Standard Hormonal Labs for Menopause Symptoms
For women under 60 experiencing menopause symptoms, measure FSH and estradiol as the primary hormone panel, with additional testing for LH, prolactin, and thyroid function when clinically indicated. 1
Primary Hormone Panel
The core diagnostic assessment consists of:
- FSH and estradiol form the essential hormone panel for evaluating menopausal status in symptomatic women, though these must be interpreted alongside clinical presentation rather than in isolation 1
- Estradiol should be measured concurrently with FSH to provide context for ovarian function, as FSH alone can be misleading during the menopausal transition 1
- LH should be checked when clinically indicated to provide additional information about ovarian function 1
- Prolactin should be measured when indicated to exclude other causes of menstrual irregularity 1
Essential Additional Testing
Beyond the primary hormone panel, several tests are critical:
- Thyroid function tests are mandatory because thyroid disease commonly mimics menopausal symptoms and must be excluded before attributing symptoms solely to menopause 1
- Glucose/insulin should be considered in women with obesity, weight gain, or other metabolic concerns 1
- Anti-Müllerian hormone (AMH) may provide additional information on ovarian reserve, though normative data are limited and it should not be used alone 1
When Laboratory Testing Is Actually Needed
Laboratory confirmation is not always necessary:
- Women aged 60 years or older do not require laboratory testing to diagnose menopause, as age alone is sufficient for clinical diagnosis 2
- For women under 60, testing is indicated after 12 months of amenorrhea to confirm postmenopausal status with both FSH in the postmenopausal range and low estradiol 2
- Testing should be performed in women with irregular menstrual cycles, vasomotor symptoms disrupting quality of life, before initiating hormone therapy, or after chemotherapy/pelvic radiation to assess ovarian function 1
Critical Interpretation Caveats
Several clinical scenarios render FSH unreliable:
- FSH is unreliable in women taking tamoxifen, toremifene, or LHRH agonists/antagonists 1
- Amenorrhea after chemotherapy does not confirm menopause, as ovarian function may resume despite absent menses 1
- FSH levels fluctuate dramatically during the menopausal transition, rising into the postmenopausal range and falling again into the fertile range, making single measurements unreliable 3
- Apparently ovulatory cycles may occur subsequent to postmenopausal FSH levels, limiting the diagnostic value of FSH measurement during the transition 3
Special Populations Requiring Expanded Testing
Certain clinical scenarios require additional hormone assessment:
- For women with menstrual irregularity or suspected hypogonadism, expand testing to include serum testosterone and SHBG when hirsutism, obesity, or polycystic ovary syndrome is suspected 1
- For women with fertility concerns, assess for anovulation with progesterone measured in the mid-luteal phase 1
- For women with chronic liver disease or osteoporosis risk, measure corrected serum calcium and phosphate levels 1
- For women at high risk of deficiency or with chronic cholestasis, measure 25-OH vitamin D levels 1
Diagnostic Algorithm for Confirming Menopause
The approach varies by age and clinical context:
- For women under 60 with ≥12 months amenorrhea (without chemotherapy, tamoxifen, or ovarian suppression), both FSH and estradiol must be in postmenopausal range to confirm menopause 1
- For women on tamoxifen or toremifene under 60, FSH and plasma estradiol levels in postmenopausal ranges are required, as FSH alone is unreliable 2
- For women with chemotherapy-induced amenorrhea, serial estradiol measurements are more useful than FSH to determine return of ovarian function 2
- For women on GnRH agonists/antagonists, menopausal status cannot be determined while receiving these medications 2
When to Refer for Specialist Evaluation
Endocrinology or gynecology referral is warranted for: