What are the typical levels of estradiol (E2), Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH) at each stage of menopause?

Hormone Levels During Different Stages of Menopause

During the menopausal transition, estradiol levels initially remain stable or may rise, while FSH begins to increase years before clinical signs appear, with LH rising later and less dramatically than FSH. This hormonal pattern varies significantly by stage of menopause and can help identify where a woman is in the transition.

Premenopause (Normal Reproductive Years)

• Estradiol (E2): 30-400 pg/mL (varies by menstrual cycle phase)
• FSH: 3-10 IU/L (early follicular phase)
• LH: 1-12 IU/L (early follicular phase)
• Normal ovulatory cycles with stable hormone patterns

Early Perimenopause (Early Menopausal Transition)

• Estradiol (E2): Often preserved or may be elevated compared to premenopausal levels (40-300 pg/mL)
• FSH: Beginning to rise (10-30 IU/L)
• LH: Slight increase but less pronounced than FSH
• Characterized by:
  • Shorter follicular phases (11±2 days vs 14±1 days in younger women) 1
  • Irregular menstrual cycles
  • FSH begins rising while estradiol remains normal or elevated 2
  • Higher overall estrone conjugate excretion compared to younger women 1

Late Perimenopause (Late Menopausal Transition)

• Estradiol (E2): Begins to decline but with significant fluctuations (25-200 pg/mL)
• FSH: Markedly elevated (>30 IU/L)
• LH: Elevated but less than FSH
• Characterized by:
  • Menstrual irregularity with skipped cycles
  • Wide hormonal fluctuations making single measurements unreliable 2
  • Diminished luteal phase progesterone production 1
  • Hypergonadotropinemia with persistent estradiol secretion 3

Early Postmenopause (1-5 years after final menstrual period)

• Estradiol (E2): Low (generally <25 pg/mL)
• FSH: Highly elevated (40-250 IU/L)
• LH: Elevated (30-100 IU/L)
• FSH reaches maximum levels 1-3 years after menopause 4
• Some women may still have detectable estradiol from residual ovarian function 3

Late Postmenopause (>5 years after final menstrual period)

• Estradiol (E2): Very low (<20 pg/mL)
• FSH: Remains elevated but may decline slightly from peak (30-120 IU/L)
• LH: Remains elevated (15-60 IU/L)
• FSH tends to plateau or slightly decrease after 5-10 years postmenopause 4

Clinical Implications and Caveats

Diagnostic Limitations

• Single hormone measurements during perimenopause are unreliable due to marked fluctuations 2
• FSH and estradiol levels should not be used alone to diagnose perimenopause 5
• The Endocrine Society recommends that accurate evaluation requires temporary discontinuation of hormone replacement therapy for 2-4 weeks before testing 6

Hormone Patterns in Special Situations

• Surgical menopause: Abrupt drop in estradiol with rapid rise in FSH and LH
• Premature menopause (before age 45): Similar pattern to natural menopause but occurring earlier, with increased stroke risk 7
• Hormone therapy users: Suppressed FSH and LH with variable estradiol depending on formulation

Clinical Definition of Menopause

Menopause can be reliably determined by:

• Age ≥60 years
• Prior bilateral oophorectomy
• Age <60 years with amenorrhea for ≥12 months (without other causes)
• FSH and estradiol in the postmenopausal range 7

Important Considerations

• During perimenopause, hormone levels fluctuate markedly, making single measurements unreliable guides to menopausal status 2
• The decline in inhibin B, reflecting falling ovarian follicle numbers, is responsible for the initial rise in FSH 2
• Testosterone levels may remain stable or even rise slightly after menopause, while DHEA and DHEAS decline with age independent of menopause 2
• Estradiol levels fall profoundly over a 3-4 year period around final menses, contributing to symptoms and bone mineral density loss 2

Understanding these hormone patterns helps clinicians accurately assess menopausal stage and guide appropriate management decisions for symptoms and long-term health.