Health A-Z

Health A-Z

For information on a particular condition or topic try our Health A-Z with links to this and other Jean Hailes websites or use the website search function.

Health Tips

Challenging the myths around dieting and weight from our Health for Women website

A few simple lifestyle changes can prevent kilo creep, without dieting. Learn more...

Around Jean Hailes

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  


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
New Look Jean Hailes for Women's Health Coming Soon

Follow us

Stay in touch

Free email updates

Stay in touch

Research studies

Would you like to participate in a study?

Learn more here

This website is certified by Health On the Net Foundation. Click to verify. Healthinsite Better Health Channel
Get Adobe Reader Get Adobe Flash Player
This site complies with the HONcode standard for trustworthy health information: verify here. Jean Hailes for Women's Health
is a healthinsite Partner
Jean Hailes for Women's Health 
is a Better Health Channel Partner
Downloadable information may require
Adobe Reader or Adobe Flash Player
© Copyright 2014 Jean Hailes for Women's Health