From the Guidelines
Laboratory tests are generally not necessary to confirm menopause in most women, but in certain situations, such as women under 45 with menopausal symptoms or those with unclear symptoms, blood tests like follicle-stimulating hormone (FSH) and estradiol may be recommended. Menopause is typically diagnosed based on clinical symptoms and the absence of menstrual periods for 12 consecutive months in women over age 45 1. The definition of menopause includes a profound and permanent decrease in ovarian estrogen synthesis, and reasonable criteria for determining menopause include prior bilateral oophorectomy, age ≥60 years, or age <60 years and amenorrheic for 12 or more months with FSH and estradiol in the postmenopausal range 1.
Key Considerations for Laboratory Testing
- FSH and estradiol levels can help confirm menopausal status, especially in women under 45 or those with unclear symptoms 1.
- The timing of hormone tests matters, as levels can fluctuate during perimenopause, so a single test may not be definitive and might need to be repeated.
- Other hormones that might be measured include anti-Müllerian hormone (AMH) and occasionally thyroid-stimulating hormone (TSH) to rule out thyroid disorders that can mimic menopausal symptoms.
- Testing is most useful in women with therapy-induced amenorrhea, where ovarian function may still be intact or resume despite anovulation/amenorrhea after chemotherapy, and in women considering certain treatments like aromatase inhibitors 1.
Interpretation of Laboratory Results
- Elevated FSH levels (>30 IU/L) and decreased estradiol levels are typically seen in menopause 1.
- A single test may not be definitive, and results should be interpreted in the context of clinical symptoms and menstrual history.
- Serial measurement of FSH and/or estradiol may be needed to ensure postmenopausal status in certain situations, such as in women with therapy-induced amenorrhea 1.
From the Research
Laboratory Tests for Menopause
- The diagnosis of menopause is typically a clinical diagnosis, made retrospectively, based on a 12-month period of consecutive amenorrhoea in a compatible age group (after 45 years of age) 2.
- No hormonal dosage or imaging is indicated to make a diagnosis of menopause in a classic situation 2.
- However, in certain situations, such as women with a history of hysterectomy, a repeat FSH≥40 combined with low estradiol (<20pg/ml) at least 3 months after the procedure could be a diagnostic orientation towards menopausal status 2.
Recommended Laboratory Tests
- FSH (Follicle-Stimulating Hormone) test: to confirm menopausal status in women with a history of hysterectomy or other complex clinical situations 2, 3.
- Estradiol test: to confirm low estrogen levels in women with a history of hysterectomy or other complex clinical situations 2, 3.
Interpretation of Laboratory Results
- Elevated FSH levels (≥40) and low estradiol levels (<20pg/ml) may indicate menopausal status in women with a history of hysterectomy or other complex clinical situations 2, 3.
- However, it is essential to consider the clinical context and medical history of the patient when interpreting laboratory results 2, 4.