Recommended Blood Work Panel for Perimenopause
For women experiencing perimenopause symptoms, laboratory evaluation should include estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as clinically indicated. 1
Primary Hormone Tests
- Estradiol: Measures estrogen levels, which can be erratically elevated during perimenopause (averaging 26% higher than normal reproductive years) 2
- FSH: While traditionally used to assess menopausal status, it's important to note that FSH is not a reliable marker of menopausal status on its own 1, 3
- LH: Helps evaluate ovarian function and hormonal fluctuations
- Prolactin: Rules out other causes of menstrual irregularity 1
Additional Recommended Tests
- Thyroid function tests: TSH and free T4 to rule out thyroid disease as a cause of symptoms that can mimic perimenopause 1
- Fasting blood glucose/HbA1c: To assess for diabetes, which can present with similar symptoms 1
Specialized Tests When Indicated
- Serial estradiol levels: Particularly useful for perimenopausal women who have become amenorrheic and later develop bleeding, to determine return of ovarian function 1
- Anti-Müllerian hormone (AMH): May provide additional information on ovarian status but is not reliable alone to ensure menopausal status 1
- Inhibin: Can provide supplementary information on ovarian function but should not be used in isolation 1
Interpretation Considerations
- During perimenopause, hormonal patterns typically show:
Clinical Pitfalls to Avoid
- Relying solely on FSH: A single FSH measurement is insufficient to diagnose perimenopause, as levels fluctuate widely during this transition 1, 3
- Misinterpreting normal hormone fluctuations: Hormonal patterns in perimenopause can be highly variable - a single measurement may not reflect the overall pattern 4
- Overlooking non-hormonal causes: Symptoms attributed to perimenopause may be due to thyroid disorders, diabetes, or other medical conditions 1
Follow-up Recommendations
- If symptoms are severe and disruptive to quality of life, consider referral to an appropriate specialist for management of menopausal hormone therapy (MHT) or non-hormonal alternatives 1, 3
- For women with vaginal dryness, a pelvic evaluation should be performed to assess for vaginal atrophy 1
- Regular monitoring of symptoms and response to any interventions is essential 3
By obtaining this comprehensive hormone panel and related tests, clinicians can better differentiate perimenopause from other conditions and develop appropriate management strategies for women experiencing perimenopausal symptoms.