From the Guidelines
For a perimenopause workup, laboratory tests are indicated to rule out other medical causes of symptoms and assess menopausal status. The following labs are recommended:
- Estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as clinically indicated 1
- These tests can help assess menopausal status, although FSH is not a reliable marker in women with prior chemotherapy or pelvic radiation exposure or those on tamoxifen 1
- Additional tests such as thyroid function tests may be considered to rule out thyroid disease, which can mimic perimenopause symptoms 1
- Serial estradiol levels can be useful to determine return of ovarian function in perimenopausal or premenopausal women who have become amenorrheic and later develop bleeding 1
- Other markers, including anti-Mullerian hormone (AMH) and inhibin, may provide additional information on ovarian status, but alone are not reliable to ensure menopausal status 1
From the Research
Laboratory Tests for Perimenopause Workup
The following laboratory tests may be considered in the workup for perimenopause:
- Follicle-stimulating hormone (FSH) levels: High FSH levels may indicate perimenopause 2, 3, 4
- Estradiol (E2) levels: Low E2 levels may indicate perimenopause, but levels can fluctuate during this time 2, 3, 4
- Inhibin B levels: Low inhibin B levels may indicate perimenopause 2
Limitations of Laboratory Tests
However, it is essential to note that:
- No single laboratory test is accurate enough to rule in or rule out perimenopause 2, 3, 5
- Laboratory tests should not be relied upon as the sole means of diagnosing perimenopause 2, 6, 3, 5
- Clinical history and age are more important factors in diagnosing perimenopause 2, 6, 3, 5
Additional Tests
Other tests that may be considered in the workup for perimenopause include: