Primary Causes & Action Plans
FSH
Very high in menopause; confirms ovarian transition complete FSH >40 mIU/mL confirms menopause (ovarian transition complete). Persistently elevated FSH indicates ongoing estrogen deficiency.
Target > 40 mIU/mL
Suggested Action Plan
FSH cannot be directly lowered; instead, optimize estradiol through hormone replacement. Retest 8-12 weeks after starting HRT.
Estradiol
Usually very low in menopause; determines treatment need and dose Postmenopausal estradiol is typically <10 pg/mL. Symptoms like hot flashes, vaginal dryness, and mood swings are driven by low estradiol.
Target Postmenopausal: <10-20 pg/mL
Suggested Action Plan
If menopausal symptoms are severe, bioidentical estradiol (patch 0.5-1.0 mg twice weekly) typically resolves symptoms within days to weeks.
Testosterone
Declines significantly post-menopause; low levels drive fatigue and loss of libido Testosterone drops dramatically at menopause and continues declining. Low testosterone drives fatigue, muscle loss, and lost libido.
Target 10-25 ng/dL (postmenopausal)
Suggested Action Plan
If testosterone is low, bioidentical testosterone cream or pellets (0.5-1.0 mg daily) improves energy, libido, bone density, and mood. Retest 6-8 weeks after starting therapy.
Thyroid Panel (TSH, Free T4)
Thyroid often declines alongside menopause; can amplify menopausal symptoms Thyroid function often declines during menopause transition. This produces additional fatigue, weight gain, and mood symptoms.
Target TSH: 1.0-2.5 mIU/L; Free T4: 1.0-1.5 ng/dL
Suggested Action Plan
If thyroid is low, thyroid hormone replacement should be started. Optimizing thyroid significantly improves menopausal symptom burden.
Vitamin D
Critical for bone health, cardiovascular health, and mood; especially important post-menopause Vitamin D deficiency accelerates bone loss (critical risk post-menopause) and worsens mood. Optimal vitamin D is essential for health maintenance post-menopause.
Target > 50 ng/mL (target 60-80)
Suggested Action Plan
If deficient, supplement vitamin D3 4000-5000 IU daily plus sun exposure. Optimal vitamin D post-menopause is critical for bone density and cardiovascular health.