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Functional tests in gynecology
Last reviewed: 07.07.2025
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Functional tests are used to clarify the functional state of various parts of the reproductive system. The principle of the study is based on the fact that hormones introduced into the body have the same properties as endogenous ones.
The following tests are most frequently used.
Test with gestagens
Indications: to determine the degree of estrogen deficiency and endometrial reactivity. Prescribed for amenorrhea of any etiology.
The test involves the administration of the gestagen progesterone at 10-20 mg per day for 3-5 days (oxyprogesterone capronate 125 mg once intramuscularly or norcolut at 5 ml per day for 8 days).
The appearance of bleeding 3-5 days after the end of the test is assessed as a positive result, the absence of it as a negative result.
A positive test indicates moderate estrogen deficiency, since progesterone causes secretory transformation of the endometrium and its rejection only if the endometrium is sufficiently prepared with estrogens. A negative test may occur with uterine amenorrhea or with estrogen deficiency.
The test can be performed as a differential diagnostic test for sclerocystic ovary syndrome. Before and after it, the excretion of 17-KS (17-ketosteroids) is studied. If after the test the excretion of 17-KS decreases by 50% or more, the test is assessed as positive and indicates the hypothalamic-pituitary genesis of the disease. The absence or minor changes in the level of 17-KS is a negative test, indicating ovarian genesis.
Test with estrogens and gestagens
Indications: to exclude diseases or damage to the endometrium (the so-called uterine form of amenorrhea) and to determine the degree of estrogen deficiency. It is performed in case of amenorrhea.
It consists of the introduction of estrogens (folliculin 20,000 U, sinestrol 2 mg, microfollin 0.1 mg) for 8-10 days, then gestagens for 5-7 days. The absence of a menstrual-like reaction 2-4 days after the end of the test is assessed as a negative reaction and indicates a uterine form of amenorrhea. A positive test indicates ovarian hypofunction.
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Gonadotropin test
Indications: suspected primary ovarian failure. Used to determine the cause of anovulation.
Pergonal is used intramuscularly (150 IU) for 5-7 days or human chorionic gonadotropin (prophase) at 1500-3000 IU for three days.
The control is the determination of the estradiol content in the blood before and after the administration of the drug. A positive test indicates an increase in the estradiol level by 3-5 times. A negative test indicates primary ovarian failure.
In addition, a decrease in CI (less than 50%), an increase in basal temperature, and an ultrasound examination of the ovaries, which registers the presence of follicles with a diameter of more than 18 mm, are of diagnostic value when conducting the test. A positive test indicates primary insufficiency of the hypothalamic-pituitary system.
Test with clomiphene
To determine the level of dysfunction of the hypothalamic-pituitary system, a test with clomiphene is also used.
Indications: diseases accompanied by chronic anovulation against the background of amenorrhea or hypomenstrual syndrome.
Before the test, a menstrual-like reaction is induced (with gestagens or oral contraceptives). From the 5th to the 9th day from the onset of the reaction, clomiphene is prescribed at 100 mg per day (2 tablets). In its action, it is an anti-estrogen, which causes a temporary blockade of estrogen receptors and increased secretion of luliberin (gonadotropic releasing hormone). This leads to the release of FSH ( follicle-stimulating hormone ) and LH ( luteinizing hormone ) by the pituitary gland and the maturation of follicles in the ovary with the synthesis of steroid hormones.
A positive test indicates preserved activity of the hypothalamus, pituitary gland and ovaries.
The clomiphene test is monitored by basal temperature and the appearance of a menstrual-like reaction 25-30 days after taking clomiphene.
In this case, anovulatory cycles are possible (menstrual reaction has occurred, basal temperature is monophasic), ovulatory cycles (basal temperature is two-phase, menstruation is on time) and cycles with luteal phase insufficiency (basal temperature is two-phase with a second phase shortened to less than 8 days and menstruation is on time).
A negative test - no increase in estradiol, gonadotropins in the blood, monophasic temperature, no menstrual-like reaction - indicates a violation of the functional capacity of both the hypothalamus and pituitary gland.
Hormonal contraceptive test
Indications: clarification of the genesis of hyperandrogenism. Preparations of the OC (oral contraceptive) type are prescribed 2 tablets per day for 10 days. Before and after the test, the excretion of 17-KS is determined. A positive test (a decrease in the excretion of 17-KS by 50% or more) indicates an ovarian genesis of the disease, a negative one - an adrenal genesis.
To establish the source of hyperandrogenism in women with clinical manifestations of virilization, a dexamethasone test is used.
Increased secretion of androgens by the ovaries is possible in endocrine diseases and virilizing tumors. The adrenal glands can also be a source of androgens, so before conducting the test it is necessary to exclude an ovarian tumor (using ultrasound diagnostics or laparoscopy ). The test is based on the inhibitory effect of high concentrations of glucocorticoids on the release of ACTH by the anterior pituitary gland, as a result of which the formation and release of androgens by the adrenal glands decreases.
There are two types of tests - small and large. The small test involves administering 0.5 mg of dexamethasone orally 4 times a day for three days. The 17-KS content is determined before and after the test.
The major test consists of administering 2 mg dexamethasone every 6 hours for three days, also with determination of 17-KS levels.
The test is considered positive when the 17-KS content decreases by 50-75% compared to the initial level and indicates the adrenal genesis of the disease (hyperplasia of the cortex).
A negative test (no decrease in 17-KS) indicates the presence of a virilizing tumor of the adrenal glands, since the secretion of androgens in it is autonomous and does not decrease with blockade of the pituitary ACTH with dexamethasone.
Skin allergy test
Based on the occurrence of an allergic reaction in response to the administration of hormonal drugs.
0.2 ml of 0.1% oil solution of estradiol benzoate is injected into the skin of the inner surface of the forearm. A small papule 5-6 mm in diameter is formed at the injection site. During ovulation (maximum estrogen content in the body), a local allergic reaction occurs in the form of reddening of the papule and an increase in its diameter to 10-12 mm, and itching. During an anovulatory cycle, there are no changes in the papule. To diagnose corpus luteum dysfunction, 0.2 ml of 2.5% oil solution of progesterone is injected. Reddening and enlargement of the papule in the late luteal phase (maximum function of the corpus luteum) indicate that ovulation has occurred and the corpus luteum is functioning satisfactorily.
The test is indicative if it is carried out over several menstrual cycles.
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