood sugar related tests may be helpful if you struggle with sugar addiction or are especially sensitive to sugars.
Ideal lab tests measure between 4.8-5.1 %. Conventional ranges are from 4.8 – 5.6% and functional lab tests range from 4.8-5.4% usually. Aim for the ideal ranges.
Lab tests for fasting insulin provide an important snapshot of your blood sugar levels. When levels are elevated they predict future metabolic health issues. If you know in advance you have unstable insulin levels now you can begin to make diet modifications and exercise modifications to help you body rebalance. If you don’t, well, you may be headed for irreversible diabetes.
Optimal ranges run from 2-10 IU/mL. Conventional ranges run from 0-24.9 IU/mL and functional ranges run from 10-15 IU/mL.
Hopefully you get these checked annually though there is some debate as to whether high cholesterol is really a strong measure of poor health or future risk of stroke and heart diseases. However, there is some indication in research that cholesterol metabolism is wonky in the presence of endometriosis.
One way to reduce bad cholesterol is to reduce ‘bad’ carbs such as from white flour and hydrogenated oils. Cholesterol from eggs, shellfish, good oils and lard may actually be protective of your health as you age.
10. Total Cholesterol
Ideal ranges run from 125-145 mg/dL.
11. HDL (good cholesterol)
Ideal ranges run from 60-135 mg/dL.
12. LDL (bad cholesterol)
Ideal ranges run from 0-70 mg/dL.
Ideal ranges run from 0-50 mg/dL.
The mother mishap gene! This is a fancy short way of describing Methylenetetrahydrofolate Reductase Deficiency. Hence the acronym that sounds like a dirty word. 🙂
So many people who have endometriosis also have this genetic mutation, but not everyone. A simple blood test will help you determine if you have it or not. If you have if, unfortunately you have a higher risk of heart related ailments and blood clots. With this genetic mutation, it is difficult to process amino acids and convert them into usable forms. Hence for the rise in methylated B12 and methylated folate, because they have already been converted for you and are easily absorbable by the gut. Without these products if you have the MTHFR you may have more inflammation symptoms.
There are two types you can have, and if you are positive for either the blood test will flag it on your lab tests. If you don’t have it, your lab tests will say your risk is low. MTHFR can also hinder fertility. Do I think the MTHFR gene causes endometriosis? No. Not everybody has this gene mutation so no I don’t think it causes endo. I think it contributes to endo in some people.
Complete Thyroid Panel
A complete thyroid panel is so important for many reasons. For one, it is not uncommon for women with endometriosis to have corresponding thyroid issues at the same time. Thyroid imbalances, gut issues, iron issues: these are topics I have covered in another post but will also cover here a bit.
The TSH or thyroid stimulating hormone is one of the basic lab tests doctors routinely order. The TSH is released by the pituitary gland and is a commonly used marker for thyroid health. It’s a good starting point, but should not be the only marker. A typical lab range is 05-5.0 mU/L, but for optimal health functional practitioners like to use 1-2 mU/L range.
The TSH will rise with T4 drops because the pituitary gland tries to stimulate the thyroid with more and more hormone (TSH). In clinical hypothyroid cases, the TSH is usually high. (It may not be that high in subclinical hypothyroid cases).
16. Free T3 (FT3)
This is a measure of free triiodothyroxine and it’s the best marker for measuring the amount of active hormone available for our body cells to utilize. If your Free T3 is low or in the lower range, you can have crazy fatigue and other hypothyroid symptoms.
17. Free T4 (FT4)
This is a measure of free thyroxine found in the blood. The thyroid gland produces free T4 when it binds with iodine. It is inactive hormone that converts to T3, the active hormone. The conversion takes place in the liver. Of your thyroid lab tests, this one is not as important as FT3.
18. Reverse T3
The body makes this hormone when a person is under stress from major trauma, surgery or chronic stress. Instead of T4 converting to T3, it converts to Reverse T3 (rT3) which is an inactive form of the hormone. When rT3 is high, T3 is blocked from entering the cells. This can exacerbate hypothyroid symptoms.
19. TPO Antibodies
TPO stands for thyroid peroxidase antibodies and are an indicator of immune system inflammation. They are elevated in 75% of Hashimoto’s patients. Most doctors do not order these lab tests because pharmaceuticals offer no solution. Diet and lifestyle play a strong role in reversing TPO antibodies.
It is not uncommon these days to have multiple immune issues, including multiple autoimmune diseases. If you have Hashimoto’s as well as menstrual irregularities then you will want to first find out and second start prioritizing a new diet, supplement and lifestyle regimen.
20. Anti-TG Antibodies
Thyroglobulin antibodies help evaluate the treatment for cancer of the thyroid and monitors cancer recurrence. Also, they may be elevated in women taking birth control pill and has elevated estrogen levels. Of the lab tests for the thyroid, this one is probably the least important but a baseline couldn’t hurt.
A note on hypothyroidism:
The general belief is that if your TSH is high and your T3/T4 conversion rate is in the bottom reference range, if your T3 is normal and yoru TPOab and TGab are normal, you haev hypothyroidism. But what if your TSH is normal? Many people who have had subclinical hypothyroidism have normal TSH but have T3/T4 rates in the bottom of the reference range. Once these folks start on armour thyroid or something comparable, they usually begin to feel a natural increase in energy and functionality again.
Can you crush it at the gym on weights? Just kidding. Well, probably not if you are actually low in iron ferritin. You will be too fatigued to do much of anything let alone a good workout where you feel energized after instead of exhausted. Learn about these lab tests which help provide a picture of the iron in your blood. Lab tests dealing with iron will provide an array of information especially if you have heavy menstrual cycles and lose a lot of blood, have a history of heavy periods, are often fatigued even after adequate rest and a diet low in iron rich foods.
Ferritin lab tests show the overall amount of iron in your body. Optimal ranges are from 75-350ng/dl in women. Less than 75 is considered just ok. More than 350 might be too high.
22. Total Iron Binding Capacity
This test shows the amount of iron your body can carry. When your iron is low it will increase because it is able to carry more than it currently carries.
23. Serum Iron
This lab test shows the amount of iron circulating in your blood. Each of these lab tests provides a snapshot into the total picture of your nearness to anemia and helps your and your health care professional’s ability in evaluating you need to supplement with iron.
24. Transferrin Saturation
This is the ration between serum iron and total iron binding capacity.
When your iron levels are not in the optimal ranges, you are more likely to experience impacts to your thyroid function. I linked to a post I wrote about how to improve your iron levels naturally with two protocols above. Check it out for natural healing remedies on how to improve your iron lab tests.
These lab tests are the top 24 that I recommend for women with endometriosis. If you have a non optimal baseline then there is room for improvement. As you improve your biomarkers naturally I predict you will also experience an increase in health and vitality. These are important steps to take in order to get to the causes of your chronic health condition(s) in the first place and to help slow down your health’s decline.
You aren’t broken. Just imbalanced. 🙂
Did you find any surprises after you got your bloodwork back? Any other tests you found helpful for optimal health? Leave a comment in the comments section below!