Hormone Levels in Perimenopausal Women

Definition and Diagnosis

The National Comprehensive Cancer Network recommends checking follicle-stimulating hormone (FSH) and estradiol levels in perimenopausal women to assess menopausal status, although these values should be interpreted in the context of clinical symptoms and menstrual history 1
FSH and estradiol are the primary hormone levels that should be checked in perimenopausal women, particularly when assessing menopausal status or considering hormone therapy, as recommended by the National Comprehensive Cancer Network 1, 2
Luteinizing hormone (LH) may be checked as clinically indicated to provide additional information about ovarian function, according to the National Comprehensive Cancer Network 1
Prolactin should be measured when clinically indicated to rule out other causes of menstrual irregularity, as suggested by the National Comprehensive Cancer Network 1
Anti-Müllerian hormone (AMH) may provide additional information on ovarian reserve status, though normative data in perimenopausal women are limited, as noted by the Journal of Clinical Oncology 3, 4

For women under age 60 with amenorrhea for ≥12 months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, both FSH and estradiol should be in the postmenopausal range to confirm menopause, as recommended by the National Comprehensive Cancer Network 2, 5
Women taking tamoxifen or toremifene who are under age 60 should have FSH and estradiol measured to confirm menopausal status, according to the National Comprehensive Cancer Network 2, 6
It is not possible to accurately determine menopausal status in women receiving LHRH agonists or antagonists, as noted by the National Comprehensive Cancer Network 5
For women who have undergone hysterectomy but still have their ovaries, FSH and estradiol levels should be checked to determine menopausal status, as recommended by the Journal of Clinical Oncology 7

Hormone testing should be performed when women present with irregular menstrual cycles, as recommended by the National Comprehensive Cancer Network 1
Hormone testing should be performed when women present with vasomotor symptoms (hot flashes, night sweats), according to the National Comprehensive Cancer Network 1
Hormone testing should be performed before initiating hormone therapy, as recommended by the National Comprehensive Cancer Network 6
Hormone testing should be performed after chemotherapy to assess ovarian function, as suggested by the National Comprehensive Cancer Network 2, 5
For perimenopausal women who become amenorrheic and later develop bleeding, serial estradiol levels can help determine if ovarian function has returned, according to the National Comprehensive Cancer Network 1
Amenorrhea after chemotherapy is not a reliable indicator of menopause, as ovarian function may still be intact or resume despite absence of menses, as noted by the National Comprehensive Cancer Network 2, 5
Hormone levels and absence of menses are unreliable indicators of menopause during treatment with tamoxifen, as reported by the Journal of Clinical Oncology 7

The National Comprehensive Cancer Network recommends measuring follicle‑stimulating hormone (FSH) and estradiol when a baseline hormonal assessment is needed before initiating hormone therapy. 8
The National Comprehensive Cancer Network advises that women who have undergone chemotherapy should have hormonal testing (FSH and estradiol) to evaluate ovarian function. 8
The National Comprehensive Cancer Network suggests measuring serum prolactin to exclude hyperprolactinemia as an alternative cause of menstrual irregularity. 8
The National Comprehensive Cancer Network cautions that hormone levels are unreliable in women receiving tamoxifen, chemotherapy, or GnRH agonists, and such testing should be interpreted with this limitation in mind. 8
For women younger than 45 years, the National Comprehensive Cancer Network recommends a comprehensive panel that includes FSH, estradiol, luteinizing hormone (LH), and prolactin to differentiate perimenopause from other causes of menstrual disturbance. 8

Anti‑Müllerian hormone (AMH) may provide insight into ovarian reserve, but because normative data are limited in the perimenopausal transition, routine AMH testing is not recommended. (Trends in Endocrinology and Metabolism) 9