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This article looks at the different diagnostic tests that are available to determine if you are experiencing an early menopause
Okay, so you think you might experience itearly menopauseor premature ovarian failure (POF). You've noticed a number ofsymptoms, and you suspect menopause may be at the heart of the matter. What now?
How can you be sure that what is happening to you is menopause or POF and not something else? The only way to be sure, as you would expect, is to see your doctor.
Even then, you may encounter problems. If your doctor has the knee-jerk reaction that a woman in her 20s or 30s is too young for menopause, you could be misdiagnosed as suffering from anything from stress (the old catch-all) to absolute nothing - the "it is everything". in your head” diagnosis.
Because of this, it's important that you know what tests to ask for — and what those tests mean.
Below is a list of the different hormone tests that can help you determine what's going on in your body - and whether or not your ovarian function is showing signs of menopause or ovarian failure.
Some important points to keep in mind
#1In general, if you're still getting your period, most doctors recommend that you get your blood work done on day 3 of your cycle - which is the third day of your period. If you no longer have a period, you can get tested at any time.
#2Because hormone levels can and do fluctuate, many doctors recommend getting tested more than once — about a month apart.
This is especially important if you're still getting your period and/or have few symptoms, as there's a low chance you're experiencing what's known as "temporary menopause" - a condition sometimes caused by traumatic stress, among other things.
Did you know?
It's also important to get tested more than once if your hormone levels are returning to normal but you have clear symptoms. It ispossibleYou can indeed go through menopause, but your hormone levels didn't show it the first time.
#3Different labs may use different ranges in their tests. So if you're being tested, ask your doctor not only about your specific results (i.e., "normal" or different), but also about theArea used by the laboratory.
Here, then, are the specific tests to consider:
Measurement of blood levels of follicle stimulating hormone (FSH).
This is the key test to determine if you are menopausal or not. A blood sample is taken to measure the level of FSH – the follicle stimulating hormone. Because your FSH levels increase when your ovaries stop producing enough estrogen, high FSH levels can signal that your body is entering menopause.
We're now going to get a bit technical about what your scores mean in this testOf.
Interpreting your FSH result
A “normal” FSH level on day 3 (when the test is done) is 3-20 mIU/ml, howeverFSH levels above 10 to 12 mIU/mlindicate that your ovaries are beginning to fail. In other words, it means you're inPerimenopause- Early menopause, when you notice physical symptoms but before you have not had a period for a year - or if you have 'decreased ovarian reserve'.
Higher FSH levels- Scores of about 30 to 40 or above - are usually taken to indicate menopause or ovarian failure. Even with FSH levels this high, you may still get your period, but it's still a sign that your body isn't producing enough estrogen to keep the ovaries functioning normally.
Keep in mind that you can end up with FSH levels well into the postmenopausal range but still get your period. This is one of the things that differentiates premature menopause, or premature ovarian failure, from "normal" menopause (i.e., menopause that occurs in older women and is generally recognized after a full year without a period).
Again, this underscores the unfortunate fact that you can actually be in a premature menopause even if you're on your period. Once your FSH levels have been at a certain level for a period of time, it is highly unlikely that they will return to pre-menopausal levels. In my case, even after my FSH was tested at over 150, I had what appeared to be normal periods for eight months.
When I was then tested again - in the hope that somehow my body had returned to normal - I was told that my FSH level had dropped, but only to 126. Since my FSH level had been well above 35 for over a year, I finally accepted that my ovaries had failed.
Because hormone levels can and do fluctuate, remember that a single, stand-alone FSH test, by itself, is anything but foolproof. Some women may test with a high FSH and then return to normal levels over the next month. Again, it's generally a good idea to get tested more than once just to be sure.
FSH test levels
| Normal Menstruation | |
|---|---|
| Follicle phase | 2,5 bis 10,2 |
| Midcycle Peak | 3.4 bis 33.4 |
| Lutealphase | 1,5 bis 9,1 |
| Postmenopausal | 23,0 bis >116,3 |
(Note: Laboratory values - or "test values" - vary from lab to lab, so you may find different values on your lab report. All measurements in mIU/mL)
estrogen (oestradiol) levels
Estradiol is the primary human estrogen — and when your ovaries begin to fail, your circulating estradiol levels drop. For this reason, doctors often do a serum estradiol concentration test to measure the amount of estradiol in your blood.
