What are the lab markers of menopause?

Updated: Jun 06, 2018
  • Author: PonJola Coney, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

Answer

Gonadotropin secretion increases dramatically after menopause. Follicle-stimulating hormone (FSH) levels are higher than luteinizing hormone (LH) levels, and both rise to even higher values than those seen in the surge during the menstrual cycle. The FSH rise precedes the LH rise. FSH is the diagnostic marker for ovarian failure. LH is not necessary to make the diagnosis.

The large cyclical variation of estradiol and estrone observed during the menstrual years ceases, and fluctuation in levels is small and inconsequential, with the mean value being considerably lower. The levels of circulating estradiol have very different ranges before and after menopause, and these levels are obviously much lower in menopause. Smears of the vaginal epithelium provide a composite picture of endogenous and exogenous estrogen stimulation over time; the more estrogen present, the greater the number of superficial cells.

No specific changes in thyroid function related to menopause have been found.

Other markers of ovarian aging include anti-Müllerian hormone (AMH) and Müllerian-inhibiting substance (MIS), which are produced by granulosa cells of all follicles. Assessment of these markers may be the earliest and most effective way of measuring progress toward menopause. At present, however, testing is not sufficiently developed to be considered a standard of care. Consequently, an increase in serum FSH and decreases in estradiol and inhibin are the major endocrine changes that occur during the transition to menopause. [1, 2]


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