Laboratory Testing for Menopause
Direct Answer
Laboratory testing is not routinely needed for diagnosing menopause in women ≥60 years old—the diagnosis is clinical based on age and amenorrhea alone. 1
When to Order Laboratory Tests
Women Who Do NOT Need Testing
- Women ≥60 years with typical menopausal symptoms require no laboratory confirmation whatsoever. 1
- The diagnosis is purely clinical in this age group. 1
Women Who DO Need Testing
For women <60 years with 12+ months of amenorrhea:
- Measure FSH and estradiol to confirm postmenopausal range 1
- This confirms the diagnosis when age alone is insufficient 1
For special populations requiring mandatory testing:
- Women on LHRH agonists/antagonists cannot have menopausal status determined while on these medications and require serial FSH/estradiol measurements 1
- Premenopausal women post-chemotherapy need serial FSH/estradiol measurements before starting aromatase inhibitors 1
- Perimenopausal/premenopausal women who became amenorrheic and later develop bleeding need serial estradiol levels to determine return of ovarian function 1
Specific Laboratory Tests and Their Interpretation
Primary Hormonal Panel (When Indicated)
- FSH: Elevated levels indicate declining ovarian follicular activity, but this marker is unreliable in women with prior chemotherapy, pelvic radiation, or those taking tamoxifen 1
- Estradiol: Postmenopausal range confirms ovarian failure 1
- LH: Elevated in postmenopausal state as part of comprehensive hormonal assessment 1
- Prolactin: Measured to exclude hyperprolactinemia as a cause of amenorrhea 1
Critical Caveat About FSH and Estradiol
During the menopausal transition, hormone levels vary markedly—making FSH and estradiol unreliable guides to menopausal status in perimenopausal women. 2 This is why serial measurements are needed in certain populations rather than single values. 1
Complementary Laboratory Assessment
Tests to Exclude Mimicking Conditions
- Thyroid function tests: Necessary to exclude thyroid disease that can mimic menopausal symptoms 1
- Full blood count, liver and renal function tests, alkaline phosphatase, and calcium levels should be obtained 1
- 25-OH vitamin D levels if high risk for deficiency 1
Common Pitfalls to Avoid
- Do not order FSH/estradiol in women ≥60 years—it adds no diagnostic value and wastes resources 1
- Do not rely on single FSH measurements during perimenopause—hormone levels fluctuate wildly during this transition 2
- Do not use FSH to assess menopausal status in women on tamoxifen, post-chemotherapy, or post-pelvic radiation—it is unreliable in these contexts 1
- Do not forget to assess for alternative causes of amenorrhea (thyroid disease, hyperprolactinemia) before attributing symptoms to menopause 1
Clinical Assessment Takes Priority
The National Comprehensive Cancer Network emphasizes that laboratory confirmation is not routinely required for diagnosing menopause in most clinical scenarios. 1 Instead, focus on: