From the Guidelines
To assess for menopause, laboratory evaluation should include estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as clinically indicated, with the most recent evidence suggesting FSH is not a reliable marker in certain populations 1. When evaluating menopausal status, it's essential to consider the clinical context, including symptoms and medical history.
- Estradiol levels can provide useful information, especially when used in conjunction with other markers.
- FSH is often used to assess menopausal status, but its reliability can be limited in women with prior chemotherapy or pelvic radiation exposure, or those taking tamoxifen 1.
- Luteinizing hormone (LH) and prolactin levels may also be measured to provide a more comprehensive understanding of hormonal status.
- Thyroid function tests (TSH, free T4) should be included to rule out thyroid disorders that can mimic menopausal symptoms.
- It's crucial to interpret these tests together, rather than individually, as hormone levels can fluctuate during perimenopause.
- The clinical diagnosis of menopause is primarily based on symptoms and menstrual history, with laboratory tests serving as confirmatory tools, especially in women under 45 years with suspected premature menopause 1.
From the Research
Labs to Assess for Menopause
To assess menopausal status, several laboratory tests can be used, including:
- Follicle-stimulating hormone (FSH) levels: FSH levels increase with age and can be used as a marker for menopause 2, 3, 4, 5
- Estradiol levels: Estradiol levels decrease with age and can be used in conjunction with FSH levels to assess menopausal status 5
- Inhibin levels: Inhibin levels also decrease with age and can be used to assess menopausal status 3
- Vaginal pH: Vaginal pH can be used as a diagnostic tool for menopause, with a sensitivity of 90% in one study 4
Limitations of Laboratory Tests
While laboratory tests can be useful in assessing menopausal status, they have several limitations, including:
- FSH levels can fluctuate and may not be reliable in all cases 2, 3
- Estradiol and inhibin levels can also fluctuate and may not be accurate in all cases 3, 5
- Vaginal pH may not be accurate in all cases, particularly in the presence of vaginal infections 4
- Laboratory tests should be used in conjunction with clinical evaluation and medical history to diagnose menopause 5
Clinical Evaluation
Clinical evaluation and medical history are essential in diagnosing menopause, including:
- Menstrual history: A woman's menstrual history can provide valuable information about her menopausal status 5
- Age: A woman's age can also provide valuable information about her menopausal status 5
- Symptoms: Symptoms such as hot flashes, night sweats, and vaginal dryness can be indicative of menopause 6