From the Guidelines
Laboratory tests for perimenopause workup should include follicle-stimulating hormone (FSH), estradiol, thyroid-stimulating hormone (TSH), and complete blood count (CBC), as well as luteinizing hormone (LH), and prolactin, as clinically indicated 1. When working up perimenopause, it is essential to consider the following laboratory tests:
- FSH and estradiol levels to assess ovarian function, with FSH levels above 30 mIU/mL and low estradiol (typically below 50 pg/mL) suggesting declining ovarian function characteristic of perimenopause
- Thyroid-stimulating hormone (TSH) to rule out thyroid disease, which can cause menopausal-like symptoms
- Complete blood count (CBC) to evaluate overall health
- Luteinizing hormone (LH) to assess ovarian function, as it may be elevated in perimenopause
- Prolactin levels to rule out hyperprolactinemia, which can cause menstrual irregularities Additional tests that may be helpful in certain situations include:
- Anti-Müllerian hormone (AMH) and inhibin B to assess ovarian reserve, particularly in women with a history of chemotherapy or pelvic radiation exposure 1
- Comprehensive metabolic panel (CMP) to evaluate liver and kidney function
- Lipid profiles to monitor cardiovascular risk as estrogen levels decline
- Fasting blood glucose and HbA1c to assess insulin resistance risk
- Vitamin D and calcium levels to evaluate bone health risk
- Progesterone levels measured during the luteal phase to confirm ovulation status
- Testosterone levels if symptoms suggest androgen imbalance It is crucial to note that FSH is not a reliable marker of menopausal status in female survivors with prior chemotherapy or pelvic radiation exposure or in female survivors on tamoxifen 1. Therefore, a comprehensive approach to laboratory testing is necessary to accurately diagnose and manage perimenopause.
From the Research
Laboratory Tests for Perimenopause
The following laboratory tests can be used to work up perimenopause:
- Follicle-stimulating hormone (FSH) levels 2, 3, 4, 5, 6
- Luteinizing hormone (LH) levels 3, 4, 5, 6
- Estradiol (E2) levels 2, 3, 4, 5, 6
- Progesterone levels 3, 4, 5, 6
- Inhibin B levels 2, 5, 6
- Anti-Mullerian hormone (AMH) levels 2, 5
- Total antioxidant status (TAS) 3
- Malondialdehyde (MDA) levels 3
- Reduced glutathione (GSH) levels 3
- Glutathione peroxidase (GSH-Px) activity 3
- Superoxide dismutase (SOD) activity 3
- Catalase (CAT) activity 3
Hormonal Changes During Perimenopause
Hormonal changes during perimenopause include:
- Erratically higher estradiol levels 2
- Decreased progesterone levels 2
- Disturbed ovarian-pituitary-hypothalamic feedback relationships 2
- Increased FSH levels 2, 3, 4, 5, 6
- Increased LH levels 3, 4
- Decreased inhibin B levels 2, 5, 6
- Decreased AMH levels 2, 5
Oxidative Stress During Perimenopause
Oxidative stress during perimenopause is characterized by: