From the Guidelines
For a perimenopause workup, laboratory tests are indicated to assess menopausal symptoms and rule out other medical causes, including estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as clinically indicated 1.
Key Laboratory Tests
- Estradiol levels to determine ovarian function, particularly in women with complaints of vaginal dryness or amenorrhea 1
- FSH levels, although not a reliable marker of menopausal status in women with prior chemotherapy or pelvic radiation exposure or those on tamoxifen 1
- LH levels to assess pituitary function
- Prolactin levels to rule out hyperprolactinemia, which can cause menstrual irregularities
- Other markers, such as anti-Mullerian hormone (AMH) and inhibin, may provide additional information on ovarian status, but are not reliable alone to confirm menopausal status 1
Additional Evaluations
- A pelvic evaluation should be performed to assess for vaginal atrophy in women with complaints of vaginal dryness, and can be accomplished by referral to an appropriate specialist 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
From the Research
Laboratory Tests for Perimenopause Workup
The following laboratory tests are indicated for a perimenopause workup:
- Follicle-stimulating hormone (FSH) measurement: FSH levels may increase in the early-mid-follicular and early postovulatory phases in women over the age of 40 years who continue to experience regular menstrual cycles 2
- Estradiol level: Estradiol levels may fluctuate during the menopausal transition, with some studies showing a decrease in estradiol levels in postmenopausal women compared to perimenopausal women 3
- Inhibin level: Inhibin levels may fall during the menopausal transition, with a subsequent rise in FSH levels 2, 4
- Anti-Mullerian hormone levels: Anti-Mullerian hormone levels may be predictive of menopause proximity 5
Limitations of Laboratory Tests
However, it is essential to note that:
- FSH measurement is of little value in the assessment of women during the menopausal transition because it cannot be interpreted reliably 2
- Serum FSH and/or estradiol levels are not accurate enough by themselves to rule in or rule out perimenopause 3
- Single hormone measurements provide little useful information, with the clinical history being the most appropriate method of assessing menopausal status 4