From the Guidelines
To assess menopause status, the most reliable laboratory tests are follicle-stimulating hormone (FSH) and estradiol levels, with FSH levels above the postmenopausal range and estradiol levels in the postmenopausal range suggesting menopause. When evaluating menopause status, it is essential to consider the clinical context, including age, menstrual history, and symptoms. According to the most recent guidelines 1, reasonable criteria for determining menopause include prior bilateral oophorectomy, age ≥60 years, or age <60 years and amenorrheic for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, with FSH and estradiol levels in the postmenopausal range.
Key Laboratory Tests
- FSH level: elevated levels above the postmenopausal range suggest menopause
- Estradiol level: levels in the postmenopausal range support menopausal status
Considerations
- Age: ≥60 years is considered postmenopausal
- Menstrual history: amenorrhea for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression
- Symptoms: menopausal symptoms such as hot flashes, night sweats, and vaginal dryness
Special Considerations
- Women receiving an LHRH agonist or antagonist: menopausal status cannot be assigned
- Women premenopausal at the beginning of adjuvant chemotherapy: amenorrhea is not a reliable indicator of menopausal status, and serial measurement of FSH and/or estradiol may be necessary to ensure postmenopausal status.
From the Research
Menopause Status Assessment
To assess menopause status in women, several laboratory tests can be used, including:
- Follicle-stimulating hormone (FSH) levels: FSH levels are often used to indicate menopause status, with levels >40 IU/L typically indicating postmenopause 2. However, FSH levels can fluctuate and may not always be a reliable indicator of menopause status 3, 4, 5.
- Oestradiol (E2) levels: E2 levels may also be used to assess menopause status, although the relationship between E2 and menopause is not always clear 3, 4.
- Luteinizing hormone (LH) levels: LH levels may also be used to assess menopause status, particularly in conjunction with FSH levels 6, 5.
- Vaginal pH: Vaginal pH has been suggested as a potential marker for menopause, with a pH >4.5 indicating postmenopause 2.
Limitations of FSH in Assessing Menopause Status
While FSH levels are often used to assess menopause status, there are several limitations to this approach, including:
- FSH levels can fluctuate and may not always be a reliable indicator of menopause status 3, 4, 5.
- There is considerable overlap in FSH levels between different reproductive stages, making it difficult to determine menopause status based on FSH alone 5.
- Age and reproductive stage are the most important determinants of FSH levels, rather than menopause status itself 5.
Alternative Markers for Menopause
Alternative markers for menopause, such as vaginal pH, may be useful in conjunction with FSH and other hormone levels to assess menopause status 2. However, more research is needed to fully understand the relationship between these markers and menopause status.