Menopause and hot flushes

Laboratory tests

• No laboratory test is needed for diagnosis after 45 years.
• FSH (only between 40 and 45 years, with symptoms and altered cycles)if needednon-French guidelineWoman aged 40 to 45 years with suggestive symptoms, including a change in cycles, without combined oestrogen-progestogen contraception or high-dose progestogen ^[2].

Laboratory tests

• Serum β-hCG
• FSH
• Oestradiol
• TSH
• AMH (if FSH is inconclusive)if needednon-French guidelineFSH borderline or discordant with the clinical picture: AMH can help to confirm the diagnosis, but is not a first-line test ^[1].

4 to 6 weeks later

• FSH (second measurement)if needednon-French guidelineNICE requires two raised FSH results 4 to 6 weeks apart ^[2]; ESHRE 2024 is satisfied with a single FSH > 25 IU/L if the picture is typical and repeats it only in case of doubt ^[1].

Once POI is confirmed (excluding iatrogenic cause), after information and consent

• Karyotype
• FMR1 premutation testing (fragile X)
• Anti-21-hydroxylase antibodies (anti-adrenal), if the cause remains unknown
• Lipid profile
• Fasting plasma glucose

Fasting laboratory tests (if not recent)

• Lipid profile (if no recent tests)if neededTo assess the level of cardiovascular risk before HRT, taking into account the classic risk factors, including dyslipidaemia ^[4,8]; pointless if a recent test is available.
• Fasting plasma glucose (if no recent tests)if neededSame aim: document the classic cardiovascular risk factors before HRT, including diabetes ^[4,8].

Laboratory tests

• TSH
• 24-hour urinary metanephrines (metanephrine and normetanephrine) with urinary creatinineif neededHypertension with palpitations, sweating or headaches ^[12], or flushes associated with hypertensive surges ^[13].
• 24-hour urinary 5-HIAAif needednon-French guidelineFlushes without sweating, with diarrhoea or other digestive signs, wheezing: look for a serotonin-secreting neuroendocrine tumour ^[14].
• Serum tryptaseif needednon-French guidelineFlushes with pruritus, urticaria, malaise or hypotension: mastocytosis ^[14].