From the Guidelines
To assess menopause status, the most reliable laboratory tests are follicle-stimulating hormone (FSH) and estradiol levels, with FSH levels above 30-40 mIU/mL and estradiol levels below 30 pg/mL suggesting menopause, as indicated by the criteria for determining menopause 1. When evaluating menopause status, it is essential to consider the clinical context and use laboratory tests to support the diagnosis.
- FSH levels are a key indicator of menopause, with elevated levels suggesting decreased ovarian function.
- Estradiol levels can also be used to support the diagnosis of menopause, with low levels indicating decreased ovarian estrogen synthesis.
- Other laboratory tests, such as thyroid function tests, may be necessary to rule out other conditions that may mimic menopausal symptoms. The criteria for determining menopause, as outlined in the study 1, include prior bilateral oophorectomy, age ≥60 years, age <60 years and amenorrheic for 12 or more months with FSH and estradiol in the postmenopausal range, or taking tamoxifen or toremifene with FSH and plasma estradiol level in postmenopausal ranges. It is crucial to note that hormone levels can fluctuate during perimenopause, and clinical judgment remains essential in interpreting laboratory results, especially in women under 45 with menopausal symptoms, women with hysterectomy without oophorectomy, or when hormone therapy use complicates the clinical picture, as suggested by the study 1.
From the Research
Menopause Status Indicators
To assess menopause status in women, several laboratory indicators can be used, including:
- Follicle-stimulating hormone (FSH) levels: FSH levels are often measured to determine menopausal status, with levels >40 IU/L indicating menopause 2
- Oestradiol (E2) levels: E2 levels may also be measured, although their diagnostic value is limited due to fluctuations during the menopausal transition 3, 4
- Vaginal pH: Vaginal pH has been proposed as a simple and cost-effective tool for diagnosing menopause, with a pH >4.5 indicating menopause 2
- Inhibin levels: Inhibin levels may also be measured, although their role in diagnosing menopause is not well established 4
- Luteinizing hormone (LH) levels: LH levels may be measured in conjunction with FSH levels to assess menopausal status 5
Limitations of Laboratory Indicators
It is essential to note that laboratory indicators have limitations in diagnosing menopause, including:
- FSH levels: FSH levels can fluctuate during the menopausal transition, making them unreliable for diagnosing menopause 3, 4
- E2 levels: E2 levels can also fluctuate, and their diagnostic value is limited 3, 4
- Vaginal pH: While vaginal pH has been proposed as a diagnostic tool, its accuracy and reliability require further study 2
Clinical Diagnosis
Menopause is often diagnosed clinically, based on symptoms such as cessation of menstruation, hot flashes, and vaginal dryness, rather than relying solely on laboratory indicators 3, 2, 6