From the Guidelines
To diagnose menopause, the primary hormones that should be checked are follicle-stimulating hormone (FSH) and estradiol, as they are the most reliable indicators of menopausal status, according to the most recent guidelines 1. When evaluating menopause, it's essential to consider the clinical context and symptoms. The definition of menopause includes the permanent cessation of menses and a profound decrease in ovarian estrogen synthesis.
- Reasonable criteria for determining menopause include:
- Prior bilateral oophorectomy
- Age ≥60 years
- Age <60 years and amenorrheic for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, with FSH and estradiol in the postmenopausal range
- If taking tamoxifen or toremifene, and age <60 years, then FSH and plasma estradiol level in postmenopausal ranges
- It's crucial to note that amenorrhea is not a reliable indicator of menopausal status in women who have undergone chemotherapy, as ovarian function may still be intact or resume despite anovulation/amenorrhea after chemotherapy 1.
- In such cases, oophorectomy or serial measurement of FSH and/or estradiol are needed to ensure postmenopausal status, especially if the use of aromatase inhibitors is considered as a component of endocrine therapy.
- While other hormones like luteinizing hormone (LH) and anti-Müllerian hormone (AMH) may provide additional information, FSH and estradiol remain the primary hormones for diagnosing menopause, as supported by the most recent guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Hormones to Check for Menopause
To diagnose menopause, several hormones can be checked, including:
- Follicle-stimulating hormone (FSH) 2, 3, 4, 5, 6
- Estradiol (E2) 2, 3, 4, 6
- Inhibin B (INH-B) 2, 3
- Luteinizing hormone (LH) 4
- Testosterone 2
- Dehydroepiandrosterone (DHEA) and DHEAS 2
- Progesterone 4
- Prolactin 4
Limitations of Hormone Testing
It's essential to note that hormone levels can fluctuate during the menopausal transition, making it challenging to rely solely on hormone testing for diagnosis 3, 5, 6. For example:
- FSH levels may increase with age, but a single value of FSH is not sufficient to distinguish between premenopausal, perimenopausal, and postmenopausal women 5
- Estradiol levels may remain relatively unchanged or rise with age until the onset of the transition, and then decline 2
- Inhibin B levels reflect the fall in ovarian follicle numbers, but may not be a reliable marker for menopausal status 2, 3
Clinical Diagnosis
Given the limitations of hormone testing, clinicians often rely on menstrual history and age to diagnose perimenopause, rather than relying solely on laboratory testing 6. A comprehensive evaluation of a woman's symptoms, medical history, and physical examination is necessary to determine menopausal status.