This article deals with the various diagnostic tests that exist to determine if you are going through early menopause.
The thought that you may be experiencing early menopause or premature ovarian failure (POF) can of course be frightening. This is particularly true when you’ve noticed a number of symptoms, and you suspect menopause might be at the heart of the matter. Now what?
How can you be sure 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 run into problems. If your doctor has the knee-jerk reaction that a woman in her 20s or 30s is too young for menopause, you may wind up being misdiagnosed as suffering from anything from stress (the old catch-all) to absolutely nothing — the “it’s all in your head” diagnosis.
This is why it is important for you to know what tests to ask for — and to know what those tests mean.
Following, then, is a list of the different hormone tests that may help you determine just what’s happening with your body — and whether or not your ovarian function is showing signs of menopause or ovarian failure.
Some Important Points to Keep in Mind
#1 In general, if you’re still getting a period, most doctors recommend that you get your blood levels taken on day 3 of your cycle — that is, the third day of your period. If you no longer are getting a period, then you can get tested at any time.
#2 Because hormone levels can and do fluctuate, many doctors advise getting tested more than once — about a month apart.
This is particularly important if you are still getting your period and/or have few symptoms, as there is a slim chance you’re experiencing what is sometimes called “temporary menopause” — a condition sometimes brought on by traumatic stress among other things.
#3 Different labs may use different ranges in their testing. So if and when you do get tested, be sure to ask your doctor not only for your specific results (i.e. “normal” or otherwise), but also for the range used by the lab.
It’s important to get tested more than once if your hormone levels come back normal, but you are experiencing definite symptoms. It’s possible you may be beginning menopause, but your hormone levels didn’t fall within menopausal ranges at the first occasion.
Here, then, are the specific tests you may want to consider asking for:
Follicle Stimulating Hormone (FSH) Blood Level Measurement
This is the key test to determine whether or not you are in menopause. A sample of your blood is taken to measure the levels of FSH — follicle-stimulating hormone. Because your FSH levels rise when your ovaries stop producing enough estrogen, high FSH levels can signal that your body is entering menopause.
We’ll now get slightly technical about what your results in this test mean for you.
Interpreting Your FSH Result
A “normal” FSH day 3 (when the test is administered) value is 3-20 mIU/ml, however, FSH levels above 10 to 12 mIU/ml indicate that your ovaries are starting to fail. In other words, this means that you are in perimenopause — the beginning stages of menopause when you notice physical symptoms, but before you have stopped having a period for a year — or that you have “diminished ovarian reserve”.
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.
Keep in mind that you may end up with FSH levels that are well in the post-menopausal range, but still be getting a period. This is one of the things that differentiates premature menopause or premature ovarian failure from “regular” menopause (i.e. menopause that occurs to older women and is generally recognized after going a full year without a period).
Yet again, this hammers home the unfortunate fact that you may indeed be in premature menopause even if you’re having periods. Once your FSH levels have reached a certain height for a period of time, it’s highly unlikely that they’ll drop back to pre-menopausal levels. In my case, even after my FSH was tested at over 150, I had apparently normal periods for eight months.
Then when I was retested — hoping that somehow my body had snapped back to normal, I learned that my FSH level had dropped, but only to 126. Since my FSH levels 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, standalone FSH test is far from foolproof in itself. Some women can test with a high FSH, then revert to normal levels the next month. Again, it’s generally wise to get tested more than once to be sure.
FSH Test Levels
|2.5 to 10.2
|3.4 to 33.4
|1.5 to 9.1
|23.0 to >116.3
(Note: Lab levels — or “assay levels” — do vary from lab to lab, so you may notice different levels listed on your lab report. All measurements in mIU/ml)
Estrogen (Estradiol) Levels
Estradiol is the primary human estrogen — and when your ovaries begin to fail, your circulating estradiol levels drop. This is why doctors often give you a serum estradiol concentration test to measure the amount of estradiol in your blood.
In this case, the doctor is looking to see if your estrogen levels are lower than normal — again, a signal of ovarian failure, or, in other words, early menopause.
Here are some guidelines on interpreting your estradiol test results:
#1 “Normal” estradiol Day 3 value — 25-75 pg/ml (stated levels may vary from lab to lab)
#2 In spite of the above number, generally, estradiol levels about 30 or below — in conjunction with a high FSH level (high in this case, meaning in the post-menopausal range, i.e. 30-40 or higher) — is considered menopausal.
#3 If your estradiol levels are lower than 50 picograms per milliliter, you may still be having a period, but also may be experiencing symptoms of low estrogen — including hot flashes, vaginal dryness, and sleep difficulties.
What does this mean for me?
If your follicle stimulating hormone (FSH) hasn’t reached post-menopausal levels but your estradiol is on the low side, you are nevertheless not considered to be experiencing fully fledged early menopause. There can be other reasons for low estradiol, including excessive exercise, low body fat, and diminished ovarian reserve.
However, estradiol levels do tend to drop over time. During the first 2 to 5 years following menopause or ovarian failure, blood levels of estradiol drop to an average range of about 25 to 35 pg/ml.
