From the Guidelines
For a postmenopausal female with menopausal symptoms, I recommend ordering follicle-stimulating hormone (FSH) and estradiol levels as the primary laboratory tests. These tests confirm menopause by showing elevated FSH (typically >30 mIU/mL) and low estradiol (<30 pg/mL) 1. A complete blood count should be included to rule out anemia, which can cause fatigue that might be confused with menopausal symptoms. Thyroid function tests (TSH, free T4) are important since thyroid disorders can mimic menopausal symptoms like hot flashes, mood changes, and fatigue. A comprehensive metabolic panel helps assess overall health and identifies conditions that might affect treatment options. If the patient reports specific symptoms like vaginal dryness or urinary issues, a urinalysis may be appropriate to rule out urinary tract infections. For women with irregular bleeding, endometrial assessment via ultrasound or biopsy may be necessary. These tests help distinguish true menopausal symptoms from other conditions with similar presentations, allowing for appropriate management strategies including hormone replacement therapy if indicated and not contraindicated. Additionally, considering the patient's menopausal status, it is essential to be aware of the recommendations for cancer screening in postmenopausal women, such as those outlined for breast, cervical, colorectal, and endometrial cancer 1. However, the primary focus for evaluating menopausal symptoms should remain on confirming menopause and ruling out other potential causes of symptoms.
From the Research
Laboratory Tests for Postmenopausal Females
To evaluate menopausal symptoms in postmenopausal females, the following laboratory tests can be considered:
- Lipid profile, including Triacylglycerol (TG), LDL-Cholesterol (LDL-C), HDL-Cholesterol (HDL-C), and Total Cholesterol (TC) 2
- Vitamin D level, as low vitamin D levels are associated with cardiovascular disease and may affect lipid profiles 2, 3
- Fasting glucose, to assess the risk of metabolic syndrome 4
- Serum calcium and ionized calcium levels, to evaluate bone health 5, 3
- C-reactive protein and urine albumin/creatinine ratio, to assess inflammation and kidney function 3
- Bone mineral density (BMD) test, to evaluate the risk of osteoporosis 5, 6
- Otolin-1, P1NP, and NTX levels, to investigate the association between benign paroxysmal positional vertigo (BPPV) and osteoporosis 6
Additional Considerations
When interpreting laboratory results, consider the following:
- The presence of metabolic syndrome, which is associated with an increased risk of cardiovascular disease and may affect menopausal symptoms 4
- The potential impact of type 2 diabetes mellitus on bone mineral density response to bisphosphonates 5
- The relationship between vitamin D levels and functional arterial parameters, such as arterial stiffness and endothelial function 3