From the Guidelines
Laboratory tests for diagnosing and managing menopause should focus on follicle-stimulating hormone (FSH) and estradiol levels, as well as other tests to rule out similar conditions and assess health risks.
Key Laboratory Tests
- FSH levels above 30 mIU/mL, combined with low estradiol levels (typically below 30 pg/mL), support a diagnosis of menopause in women over 45 with appropriate symptoms like hot flashes, vaginal dryness, and irregular periods 1.
- Thyroid function tests (TSH, free T4) to rule out thyroid disorders that can mimic menopausal symptoms.
- A lipid panel to assess cardiovascular risk which increases after menopause.
- For women considering hormone therapy, baseline liver function tests and a complete blood count are advisable.
- Bone density testing (DEXA scan) is recommended for women at risk of osteoporosis, particularly those with early menopause (before age 45) 1.
Determining Menopausal Status
Reasonable criteria for determining menopause include:
- Prior bilateral oophorectomy
- Age ≥60 y
- Age <60 y and amenorrheic for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression and follicle-stimulating hormone (FSH) and estradiol in the postmenopausal range
- If taking tamoxifen or toremifene, and age <60 y, then FSH and plasma estradiol level in postmenopausal ranges 1. It is not possible to assign menopausal status to women who are receiving an LHRH agonist or antagonist, and for women premenopausal at the beginning of adjuvant chemotherapy, amenorrhea is not a reliable indicator of menopausal status 1.
Clinical Considerations
These tests are most useful in ambiguous cases, as menopause is primarily a clinical diagnosis based on 12 consecutive months without menstruation. The tests help clinicians distinguish between menopause and other conditions with similar presentations, monitor health risks associated with estrogen decline, and guide appropriate treatment decisions for symptom management and prevention of long-term health consequences.
From the Research
Laboratory Tests for Menopause
The diagnosis and management of menopause involve various laboratory tests to assess hormonal changes and menopausal status.
- Follicle-stimulating hormone (FSH) measurement is frequently advocated as a useful indicator of menopausal status 2, 3, 4.
- However, studies have shown that FSH levels can fluctuate during the menopausal transition, making it challenging to interpret reliably 2, 3, 4.
- Oestradiol (E2) and inhibin levels can also be measured to assess menopausal status, but their reliability is also limited 3.
- A single FSH measurement can be sufficient to characterize the serum FSH level in postmenopausal women, but repeated measurements are desirable for premenopausal women 5.
Limitations of FSH Measurement
- FSH levels can increase in women over 40 years old who continue to cycle regularly, making it difficult to distinguish between premenopausal and perimenopausal women 2, 4.
- No single FSH value can reliably distinguish between premenopausal, perimenopausal, and postmenopausal women 4.
- The frequently recommended FSH cutoff of 40 IU/L is not appropriate for clinical determination of postmenopausal status 4.
Hormone Replacement Therapy (HRT)
- HRT is considered the gold standard for managing vasomotor and vaginal symptoms of menopause 6.
- However, HRT carries significant risks, including stroke, cardiovascular disease, breast cancer, and venous thromboembolism 6.
- The prescription of HRT requires careful consideration of cyclic vs continuous administration, tapering therapy, and dosage forms 6.