Women not on hormone replacement therapy (HRT) generally will see this number drop even more over time; after about five years, it’s common for menopausal women who aren’t on HRT to have estradiol levels below 25.
Estrogen (Estradiol) Test Levels
(Note: generally, it is recommended that you raise estradiol levels to a minimum of 40 to 50 pg/mL to prevent bone loss, but 60 pg/mL or higher is optimal — with many specialists advocating levels of about 100 pg/mL for younger women. All measurements in table in pg/mL.)
Other Ovarian Hormones
It’s not necessary to determine whether you are definitely menopausal or not, but — depending on your symptoms — you or your doctor may also want to test your levels of the other major ovarian hormones: testosterone, progesterone, and lueienizing hormone (LH).
There has been more attention paid recently to testosterone — and more doctors and studies have been concluding that low levels are often a problem for a woman with premature ovarian failure or early menopause (particularly women who’ve undergone surgical menopause).
The general rule of thumb is that total testosterone levels that are 25 ng/dL or less is indicative of a deficiency, as are free testosterone levels of 1.5 pg/mL or less. (Women over age 50 are considered to have a deficiency at a lower level — 1.0 pg/mL or less).
But if you’re just a little bit above these levels — and have symptoms of low testosterone such as a lagging libido or excessive fatigue — then you may 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 pre-menopausal women and 0.22-4.3 ng/dl for post-menopausal women who aren’t on HRT.
Most labs and studies state a “normal” range for menopausal women of about 0.03-0.3 ng/ml. By way of comparison, pre-menopausal women will have progesterone levels at about 7-38 ng/ml during their luteal phase.
Luteinizing Hormone (LH)
“Normal” Day 3 LH levels are 5-20 mIU/ml. If your LH levels are high in ratio to your FSH levels, this could indicate that you aren’t in menopause or going through premature ovarian failure, but instead have polycystic ovarian syndrome (PCOS) which can cause some similar symptoms (source).
Finally, there’s DHEA, another androgen (like testosterone). This often isn’t tested unless you have been exhibiting symptoms of low androgens (as with testosterone, the symptoms include decrease in libido and energy levels). For women under 50, DHEA levels of less than 150 ng/dL are considered low.
Many doctors will also recommend that you have your thyroid tested when you suspect menopause. This makes sense for two reasons: first, many women in premature menopause are also at a higher risk for thyroid problems. Second, many symptoms of thyroid disease overlap with menopausal symptoms.
In fact, thyroid diseases often interfere with menstruation. Testing your thyroid, then, will help determine whether you are in premature menopause — or instead have thyroid disease. In this case, your doctor will probably check your thyroxine and thyrotropin levels.
Salivary Hormone Tests
Some doctors recommend saliva testing to measure hormone levels. This isn’t as widely used as blood testing, but advocates clam that it is quicker, less expensive and reliable. There is, however, debate in the medical community about saliva testing — with some claiming that the blood levels (serum testing) are the gold standard and others advocating for the validity of saliva tests.
With salivary 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 saliva hormone tests will show the levels of “free” hormones in your body — that is, the hormones that aren’t bound to proteins but instead are able to move into cells.
Because about 95% or more of your blood hormones are bound, the saliva tests measure only the remaining 1 to 5% — so the results may be markedly lower than that which you see on your blood test results. In addition to getting saliva tests at your doctor’s, you can also order kits to test your hormone levels at home.
If you do choose to do this, though, be sure to go over any results with your doctor. There are several pharmacies online that offer saliva testing (and FSH urine testing), however EarlyMenopause.com does not specifically endorse or recommend any particular provider.
In some cases, your doctor may perform high resolution ovarian ultrasound to view your ovaries. This will determine whether you still have any eggs and follicles. However, generally, this information doesn’t help that much. Studies have indicated that perhaps up to two-thirds of women diagnosed with premature ovarian failure (POF) do indeed have remaining follicles.
The problem is, even when eggs are detected, attempts to stimulate ovulation through hormones have been relatively unsuccessful. However, ultrasound may make sense if you are in the early stages of premature menopause and are intending to pursue an aggressive fertility program.
Discovering you’re going through menopause well before you expected can be a trying time emotionally. However, before moving forward with your life you need a proper diagnosis, which can only be reached in consultation with your doctor.
The information we’ve provided above is intended to act as a useful guideline, and to better your understanding of the pivotal role hormones play in menopause. When your ovaries begin to fail, your circulating estradiol levels fall. Your body “reacts” to this flagging estrogen by synthesizing more FSH, and this is why an FSH serum (blood) measurement is so useful in a diagnostic capacity.
Selected Sources & Further Reading
Farhi, J., Homburg, R., Ferber, A. “Non-response to ovarian stimulation … – A clinical sign of impending onset of ovarian failure pre-empting the rise in basal follicle stimulating hormone levels.” Human Reproduction 1997; 12(2); 241-243. (Link)
Okeke et al. “Premature Menopause.” Ann Med Health Sci 2013. (Link)
Gold, E. “The Timing of the Age at Which Natural Menopause Occurs.” Obstet Gynecol Clin North Am. 2011. (Link)