What hormone levels should be checked in perimenopausal women?

Hormone Levels to Check in Perimenopausal Women

For perimenopausal women, follicle-stimulating hormone (FSH) and estradiol levels should be checked, though these values alone are not reliable indicators of menopausal status and should be interpreted in the context of clinical symptoms and menstrual history. 1

Definition of Perimenopause

Perimenopause is the transition period before permanent cessation of menses when endocrine, biological, and clinical features of approaching menopause begin, typically marked by menstrual irregularity. 2

Recommended Hormone Testing

• FSH and estradiol are the primary hormone levels that should be checked in perimenopausal women, particularly when assessing menopausal status or considering hormone therapy. 1

• Luteinizing hormone (LH) may be checked as clinically indicated to provide additional information about ovarian function. 1

• Prolactin should be measured when clinically indicated to rule out other causes of menstrual irregularity. 1

• Anti-Müllerian hormone (AMH) may provide additional information on ovarian reserve status, though normative data in perimenopausal women are limited. 1

Interpretation Challenges

• FSH levels during perimenopause can fluctuate dramatically, often showing abrupt spikes followed by returns to premenopausal ranges, making single measurements unreliable. 3, 4

• Estradiol levels may remain relatively unchanged or even increase during early perimenopause before declining in late perimenopause. 2, 5

• During perimenopause, hormone levels frequently vary markedly, making FSH and estradiol unreliable as standalone indicators of menopausal status. 2

• There is no significant correlation between FSH or estradiol levels and age or years since last menstruation. 6

Special Considerations

• For women under age 60 with amenorrhea for ≥12 months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, both FSH and estradiol should be in the postmenopausal range to confirm menopause. 1

• Women taking tamoxifen or toremifene who are under age 60 should have FSH and estradiol measured to confirm menopausal status. 1

• It is not possible to accurately determine menopausal status in women receiving LHRH agonists or antagonists. 1

• For women who have undergone hysterectomy but still have their ovaries, FSH and estradiol levels should be checked to determine menopausal status. 1

Clinical Application

• Hormone testing should be performed when women present with:

  • Irregular menstrual cycles 1
  • Vasomotor symptoms (hot flashes, night sweats) 1
  • Before initiating hormone therapy 1
  • After chemotherapy to assess ovarian function 1

• For perimenopausal women who become amenorrheic and later develop bleeding, serial estradiol levels can help determine if ovarian function has returned. 1

Common Pitfalls

• Relying solely on FSH levels to determine menopausal status is problematic due to significant fluctuations during perimenopause. 4

• A single normal FSH measurement does not rule out perimenopause, as levels can temporarily return to premenopausal ranges. 3, 4

• Amenorrhea after chemotherapy is not a reliable indicator of menopause, as ovarian function may still be intact or resume despite absence of menses. 1

• Hormone levels and absence of menses are unreliable indicators of menopause during treatment with tamoxifen. 1