What hormone levels should be checked for perimenopause?

Hormone Levels to Check for Perimenopause

For perimenopause diagnosis, estradiol and follicle-stimulating hormone (FSH) levels should be measured, with measurements repeated at least twice, 4-6 weeks apart, ideally during the early follicular phase of the menstrual cycle. 1

Primary Hormone Tests for Perimenopause

• Follicle-stimulating hormone (FSH)

  • Most established marker for ovarian function
  • Typically elevated during perimenopause (>40 IU/L suggests menopausal transition)
  • Should be measured in early follicular phase when possible 1
  • Must be interpreted cautiously as levels can fluctuate dramatically during perimenopause 2, 3

• Estradiol (E2)

  • Helps confirm menopausal status when combined with FSH
  • During perimenopause, levels may be erratic and can be paradoxically elevated 4, 5
  • Levels typically <30 pg/mL suggest menopausal status 1

Additional Recommended Tests

• Luteinizing Hormone (LH)

  • Often checked alongside FSH to help confirm menopausal status 1
  • Rises during perimenopause similar to FSH

• Anti-Müllerian Hormone (AMH)

  • Emerging marker that correlates well with ovarian reserve 6
  • More stable across menstrual cycle than FSH
  • Not affected by hormonal contraceptives
  • Particularly useful in younger women with suspected premature ovarian insufficiency

Important Testing Considerations

Timing of Tests

• Measure FSH and estradiol at least twice, 4-6 weeks apart 1
• Ideally test during early follicular phase (days 2-5 of menstrual cycle)
• Remember that single measurements can be misleading during perimenopause

Interpretation Challenges

• FSH levels can fluctuate dramatically during perimenopause, rising into postmenopausal range and then falling back to premenopausal levels 2
• Estradiol levels may be erratically elevated rather than consistently low during perimenopause 4, 5
• Hormone measurements alone are insufficient for diagnosis - clinical symptoms must be considered 1

Special Situations

• FSH is unreliable in women who have:
  • Received chemotherapy
  • Had radiation exposure to ovaries
  • Are taking tamoxifen or toremifene 1
• In these cases, additional monitoring with AMH may be helpful

Clinical Context

• Diagnosis of perimenopause is primarily clinical, with laboratory tests serving as confirmatory tools 1
• Key symptoms to assess alongside hormone testing:
  • Vasomotor symptoms (hot flashes, night sweats)
  • Menstrual irregularity
  • Sleep disturbances
  • Mood changes
  • Vaginal dryness

Common Pitfalls to Avoid

• Relying solely on a single FSH measurement for diagnosis
• Failing to consider clinical symptoms alongside laboratory values
• Misinterpreting normal fluctuations in hormone levels as pathological
• Not repeating tests to confirm findings
• Over-reliance on hormone testing in women taking hormonal medications

Remember that perimenopause is characterized by hormonal fluctuations rather than steady decline, and the most symptomatic women often have higher estradiol and lower progesterone levels rather than simply low estradiol 4, 5.