What laboratory tests are ordered for a female experiencing perimenopause (premenopause) symptoms?

From the Guidelines

For a female suspected to be going through menopause, the primary laboratory tests to order include estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as clinically indicated. When evaluating menopausal symptoms, it's essential to assess and treat medical causes of symptoms such as thyroid disease and diabetes, as suggested by the NCCN clinical practice guidelines in oncology 1.

Key Laboratory Tests

• Estradiol levels to assess the decrease in estrogen production
• FSH levels to evaluate the increase in follicle-stimulating hormone, although it's noted that FSH is not a reliable marker of menopausal status in female survivors with prior chemotherapy or pelvic radiation exposure or in female survivors on tamoxifen 1
• LH levels to assess luteinizing hormone
• Prolactin levels as clinically indicated

Additional Considerations

• A pelvic evaluation should be performed to assess for vaginal atrophy in women with complaints of vaginal dryness, which can be accomplished by referral to an appropriate specialist 1
• For perimenopausal or premenopausal female survivors who have become amenorrheic and later develop bleeding, serial estradiol levels can be useful to determine return of ovarian function 1
• Other markers, including anti-Mullerian hormone (AMH) and inhibin, may provide additional information on ovarian status in female cancer survivors with prior chemotherapy or those on tamoxifen, but alone are not reliable to ensure menopausal status 1

From the Research

Laboratory Tests for Menopause

To diagnose menopause, healthcare providers may order several laboratory tests, including:

• Follicle-stimulating hormone (FSH) test to check hormone levels 2, 3, 4
• Estradiol test to measure estrogen levels 2, 3, 4
• Thyroid function tests to rule out thyroid disorders, which can cause similar symptoms 2, 3, 4
• Complete blood count (CBC) to check for anemia or other blood disorders 2, 3, 4

Diagnostic Criteria

The diagnosis of menopause is typically based on a combination of clinical symptoms and laboratory test results, including:

• Irregular menstrual periods or amenorrhea (absence of menstruation) 2, 3, 4
• Vasomotor symptoms, such as hot flashes and night sweats 2, 3, 4
• Genitourinary symptoms, such as vaginal dryness and dyspareunia 2, 3, 4

Hormone Therapy

Hormone therapy may be prescribed to alleviate menopausal symptoms, including:

• Estrogen-containing hormone therapy to treat vasomotor symptoms 2, 3
• Nonhormonal medications, such as selective serotonin reuptake inhibitors and gabapentin, to treat vasomotor symptoms 2
• Hormone-free vaginal moisturizers to treat genitourinary syndrome of menopause 2