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Home Health Professionals Early/Premature Menopause Lab investigations

Laboratory investigations

Laboratory investigations (see Table: Laboratory investigations) are necessary to establish the diagnosis, determine aetiology and screen for complications.

The diagnostic criteria for premature ovarian failure (POF) includes greater than 4 months of amenorrhoea and FSH levels >40IU/L on two separate occasions at least one month apart with exclusion of secondary causes of amenorrhoea (see Table: Causes of secondary amenorrhoea).

Measurement of gonadotrophins (LH and FSH) must be performed in the absence of any exogenous hormone therapy (oral contraceptive pill (OCP) should be ceased at least one month prior) otherwise the results will be uninterpretable.

At present there is no test able to predict premature menopause. Studies assessing ovarian reserve during assisted reproduction indicate that women with higher early follicular phase levels of FSH, low serum inhibin B and lower antral follicle count (number of eggs visible on ultrasound) have a poorer response to ovulation induction and an increased risk of premature menopause / early menopause.

Other hormonal and biophysical markers, such as anti-mullerian hormone and ovarian stromal blood flow respectively, remain as research tools. Progesterone withdrawal test, ovarian antibody determination and ovarian biopsy are not routinely performed. Transvaginal or pelvic ultrasound may be useful to exclude outflow obstruction, detect follicles, assess the endometrium and ovarian volume. The presence of ovarian follicles has been reported in 30-50% of women with spontaneous karyotypically normal POF with evidence of intermittent ovarian function. Streak gonads (undifferentiated gonadal tissue) may be observed in patients with gonadal dysgenesis.

Table: Laboratory Investigations  
Investigation 

Rationale  

Initial investigations:  

 

FSH and oestradiol (E2) on 2 occasions at least one month apart

Day 3 FSH and E2 if still menstruating.  

Diagnostic criteria: FSH > 40 IU/L

Assess ovarian reserve and fertility. Adequate ovarian reserve is suggested by FSH300pmol/l

 

Prolactin, LH, thyroid function tests, pregnancy test, DHEAS, androstenedione

Sensitive testosterone, sex hormone binding globulin (SHBG), free androgen index or free testosterone  

Exclude causes of secondary amenorrhoea including hypogonadotrophic hypogonadism 
Transvaginal ultrasound (transabdominal ultrasound if sexually inactive)  

Exclude outflow obstruction

Detect presence of follicles

Assess endometrial thickness and determine ovarian volume 

Following diagnosis:  

 

Thyroid function tests, thyroid autoantibodies

Adrenal autoantibodies. (If positive antibodies or symptoms of adrenal insufficiency then am cortisol and ACTH +/- short synacthen test)

Fasting glucose

Liver function tests

Full blood examination, serum B12, gastric parietal cell antibodies, intrinsic factor antibodies

ESR, ANA, rheumatoid factor

Transglutaminase and endomysial antibodies

Ovarian antibodies are not helpful 

Identify autoimmune disease associated with POF

 

Karyotype and fragile X assessment  

Identify any genetic abnormality  

Fasting lipids

Dual X-Ray Densitometry (DEXA) scan

(If osteopaenic then 25OH Vitamin D, parathyroid hormone, serum calcium, phosphate, albumin and alkaline phosphatase)  

Complication screening

 
Content Updated November 20, 2007
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