From the FDA Drug Label
Circulating estrogens modulate the pituitary secretion of the gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH), through a negative feedback mechanism. The hormones to check for perimenopause are:
- Estradiol
- Luteinizing hormone (LH)
- Follicle stimulating hormone (FSH) 1
From the Research
To check for perimenopause, doctors should measure follicle-stimulating hormone (FSH), estradiol, and sometimes luteinizing hormone (LH) levels in the blood, with FSH being the most important hormone to test, as levels typically rise during perimenopause when the ovaries become less responsive, as suggested by 2. The diagnosis of perimenopause is primarily clinical, supported by laboratory findings, and should consider clinical symptoms like irregular periods, hot flashes, sleep disturbances, and mood changes. Some key points to consider when checking for perimenopause include:
- FSH levels typically rise during perimenopause, with an FSH level above 30 mIU/mL on day 3 of the menstrual cycle often suggesting perimenopause, though a single elevated reading isn't definitive since levels can fluctuate significantly during this transition, as noted in 3.
- Estradiol levels may be low or fluctuating, reflecting the declining ovarian function, and additional helpful tests include thyroid-stimulating hormone (TSH) to rule out thyroid disorders that can mimic perimenopausal symptoms, and anti-Müllerian hormone (AMH), which decreases with declining ovarian reserve, as discussed in 4 and 5.
- Testing should ideally be done on day 2-5 of the menstrual cycle for accuracy, though this timing becomes challenging with irregular cycles common in perimenopause, as mentioned in 2.
- The most recent and highest quality study, 6, suggests that menopausal hormone therapy with estradiol and progesterone may have a better safety profile compared to other estrogens and progestins, but this does not directly impact the diagnosis of perimenopause. Overall, the diagnosis of perimenopause should be based on a combination of clinical symptoms and laboratory findings, with FSH being a key hormone to test, as suggested by the most recent and highest quality evidence 2.