What laboratory tests are recommended for a woman in menopause?

Laboratory Testing for Women in Menopause

For a woman in menopause, obtain FSH, LH, estradiol, and prolactin as the core hormone panel, with TSH added if thyroid symptoms are present, plus routine metabolic screening including fasting glucose and lipid panel. 1

Core Hormone Panel

The essential laboratory evaluation includes:

• FSH and LH should be measured as part of the standard workup, though FSH alone is unreliable for confirming menopausal status due to significant fluctuations during the transition period 1, 2
• Estradiol helps determine ovarian function, particularly when serial measurements are obtained in women with irregular bleeding patterns 1, 2
• Prolactin must be included to exclude other causes of amenorrhea that can mimic menopause 1

Important caveat: Hormone levels fluctuate markedly during the menopausal transition, making single measurements of FSH and estradiol unreliable guides to menopausal status 3. Always interpret laboratory results alongside clinical symptoms, as menopause is primarily a clinical diagnosis 1, 2.

Thyroid Function Assessment

• TSH should be checked routinely, as thyroid disorders are common in this age group and symptoms overlap significantly with menopausal complaints 1, 4
• Thyroid antibodies (TPO-Ab) should be added if thyroid dysfunction is suspected 2
• The prevalence of subclinical thyroid disease in postmenopausal women reaches 23.2%, with 73.8% being hypothyroid 4

Metabolic Screening

• Fasting glucose or 2-hour oral glucose tolerance test should be performed, as metabolic changes accelerate during menopause and insulin resistance becomes more prevalent 1, 2
• Lipid panel is warranted given increased cardiovascular risk after menopause 4

Cancer Screening Considerations

• Counsel women about endometrial cancer risks and instruct them to report any unexpected vaginal bleeding or spotting immediately 5, 1
• Continue age-appropriate cancer screening per standard guidelines (mammography annually, colorectal screening, cervical cancer screening based on prior history) 5

Optional Advanced Testing

• Anti-Müllerian hormone (AMH) and inhibin may provide additional information on ovarian reserve but are not reliable alone to confirm menopausal status 2
• Bone density testing (DXA scan) should be considered, as bone loss accelerates in late perimenopause when estradiol levels fall 3

When Additional Testing Is Most Useful

Laboratory testing beyond routine screening is particularly valuable when:

• Menopausal status is uncertain in younger women (under age 40) 1
• Symptoms are severe, atypical, or refractory to initial management 2
• Determining if ovarian function has returned after a period of amenorrhea 1