From the Guidelines
To determine if a patient is menopausal or perimenopausal based on FSH and LH levels, elevated FSH levels above 30-40 mIU/mL, particularly when persistent on multiple tests, strongly suggest menopause, as indicated by the criteria for determining menopause which include FSH and estradiol in the postmenopausal range 1. During perimenopause, FSH levels may fluctuate but generally trend upward (often 10-30 mIU/mL), while LH levels typically rise in parallel but are less reliable diagnostically. Some key points to consider in the diagnosis include:
- A single hormone measurement is insufficient; clinical assessment should include evaluation of menstrual pattern changes, vasomotor symptoms like hot flashes, and age consideration (perimenopause typically begins in the mid-40s, with menopause occurring at an average age of 51) 1.
- For accurate diagnosis, FSH testing should be performed on day 2-5 of the menstrual cycle if periods are still occurring.
- In perimenopause, hormone levels may vary widely from month to month, so repeated testing may be necessary.
- These hormonal changes occur because as ovarian follicles diminish, negative feedback on the pituitary decreases, allowing FSH and LH levels to rise.
- It's also important to note that hormonal contraceptives can suppress FSH and LH levels, potentially masking menopausal status, and certain conditions like primary ovarian insufficiency can cause similar hormonal patterns at younger ages.
- The LH/FSH ratio can also be useful, with a ratio >2 suggesting a possible reproductive endocrine disorder, and FSH >35 IU/l indicating menopause 1. However, the most recent and highest quality study 1 provides the most reliable criteria for determining menopause based on FSH and LH levels.
From the Research
Determining Menopause or Perimenopause based on FSH and LH
To determine if a patient is menopausal or perimenopausal based on FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone) levels, several factors must be considered.
- FSH levels are often used as an indicator of menopause, but the timing of the measurement is crucial. According to a study 2, measuring FSH on the 7th day of the pill-free interval may not be a sensitive test for menopause.
- The FSH:LH ratio may be a more appropriate marker of menopause, with a ratio greater than 1 indicating menopause 2.
- Additionally, estrogen (E2) levels can also be used to determine menopause, with levels less than 20 pg/mL (73 pmol/L) indicating menopause 2.
- It is essential to note that these hormone levels can fluctuate during the menopausal transition, and a single measurement may not be sufficient to determine menopausal status.
- Perimenopause, or the menopausal transition, is a period of time during which hormone levels may fluctuate, and symptoms such as hot flashes, vaginal and sexual changes, altered mood and sleep, and changing bleeding patterns may occur 3.
- Hormone therapy, including estrogen and progesterone, can be effective in managing menopausal symptoms, but the type and route of administration, as well as patient-specific considerations, should be taken into account 4, 5, 6.