What laboratory tests are recommended for premenopausal women?

Recommended Laboratory Tests for Premenopausal Women

For premenopausal women, recommended laboratory tests include complete blood count (CBC), ferritin, celiac serology (tTG Ab), comprehensive metabolic panel, and urinalysis, with additional testing based on specific risk factors or symptoms. 1

Core Laboratory Tests for All Premenopausal Women

• Complete Blood Count (CBC) - Screens for anemia, which is common in premenopausal women due to menstrual blood loss 1
• Ferritin - Assesses iron stores, particularly important for menstruating women 1
• Comprehensive Metabolic Panel - Evaluates kidney and liver function, electrolyte balance, and glucose levels 1
• Urinalysis - Screens for kidney disease, urinary tract infections, and diabetes 1
• Celiac serology (tTG Ab) - Recommended as celiac disease is present in up to 4% of premenopausal women with iron deficiency anemia 2, 1

Testing for Iron Deficiency Anemia

Iron deficiency anemia (IDA) is common in premenopausal women due to menstrual losses, pregnancy, and poor dietary intake 2. When evaluating for IDA:

• Hemoglobin - Values <12 g/dL in non-pregnant women indicate anemia 2
• Ferritin - Values <45 ng/mL indicate iron deficiency 2
• Red cell indices - Microcytosis and hypochromia provide sensitive indication of iron deficiency 2

Management of Iron Deficiency Anemia in Premenopausal Women

• All premenopausal women with IDA should be screened for celiac disease 2
• Further GI investigation is generally not warranted unless there are additional concerning features 2:
  • Age over 50 years
  • Non-menstruating status (e.g., after hysterectomy)
  • Presence of GI symptoms
  • Strong family history of colorectal cancer
  • Persistent IDA despite iron supplementation

Hormone-Related Testing

• Serum estradiol and LH/FSH - Indicated for women with menstrual irregularity or other evidence of hypogonadism 1
• Serum testosterone/SHBG - Recommended for evaluation of hyperandrogenic states 1

Additional Testing Based on Risk Factors

• Genetic screening - Based on family history, ethnic background, and risk factors 1
• Cystic fibrosis carrier screening - If indicated by family history or ethnicity 1
• Bone mineral density (DXA) - For premenopausal women with risk factors for osteoporosis, including chronic renal failure, inflammatory arthritis, eating disorders, organ transplantation, prolonged immobilization, endocrine disorders, or long-term glucocorticoid therapy 1, 3

Frequency of Testing

• Laboratory tests should be repeated every 1-2 years in healthy premenopausal women 1
• Women with IDA should be monitored at 3-month intervals for 1 year, then after a further year, and again if symptoms of anemia develop 2

Common Pitfalls to Avoid

1. Overlooking celiac disease - A common cause of iron deficiency in premenopausal women that should be screened for in all cases of IDA 1

2. Unnecessary GI investigations - Extensive GI investigations have low yield in premenopausal women <50 years with IDA but no GI symptoms or family history 1

3. Misinterpreting CA-125 levels - For premenopausal women with pelvic masses, a cutoff of >50 units/mL (not >200 units/mL) is a better discriminator between benign and malignant masses 1

4. Neglecting to monitor response to iron therapy - Further investigation is necessary if hemoglobin and red cell indices cannot be maintained with iron supplementation 2

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