Name: The hormone tests worth asking for.
Creator: Dr. Maya Okonkwo

Below is a structured summary of the key points about hormone testing in perimenopause and what major guidelines actually recommend.

Key takeaways so far

01For women over 45 with typical perimenopausal symptoms and cycle changes, major guidelines (ACOG, NICE NG23, NAMS) recommend *clinical* diagnosis without routine hormone testing.
02FSH fluctuates widely during perimenopause; a single normal value does not exclude perimenopause, and a single elevated value does not reliably confirm or stage it.
03FSH testing is reserved for specific indications such as suspected premature ovarian insufficiency, certain contraception decisions near age 50, and assessing menopausal status when bleeding patterns are masked by contraception.
04AMH is stable and can help estimate time to the final menstrual period and inform fertility or treatment planning, but it does not diagnose perimenopause or explain current symptoms on its own.
05Single estradiol measurements are too variable to be clinically useful for diagnosing or staging perimenopause.
06Salivary hormone testing is not validated or guideline-endorsed for perimenopause or menopause management and should not guide treatment decisions.
07The most useful tests in a perimenopausal workup are non-glamorous basics: TSH (± free T4, anti-TPO), CBC with ferritin, fasting lipids, HbA1c and fasting glucose, and vitamin B12.

Sources

Written by

Dr. Maya Okonkwo

Internal medicine; ten years women's health, Internal medicine. Ten years in women's health.

Reviewed by

Dr. R. Chen, MD

OB-GYN; NAMS-certified menopause practitioner, Board-certified OB-GYN, NAMS-certified menopause practitioner.

The hormone tests worth asking for.

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