What hormones should be checked in a perimenopausal woman?

Hormone Testing for Perimenopausal Women

For perimenopausal women, estradiol and follicle-stimulating hormone (FSH)/luteinizing hormone (LH) levels should be monitored, particularly in women under 60 years who have been amenorrheic for ≤12 months or who have become amenorrheic after chemotherapy or hormonal treatments. 1

Key Hormones to Check

Primary Hormonal Tests

• Estradiol: To assess ovarian function and estrogen levels
• FSH/LH: To evaluate pituitary response and menopausal status
  • Testing should be individualized based on clinical presentation
  • Should be checked particularly in women under age 60 who have been amenorrheic for ≤12 months 1

Additional Recommended Tests

• Anti-Müllerian Hormone (AMH):

  • Better predictor of ovarian reserve than age, basal FSH, estradiol, and inhibin B 1
  • Does not vary by menstrual day or exogenous hormone use
  • Shows promise as a predictor of ovarian reserve and timing of menopause onset
  • Low levels indicate ovarian failure

• Inhibin B:

  • Reflects declining ovarian follicle numbers 2
  • Decreases earlier than estradiol in perimenopause

When to Test

1. Baseline Assessment:

   • At age 13 for survivors of childhood cancer 1
   • For perimenopausal women with symptoms

2. Follow-up Testing:

   • When experiencing irregular menses
   • With primary or secondary amenorrhea
   • With clinical signs of estrogen deficiency
   • Prior to next dose of GNRH agonist (if applicable)
   • After switching from tamoxifen to an aromatase inhibitor 1

3. Special Circumstances:

   • If vaginal bleeding occurs while on aromatase inhibitors 1
   • After chemotherapy or radiation therapy
   • When considering hormone replacement therapy

Clinical Considerations

Interpreting Results

• Perimenopause is characterized by highly variable hormone levels rather than steady decline 3, 4
• FSH levels begin to increase years before clinical indications of approaching menopause 2
• Estradiol levels may be preserved or even elevated during early perimenopause 4
• Single hormone measurements are unreliable guides to menopausal status during the transition 2

Common Pitfalls

• Relying on single measurements: Hormone levels fluctuate markedly during perimenopause, requiring multiple measurements over time 5
• Using FSH alone: FSH is documented to be ineffective in predicting menopause proximity 4
• Ignoring symptoms: Clinical symptoms should be considered alongside laboratory values
• Missing "LOOP" events: Approximately one-third of perimenopausal cycles have surges in estradiol during the luteal phase 4

When to Refer

• Endocrinology/gynecology for:
  • Delayed puberty
  • Persistently abnormal hormone levels
  • Hypogonadism
  • Severe menopausal symptoms requiring management 1

Monitoring Approach

• Initial hormone assessment when perimenopause is suspected
• Follow-up testing at 3-6 month intervals if symptoms persist or worsen
• Consider bone mineral density testing for women with evidence of hypogonadism 1
• Monitor for symptoms requiring intervention (vasomotor symptoms, vaginal dryness, etc.)

Remember that perimenopause represents a dynamic hormonal state with significant individual variation, not simply a time of declining estrogen 4.