Investigations
1st investigations to order
pregnancy test
Test
Indicated in sexually active women with amenorrhoea. A negative urine human chorionic gonadotrophin (hCG) test reliably excludes pregnancy.
Quantitative blood tests for hCG should be reserved for specific clinical circumstances, such as following a possible ectopic pregnancy.
Result
negative
Investigations to consider
follicle-stimulating hormone (FSH)
Test
Recommended for diagnosis in women aged under 40 years, and may be helpful in women aged 40 to 45 years.[1][28] An elevated FSH level may be predictive of impending menopause after several months of amenorrhoea.
Not recommended in women aged over 45 years; testing for FSH early in perimenopause is usually not helpful because of variability in levels from day to day and during the menstrual cycle.
Result
elevated >30 IU/L (>30 mIU/mL)
serum estradiol
Test
Testing is not usually indicated.
Estradiol is the predominant oestrogen before the menopause. Serum estradiol levels vary throughout the menstrual cycle but average about 367 picomol/L (100 picograms/mL).
After the menopause, oestrone, which is derived from estradiol metabolism in the liver and peripheral conversion of androstenedione in adipose tissue, becomes the dominant oestrogen.
Result
<110 picomol/L (<30 picograms/mL)
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