In this case, the doctor checks whether your estrogen levels are lower than normal - again a signal of ovarian failure or, in other words, early menopause.
Here are some guidelines for interpreting your estradiol test results:
#1"Normal" estradiol level on day 3 - 25-75 pg/ml (reported values may vary from laboratory to laboratory)
#2Despite the number above, estradiol levels are generally around 30 or below –in connection with a high FSH level(in this case high, i.e. in the postmenopausal range, i.e. 30-40 or higher) - considered menopausal.
#3If your estradiol levels are below 50 picograms per milliliter, you may still have your period, but you may also have symptoms of low estrogen — including hot flashes, vaginal dryness, and trouble sleeping.
What does that mean for me?
If your follicle-stimulating hormone (FSH) hasn't reached postmenopausal levels but your estradiol is low, you still arenotbe experienced as fully formed early menopause. There can be other reasons for low estradiol, including excessive exercise, low body fat, and decreased ovarian reserve.
However, estradiol levels tend to decrease over time. During the first 2 to 5 years after menopause or ovarian failure, blood levels of estradiol fall to an average range of about 25 to 35 pg/mL.
Women who are not on hormone replacement therapy (HRT) will generally find that this number continues to fall over time; After about five years, it is common for menopausal women who are not on HRT to have estradiol levels below 25.
Estrogen (estradiol) test values
| Non-menopausal: | |
|---|---|
| Follicle phase | 24-138 |
| Lutealphase | 19-164 |
| periovulatory | 107-402 |
| Postmenopause: | |
|---|---|
| No HRT | <36 |
| With HRT | 18-361 |
(Note: It is generally recommended to increase estradiol levels to at least 40 to 50 pg/mL to prevent bone loss, but 60 pg/mL or more is optimal - with many specialists advocating levels of around 100 pg/mL in younger women. All measurements in the table in pg/ml.)
Other ovarian hormones
It's not necessary to determine whether or not you're definitely going through menopause, but depending on your symptoms, you or your doctor may want to test your levels of the other key ovarian hormones as well:Testosterone,Progesterone, Andleuking hormone (LH).
Testosterone
More attention has been paid to testosterone lately – and more doctors and studies have concluded that low levels are often a problem for women with premature ovarian failure or early menopause (especially women who have undergone surgical menopause).
As a general rule of thumb, total testosterone levels of 25 ng/dL or less indicate deficiency, as do free testosterone levels of 1.5 pg/mL or less. (For women over 50 years of age, a lower deficiency is assumed - 1.0 pg/ml or less).
But if you're just a little above those levels - and have symptoms of low testosterone like decreased libido or excessive fatigue - then you can still benefit from testosterone supplementation.
Some doctors and labs also test bioavailable testosterone levels. Normal ranges for this are 0.6 - 5.0 ng/dl for premenopausal women and 0.22 - 4.3 ng/dl for postmenopausal women not taking HRT.
Progesterone
Most laboratories and studies indicate a "normal" range for menopausal women to be around 0.03-0.3 ng/mL. For comparison, premenopausal women have progesterone levels of around 7-38 ng/mL during their luteal phase.
Luteinizing Hormone (LH)
“Normal” LH levels on day 3 are 5-20 mIU/mL. If your LH levels are high relative to your FSH levels, this is the casecouldindicate that you are not going through menopause or have premature ovarian failure, but rather have polycystic ovarian syndrome (PCOS), which can cause similar symptoms (Those).
DHEA
Finally, there is DHEAAndrogen(like testosterone). This often goes untested unless you have exhibited symptoms of low androgens (as with testosterone, symptoms include a decrease in libido and energy levels). In women under 50, DHEA levels less than 150 ng/dL are considered low.
thyroid
Many doctors will also recommend getting your thyroid tested if you suspect menopause. This makes sense for two reasons: First, many women going through premature menopause also have a higher risk of thyroid problems. Second, many symptoms of thyroid disease overlap with menopausal symptoms.
