What hormones indicate menopause in a woman?

Hormones That Indicate Menopause

Primary Diagnostic Hormones

Menopause is diagnosed clinically based on age and menstrual pattern—not hormone testing—but when laboratory confirmation is needed, elevated FSH (>25-40 IU/L) combined with low estradiol (<50 pg/mL) in the appropriate clinical context supports the diagnosis. 1, 2

Follicle-Stimulating Hormone (FSH)

• FSH rises 10-15 fold after menopause, representing the most dramatic hormonal change and serving as the primary laboratory marker when testing is performed 3, 4
• Early follicular phase FSH begins increasing several years before clinical menopause, reflecting declining ovarian follicle numbers 3, 5
• Postmenopausal FSH levels typically exceed 25-40 IU/L, though specific cutoffs vary by laboratory 6, 3

Estradiol (E2)

• Estradiol falls to consistently low levels (<50 pg/mL) only after menopause is complete, remaining relatively preserved until late perimenopause despite rising FSH 3, 5
• After menopause, estradiol levels drop to <20 pg/mL as ovarian follicular activity ceases 7, 3
• The profound fall in estradiol over 3-4 years around final menses drives menopausal symptoms and bone loss 3

Luteinizing Hormone (LH)

• LH increases after menopause due to loss of negative feedback from ovarian hormones, though less dramatically than FSH 6, 7
• LH is measured alongside FSH and estradiol when hormonal assessment is clinically indicated 6

Secondary Hormonal Markers

Inhibin B

• Inhibin B declines before FSH rises, representing the earliest detectable hormonal change in the menopausal transition 3, 5
• Inhibin B becomes undetectable after menopause, reflecting complete loss of small antral follicles 5, 8
• The fall in inhibin B (a product of granulosa cells) removes negative feedback on FSH, causing FSH elevation 3, 8

Anti-Müllerian Hormone (AMH)

• AMH appears to be the first marker to change during the menopausal transition, declining progressively with age and follicle depletion 5, 9
• AMH reaches undetectable levels at menopause and correlates well with ovarian reserve 6, 5
• AMH shows promise as a predictor of timing of menopause, though normative data remain limited and no validated cutpoints exist for clinical use 6, 9

Androgens

• Testosterone levels change little during the menopausal transition and may even rise slightly after menopause, having already declined by ~50% between ages 20-40 3
• DHEA and DHEAS decline progressively with age without specific influence from menopause 3

Critical Clinical Caveats

When Hormone Testing Should NOT Be Performed

• For women ≥60 years, menopause should be diagnosed clinically without hormone testing based on age and menstrual pattern alone 2
• Hormone testing is not clinically useful for diagnosing perimenopause because FSH and estradiol fluctuate erratically during the transition, making single measurements unreliable 2, 4, 8
• FSH may rise into postmenopausal range then fall back to premenopausal levels during the transition, with ovulatory cycles occurring even after "postmenopausal" FSH levels 4, 8
• Do not use hormone levels to guide or justify HRT decisions—management should be symptom-based, not laboratory-based 10, 1, 2

Populations Where FSH Is Particularly Unreliable

• Women with prior chemotherapy or pelvic radiation show unreliable FSH patterns 1
• Women taking tamoxifen or other selective estrogen receptor modulators have unreliable FSH measurements 1
• During perimenopause, FSH can fluctuate from postmenopausal to premenopausal ranges within weeks 4, 8

When Hormone Testing May Be Appropriate

• For women <60 years with 12+ months amenorrhea where menopausal status confirmation is clinically necessary (e.g., considering fertility preservation, evaluating premature ovarian insufficiency) 2
• For cancer survivors with menopausal symptoms disruptive to quality of life, to assess for alternative medical causes like thyroid disease 1
• For perimenopausal women considering hormone therapy who are not clearly postmenopausal, to guide alternative endocrine agent selection 1
• For women who became amenorrheic and later develop bleeding, serial estradiol can help determine return of ovarian function 1

Practical Algorithm for Hormone Assessment

Step 1: Determine if Testing Is Needed

• Age ≥60 years + amenorrhea: Diagnose menopause clinically, no testing needed 2
• Age <60 years + 12 months amenorrhea: Menopause diagnosed clinically, testing optional for confirmation 2
• Irregular cycles (perimenopause): Do NOT test—diagnosis is clinical, hormone levels are unreliable 2, 4

Step 2: If Testing Is Performed

• Measure early follicular phase (days 2-5) FSH and estradiol if cycles still occurring 6, 3
• Add LH if comprehensive assessment needed 6
• Consider inhibin B or AMH only in research settings or specialized fertility evaluation 6, 5

Step 3: Interpretation

• Postmenopausal pattern: FSH >25-40 IU/L + estradiol <50 pg/mL + undetectable inhibin B 3, 5
• Perimenopausal pattern: Fluctuating FSH and estradiol—cannot reliably predict timing to menopause 4, 9, 8
• Premenopausal pattern: Normal FSH (<10 IU/L) + normal estradiol (>50 pg/mL) 3

Step 4: Clinical Action

• Base treatment decisions on symptoms and risk factors, not hormone levels 10, 1, 2
• Reassess bone density, cardiovascular risk, and symptom burden rather than repeating hormone tests 1