Testing for Menopause Symptoms
In most menopausal women with classic symptoms (hot flashes, night sweats, vaginal dryness), laboratory testing is not routinely needed—diagnosis is clinical based on age and symptom pattern. 1
When Laboratory Testing IS Indicated
Laboratory evaluation should be performed only in specific clinical scenarios:
- Women aged 40-45 years with menopausal symptoms where diagnosis is uncertain 2
- Women under age 40 with suspected premature menopause 3
- Women on tamoxifen or with prior chemotherapy/pelvic radiation where hormonal status is unclear 2
Specific Laboratory Tests to Order
When testing is clinically indicated, order the following panel 2:
- Estradiol (most useful for tracking ovarian function)
- FSH (follicle-stimulating hormone)
- LH (luteinizing hormone)
- Prolactin
Critical Testing Caveat
FSH is NOT a reliable marker of menopausal status in women with prior chemotherapy, pelvic radiation exposure, or those taking tamoxifen. 2 In these populations, serial estradiol levels are more useful for determining return of ovarian function. 2
Essential Clinical Assessment (Instead of Labs)
Rather than reflexive laboratory testing, focus your evaluation on:
Symptom Characterization 2, 1
- Vasomotor symptoms: Document frequency and severity of hot flashes and night sweats
- Genitourinary symptoms: Assess for vaginal dryness, dyspareunia, urinary urgency, and pruritus
- Associated symptoms: Evaluate sexual dysfunction, reduced libido, and sleep disturbance
Quality of Life Impact 2, 1
Use standardized assessment tools:
- Greene Scale for comprehensive symptom assessment including sexual function 2
- MENQOL (Menopause-Specific Quality of Life questionnaire) 1
- Document impact on activities of daily living 2
Physical Examination 2
For women complaining of vaginal dryness, perform a pelvic examination to assess for vaginal atrophy or refer to an appropriate specialist for this evaluation. 2
Additional Medical Workup
Screen for alternative causes of symptoms that mimic menopause 2:
- Thyroid function tests (thyroid disease can cause similar symptoms)
- Fasting glucose or HbA1c (diabetes can present with similar complaints)
Establish Treatment Goals Before Testing
Before ordering any tests, determine what the patient wants from intervention 2, 1:
- Reduction in symptom frequency/severity
- Information and education about menopause
- Specific quality of life improvements
Set realistic expectations: many women are satisfied with a 50% reduction in symptom severity with non-hormonal treatments. 1
Common Pitfall to Avoid
Do not order FSH testing in women over age 45 with classic menopausal symptoms—this adds no clinical value and may cause confusion if results are equivocal. 3 The diagnosis is clinical in this population, and treatment decisions should be based on symptom severity and quality of life impact, not hormone levels. 1