In fact, thyroid disease often disrupts menstruation. Testing your thyroid then will help determine if you are in premature menopause — or have thyroid disease instead. In this case, your doctor will likely check your thyroxine and thyrotropin levels.
salivary hormone tests
Some doctors recommend saliva tests to measure hormone levels. This isn't as widely used as blood testing, but proponents claim it's faster, cheaper, and more reliable. There is howeverdebatein the medical community about saliva testing - with some claiming that blood counts (serum tests) are the gold standard and others arguing for the validity of saliva testing.
With saliva testing, your doctor takes samples of your saliva to see the levels of hormones you are producing and to determine if you have any deficiencies.
Unlike the blood tests, the salivary hormone tests show the levels of "free" hormones in your body — that is, the hormones that aren't bound to proteins but can get into cells instead.
Since around 95% or more of your blood hormones are bound, saliva tests only measure the remaining 1 to 5% - so the results can be significantly lower than what you see on your blood test results. In addition to saliva tests from your doctor, you can also order kits to test your hormone levels at home.
However, if you decide to do it, go over all the results with your doctor. There are several online pharmacies that offer saliva (and FSH urine) tests, however EarlyMenopause.com does not endorse or recommend any particular provider.
Ultrasonic
In some cases, your doctor may do a high-resolution ovarian ultrasound to see your ovaries. This will determine if you still have eggs and follicles. In general, however, this information does not help that much. Studies have shown that perhaps up to two-thirds of women diagnosed with premature ovarian failure (POF) actually still have follicles.
The problem is that even when ova are detected, attempts to use hormones to stimulate ovulation have been relatively unsuccessful. However, ultrasound may be useful if you are in the early stages of premature menopause and intend to pursue an aggressive fertility program.
Basic lesson
Discovering that you're going through menopause well ahead of your expectations can be a difficult time emotionally. However, before you move forward with your life, you mustneeda correct diagnosis, which can only be made in consultation with your doctor.
The information provided above is intended to serve as a useful guide and to increase your understanding of the central role of hormones in menopause. When your ovaries begin to fail, your circulating estradiol levels drop. Your body "reacts" to this declining estrogensynthesize more FSH,This is why measuring FSH serum (blood) is so useful from a diagnostic point of view.
Selected sources and further reading
Farhi, J., Homburg, R., Ferber, A. "Non-response to ovarian stimulation...--A clinical sign of imminent onset of ovarian insufficiency that forestalls the rise in basal follicle-stimulating hormone levels."human reproduction1997; 12(2); 241-243. (shortcut)
Okeke et al. "Premature menopause." Ann Med Health Sci 2013. (shortcut)
Gold, E. "The Timing of Age at which Natural Menopause Occurs."Obstetrics Gynecol Clin North Am.2011. (shortcut)
FAQs
What FSH level indicates early menopause? ›
Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause. When a woman's FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.
What is early menopause estradiol levels? ›Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause. However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone (FSH).
What is the FSH range for menopause? ›Women who are still menstruating: 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L) After menopause: 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L)
Are FSH levels high in early menopause? ›As the number of follicles drops, the level of FSH increases. The most common reason for very high FSH levels is that you are beginning menopause. Because you have fewer remaining follicles, your body produces less of a hormone called Inhibin B, which is responsible for keeping FSH levels down.
How do you test for early menopause? ›Diagnosing early and premature menopause
Your GP can carry out a blood test to measure your hormone levels. It can take a long time for a diagnosis of premature menopause to be made as symptoms could be due to other conditions. Your blood test can rule out diabetes and thyroid problems.
The blood test measures a hormone called FSH (follicle‑stimulating hormone). FSH is found in higher levels in menopause. You should not be offered this test if you are taking a contraceptive containing oestrogen and progestogen or high‑dose progestogen because the contraceptive changes your natural FSH levels.
How do I read my estradiol test results? ›- Male - 10 to 50 pg/mL (36.7 to 183.6 pmol/L)
- Female (premenopausal) - 30 to 400 pg/mL (110 to 1468.4 pmol/L)
- Female (postmenopausal) - 0 to 30 pg/mL (0 to 110 pmol/L)
Having estrogen levels that are consistently low is different. Consistently low estrogen may mean that you're going through a natural change, like menopause. Sometimes, low estrogen is a sign of a condition that slows your sexual development, which can make it harder to become pregnant.
