From the FDA Drug Label
Estrogens are hormones made by a woman’s ovaries Between ages 45 and 55, the ovaries normally stop making estrogens. This leads to a drop in body estrogen levels which causes the “change of life” or menopause
The hormones to check for perimenopausal flushing are estrogen levels, as the drop in estrogen levels can cause symptoms such as hot flashes or hot flushes 1.
- Estrogen levels should be evaluated to determine the cause of perimenopausal flushing. It is essential to consult a healthcare provider to discuss the best course of action for evaluating and treating perimenopausal flushing 2.
From the Research
For a woman experiencing perimenopausal flushing, the key hormones that should be checked include follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), and thyroid-stimulating hormone (TSH). These tests help confirm perimenopause and rule out other conditions that might cause similar symptoms. FSH levels typically rise during perimenopause as the ovaries become less responsive, while estradiol levels fluctuate and eventually decline 3. LH testing provides additional information about ovarian function and helps establish hormonal patterns. TSH is important to exclude thyroid disorders, which can mimic perimenopausal symptoms.
Some key points to consider when evaluating hormone levels in perimenopausal women include:
- FSH levels are higher in women who experience hot flushes at least once a day or more 4
- Estradiol levels are higher in women experiencing one or no hot flushes per week 4
- LH levels can provide additional information about ovarian function 3
- TSH levels can help exclude thyroid disorders that may mimic perimenopausal symptoms
Blood tests should ideally be drawn on day 2-5 of the menstrual cycle if periods are still occurring, though this timing becomes less critical as cycles become irregular. For comprehensive evaluation, these hormone tests should be interpreted alongside the patient's age, menstrual history, and symptom pattern. Testing progesterone levels may also be considered if there are concerns about irregular bleeding patterns during this transition. The most recent study 5 suggests that androgen levels, such as testosterone and DHEA-S, may also play a role in the development of hot flushes during the menopausal transition. However, the highest quality and most recent study 5 should be prioritized when making a definitive recommendation.