What laboratory tests are recommended for premenopausal women?

Laboratory Tests for Premenopausal Women

For premenopausal women, recommended laboratory tests should include screening for iron deficiency anemia, coeliac disease, and thyroid function, with additional testing based on specific risk factors or symptoms.

Core Laboratory Tests for Premenopausal Women

Hematologic Testing

• Complete Blood Count (CBC) - To screen for anemia, which affects many premenopausal women due to menstruation 1
• Ferritin levels - To assess iron stores, particularly important for menstruating women 1
  • Low ferritin confirms iron deficiency when anemia is present

Thyroid Function

• Thyroid function tests (TSH, Free T4) - Thyroid disorders can affect menstrual cycle and overall health 2, 3
  • Thyroid status varies with age and estrogen profile in women

Celiac Disease Screening

• Celiac serology (tTG Ab) - All premenopausal women with iron deficiency anemia should be screened for celiac disease 1
  • Celiac disease is present in up to 4% of premenopausal women with iron deficiency anemia

Risk-Based Additional Testing

For Women with Pelvic Masses

• CA-125 - For premenopausal women with pelvic masses 1
  • CA-125 level >50 units/mL is a better discriminator of cancer versus benign masses for premenopausal women

For Women with Bone Health Concerns

• Bone mineral density (DXA) - For premenopausal women with risk factors for osteoporosis 1
  • Risk factors include:
    • Chronic renal failure
    • Inflammatory arthritis
    • Eating disorders
    • Organ transplantation
    • Prolonged immobilization
    • Conditions causing secondary osteoporosis
    • Endocrine disorders affecting BMD
    • Long-term glucocorticoid therapy (>3 months)
    • Medications affecting BMD (anticonvulsants, chronic heparin)

For Women with Menstrual Irregularities

• Serum estradiol and LH/FSH - Should be assessed if there is menstrual irregularity or other evidence of hypogonadism 1
• Serum testosterone/SHBG - For evaluation of hyperandrogenic states 1
  • Free testosterone index (total testosterone/SHBG ratio) <0.3 indicates hypogonadism

Cancer Screening Recommendations

Breast Cancer

• Clinical breast examination - Part of periodic health examination, preferably at least every 3 years for women in their 20s and 30s 1

Cervical Cancer

• Pap test - Beginning approximately 3 years after first vaginal intercourse, but no later than age 21 1
  • Every year with conventional Pap tests or every 2 years using liquid-based Pap tests
  • After age 30, screening every 2-3 years with cervical cytology alone, or every 3 years with HPV DNA test plus cervical cytology

Special Considerations

For Women with Iron Deficiency Anemia

• Additional GI investigation is recommended for:
  • Women aged ≥50 years
  • Those with upper GI symptoms
  • Those with colonic symptoms
  • Those with a strong family history of colorectal cancer
  • Those with persistent IDA after iron supplementation 1

For Women with Chronic Liver Disease

• Bone function tests - Corrected serum calcium and serum phosphate 1
• 25-OH vitamin D level - Particularly in patients with chronic cholestasis 1

Common Pitfalls to Avoid

1. Overlooking celiac disease - This is a common cause of iron deficiency in premenopausal women and should be screened for in all cases of IDA 1

2. Misinterpreting CA-125 levels - For premenopausal women, a CA-125 cutoff of >50 units/mL (not >200 units/mL) is more appropriate for distinguishing between benign and malignant pelvic masses 1

3. Unnecessary GI investigations - For premenopausal women <50 years with IDA but no GI symptoms or family history, extensive GI investigations have low yield and can be deferred while treating with iron supplementation 1

4. Ignoring hormone timing - Serum for testosterone levels should be taken in the morning because of significant diurnal variation 1

By following these evidence-based laboratory testing recommendations, clinicians can effectively screen for common health issues in premenopausal women while avoiding unnecessary testing.