What should hormone levels show for postmenopausal women on labs?

Hormone Levels in Postmenopausal Women on Laboratory Tests

In postmenopausal women, laboratory tests should show low estradiol levels (typically undetectable to 10.7 pg/mL when measured by sensitive assays), elevated FSH (>35 IU/L), and elevated LH (>11 IU/L). 1, 2

Estrogen Levels

• Estradiol levels in postmenopausal women are typically very low, ranging from undetectable to 10.7 pg/mL when measured by sensitive and specific assays such as liquid or gas chromatography/mass spectroscopy (LC or GC/MS/MS) 2
• After menopause, most endogenous estrogen is produced by conversion of androstenedione (secreted by the adrenal cortex) to estrone in peripheral tissues, making estrone and estrone sulfate the most abundant circulating estrogens in postmenopausal women 3
• Direct estradiol assays used to measure levels in normal cycling women are often insensitive below 20 pg/mL, making accurate measurement of postmenopausal levels challenging 1
• Extraction-based (indirect) assays correlate better with mass spectrometry measurements than non-extraction-based (direct) assays for measuring the low estradiol levels in postmenopausal women 4

Gonadotropin Levels

• FSH levels are typically elevated in postmenopausal women (>35 IU/L) 1
• LH levels are also elevated (>11 IU/L) 1
• The elevated gonadotropins reflect the loss of negative feedback from ovarian estrogen production 3

Other Hormone Parameters

• Progesterone levels are typically low (<6 nmol/L) due to absence of ovulation 1
• Testosterone levels should be within normal range (<2.5 nmol/L) 1
• Prolactin should be normal (<20 μg/L) 1

Measurement Considerations and Challenges

• Estradiol measurements in postmenopausal women are technically challenging due to the very low concentrations 5
• Up to 50% of estradiol levels in postmenopausal women may be below the sensitivity of some assays 6
• Direct immunoassays without purification steps lack specificity for estradiol and can substantially overestimate levels in postmenopausal women 5
• Mass spectrometry methods (LC/MS or GC/MS) provide the most accurate measurements but are not always available in routine clinical practice 2, 4
• Estrone levels may be more reliably measured than estradiol in postmenopausal women and can serve as an indicator of total estrogen status 6

Clinical Implications

• Hormone levels outside these ranges may indicate various conditions:

  • Persistent estradiol production may suggest hormone replacement therapy, adrenal or ovarian tumors, or obesity (increased peripheral conversion) 1
  • Inappropriately low FSH/LH with low estradiol may indicate central hypogonadism (pituitary or hypothalamic dysfunction) 1
  • Elevated testosterone may suggest polycystic ovary syndrome (PCOS) or other androgen-producing conditions 1

• Understanding normal postmenopausal hormone levels is important for:

  • Confirming menopausal status 1
  • Evaluating hormone-related symptoms 1
  • Assessing risk for conditions like osteoporosis 1, 3
  • Monitoring hormone therapy when used 7

Remember that laboratory reference ranges may vary between different assay methods and laboratories, so results should always be interpreted in the context of the specific assay used 2, 4.