From the Guidelines
Laboratory tests for diagnosing menopause typically include follicle-stimulating hormone (FSH) and estradiol levels, with FSH levels above 30 mIU/mL and low estradiol levels (below 50 pg/mL) supporting a diagnosis in women over 45 with appropriate symptoms. These tests are most useful in ambiguous cases, as menopause is primarily diagnosed clinically based on amenorrhea for 12 consecutive months 1. Additional recommended tests include:
- 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
- Baseline liver function tests, complete blood count, and mammography for women considering hormone therapy
- Anti-Müllerian hormone (AMH) testing may help predict the timing of menopause in younger women but is not routinely needed for diagnosis 1. It is essential to interpret these laboratory tests in the context of the patient's age, symptoms, and medical history, as hormone levels can fluctuate significantly during perimenopause, potentially leading to misleading results if relied upon exclusively 1.
From the Research
Laboratory Tests for Menopause
The diagnosis and management of menopause involve various laboratory tests to assess hormonal changes and their effects on the body. Some key tests include:
- Follicle-stimulating hormone (FSH) measurement: Although FSH levels increase with age, they are not a reliable indicator of menopausal status, as levels can fluctuate greatly during the menopausal transition 2, 3.
- Oestradiol (E2) measurement: E2 levels may decrease with age, but their measurement is not a definitive diagnostic tool for menopause 2, 3.
- Inhibin measurement: Inhibin levels decrease with age and are inversely correlated with FSH levels 3.
- Bone mineral density (BMD) tests: BMD tests, such as dual-energy x-ray absorptiometry, can help assess the risk of osteoporosis in postmenopausal women 4.
- Body composition analysis: Body composition parameters, such as appendicular lean mass and fat mass, can be associated with low bone mass in postmenopausal women 4.
- Sex hormone-binding globulin (SHBG) and free estrogen index: These measurements can help assess the risk of low bone mass in postmenopausal women 4.
Limitations of Laboratory Tests
While laboratory tests can provide valuable information, they have limitations in diagnosing and managing menopause. For example:
- FSH measurement is not a reliable indicator of menopausal status due to fluctuating levels during the menopausal transition 2, 3.
- Hormone levels, such as E2 and inhibin, can also fluctuate and are not definitive diagnostic tools for menopause 2, 3.
- BMD tests and body composition analysis can provide information on osteoporosis risk and body composition, but may not directly diagnose menopause 4.
Clinical Applications
Laboratory tests can be used in conjunction with clinical evaluation to diagnose and manage menopause. For example:
- FSH measurement can be used to support the diagnosis of menopause, but should not be relied upon as the sole diagnostic tool 5.
- BMD tests and body composition analysis can help identify postmenopausal women at risk of osteoporosis and inform treatment decisions 4.
- Hormone replacement therapy (HRT) and selective estrogen receptor modulators (SERMs) can be used to manage menopausal symptoms and prevent osteoporosis, but their use should be individualized based on clinical evaluation and laboratory test results 6.