What is the normal range for estradiol levels by age? ›| Tanner Stages# | Mean Age | Reference Range |
|---|---|---|
| Stage I (>14 days and prepubertal) | 7.1 years | Undetectable-20 pg/mL |
| Stage II | 10.5 years | Undetectable-24 pg/mL |
| Stage III | 11.6 years | Undetectable-60 pg/mL |
| Stage IV | 12.3 years | 15-85 pg/mL |
Menopause is a point in time 12 months after a woman's last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause. The menopausal transition most often begins between ages 45 and 55.
What are the 3 stages of menopause? ›
- Perimenopause is the time leading up to menopause. ...
- Menopause occurs when you've stopped producing the hormones that cause your menstrual period and have gone without a period for 12 months in a row.
Higher FSH levels — levels of about 30 to 40 or above — are usually taken to signal menopause or ovarian failure. You may still even be getting periods with your FSH levels this high, but it still is a sign that your body isn't producing enough estrogen to maintain regular ovarian function.
What causes early menopause? ›Causes of early menopause
Early menopause can happen naturally if a woman's ovaries stop making normal levels of certain hormones, particularly the hormone oestrogen. This is sometimes called premature ovarian failure, or primary ovarian insufficiency.
Women, when they undergo menopause, lose bone and gain body fat. FSH, which rises at menopause, could be responsible for the weight gain and bone loss that many women experience in their middle ages.
What is considered high estradiol? ›What's considered a high estradiol level? Elevated estradiol levels—typically beyond 350 picograms per milliliter in venous samples in adult women who have regular menstrual cycles—can occur with certain medical conditions that lead to overproduction of the estrogen hormone.
Does early menopause mean early aging? ›False. Menopause happens gradually, over time. Perimenopause can start years before your last menstrual cycle. The first signs of perimenopause are irregular periods, hot flashes, vaginal dryness, and sleep issues.
Do I need a blood test to confirm menopause? ›There is no single blood test that reliably predicts when a woman is going through menopause, or menopausal transition. Therefore, there is currently no proven role for blood testing regarding menopause except for tests to exclude medical causes of erratic menstrual periods other than menopause.
What is a normal range for estradiol? ›Normal levels for estradiol are: 30 to 400 pg/mL for premenopausal women. 0 to 30 pg/mL for postmenopausal women. 10 to 50 pg/mL for men.
What is the best test for menopause? ›- Everlywell Perimenopause Test.
- reveal Menopause Test.
- Thorne Menopause Test.
- myLAB Box Perimenopause Test.
- LetsGetChecked Female Hormone Test.
A positive test indicates that you may be in a stage of menopause. If you have a positive test, or if you have any symptoms of menopause, you should see your doctor. Do not stop taking contraceptives based on the results of these tests because they are not foolproof and you could become pregnant.
Can you get pregnant with FSH 11? ›
The short answer is yes, studies show it is possible to get pregnant with high FSH levels. As long as you still have a period and ovulate, even if it is one single ovulation per year, you can conceive. However, it's important to note that while pregnancy with high FSH is possible, it can be more difficult to conceive.
What are normal hormone levels for a 50 year old woman? ›Normal levels for estradiol are: 30 to 400 pg/mL for premenopausal women. 0 to 30 pg/mL for postmenopausal women. 10 to 50 pg/mL for men.
What does a FSH level of 35 mean? ›Higher FSH levels — levels of about 30 to 40 or above — are usually taken to signal menopause or ovarian failure. You may still even be getting periods with your FSH levels this high, but it still is a sign that your body isn't producing enough estrogen to maintain regular ovarian function.
What FSH level indicates fertility? ›Your FSH Levels
When trying to conceive, your Follicle Stimulating Hormone level needs to be below 10mIU/ml. When FSH levels are too high or too low, achieving pregnancy can become much more difficult because it affects your menstrual cycle and whether or not you ovulate.