From the Guidelines
To check for premenopause, the most important lab tests include estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as clinically indicated, according to the NCCN clinical practice guidelines in oncology 1. When evaluating premenopausal symptoms, it's essential to consider the clinical context and potential medical causes of symptoms, such as thyroid disease and diabetes.
- Laboratory evaluation should include:
- Estradiol
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Prolactin However, it's crucial to note that FSH is not a reliable marker of menopausal status in female survivors with prior chemotherapy or pelvic radiation exposure or in female survivors on tamoxifen 1. For perimenopausal or premenopausal female survivors who have become amenorrheic and later develop bleeding, serial estradiol levels can be useful to determine return of ovarian function, and other markers like anti-Mullerian hormone (AMH) and inhibin may provide additional information on ovarian status, but alone are not reliable to ensure menopausal status 1. In clinical practice, these lab tests should be interpreted alongside clinical symptoms, as premenopause is primarily diagnosed based on changing menstrual patterns and symptoms like hot flashes, sleep disturbances, and mood changes.
From the Research
Labs to Check for Pre-Menopause
To determine if a woman is entering pre-menopause, several laboratory tests can be conducted. These tests include:
- Follicle-stimulating hormone (FSH) levels: FSH levels increase as women approach menopause 2
- Luteinizing hormone (LH) levels: LH levels also increase during the perimenopausal and postmenopausal phases 3
- Estradiol levels: Estradiol levels decrease during the perimenopausal and postmenopausal phases 3
- Thyroid function tests: Thyroid dysfunction is common in women, especially during the perimenopausal and postmenopausal phases 4, 5
- Antioxidant status: Oxidative stress increases during the perimenopausal and postmenopausal phases, and antioxidant levels decrease 3
Hormonal Changes
Hormonal changes occur during the pre-menopausal phase, including:
- Increased FSH and LH levels
- Decreased estradiol and progesterone levels
- Changes in thyroid hormone levels
Screening for Thyroid Dysfunction
Screening for thyroid dysfunction is important, especially in older women, as untreated thyroid disease can exacerbate the risks of osteoporosis and cardiovascular disease 5. However, screening for thyroid dysfunction in asymptomatic individuals is controversial.
Laboratory Tests for Thyroid Function
Laboratory tests for thyroid function include:
- Thyroid-stimulating hormone (TSH) levels
- Free thyroxine (FT4) and free triiodothyronine (FT3) levels
- Thyroid antibody tests to diagnose autoimmune thyroid disease