Menopause can be difficult to pin down as the cause of why you aren’t feeling yourself. Years of poor sleep, mood issues, low energy, and many other symptoms that may or may not be due to changing hormone levels can leave you confused and unsure.
It would all be so easy if there was a reliable blood test to answer one simple question, “Are you menopausal or not?”
Menopause testing can be complicated and frustrating. There are limited circumstances in which tests for menopause are accurate or useful. Read on to find out why.
Find what you need quickly
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What hormones are tested for at menopause?
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Is there a perimenopause test?
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Who should have a menopause blood test?
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How do you know if you have been through the menopause?
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How to test for early menopause?
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Do home menopause test kits work?
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How can a menopause blood test help you decide about contraception?
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What hormones are tested for at menopause?
During menopause, your body experiences several hormonal changes. These eventually lead to the end of your periods and can cause a whole host of menopause symptoms, such as hot flashes, mood changes, and sleep problems.
Low or fluctuating levels of estrogen are responsible for most menopause symptoms, and hormone therapy (HT) works by replacing estrogen. However, an estrogen level is rarely recommended as a test for menopause. This is because estrogen levels can be highly variable even after menopause, and are not reliable.
Most tests instead focus on your follicle-stimulating hormone (FSH) and, occasionally, your luteinizing hormone (LH). These are both important in controlling your menstrual cycle during your premenopausal life.
While FSH and LH fluctuate throughout the month while you are still having periods, they will be consistently high after menopause.
A high level of FSH and LH can be a reliable sign that you have been through menopause – but even high FSH may only be temporary. The test should be interpreted by your healthcare provider as there can be exceptions.
Is there a perimenopause test?
No, there isn’t a test to find out if you are in perimenopause. It is very difficult to get an accurate measure of your hormone levels during this phase as your hormones are constantly fluctuating. This is why it’s not particularly useful to measure any of the hormones during perimenopause. A blood test will only give you a snapshot of what your hormones are doing at the time your sample was taken, but things could be radically different even by the next day.
The best way to decide whether you are in perimenopause is to look out for the tell-tale symptoms, such as:
- A change in your periods. These may start occurring more or less frequently, become irregular, heavier, or lighter
- Hot flashes
- Fatigue
- Mood changes, including low mood, anxiety, and irritability among others
- Sleep issues
- Problems with memory and concentration, including brain fog
- Weight gain
- Vaginal symptoms, including burning, tightness, dryness, painful sex, itching
- Urinary symptoms, including recurrent infections, needing to pee more often and pain when peeing
Your healthcare provider can review your symptoms and tell you if you are perimenopausal. This is a clinical diagnosis and, while it may seem low-tech, it is actually more accurate than hormone tests at this stage. Clinical diagnosis is recommended as the best option by organizations including the National Institute of Health (NIH) and the North American Menopause Society (NAMS) in most circumstances.
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Who should have a menopause blood test?
There are a few situations in which hormone blood tests for menopause can be useful. It is recommended that FSH levels are tested if you are:
- 45+ and having symptoms which are not typical of menopause
- Under 40 with suspected premature menopause
- 50+, using progesterone-only contraceptives (like the pill, contraceptive injection, or IUD) and want to know whether you need to continue
Note, the North American Menopause Society does not recommend routine testing of FSH levels if you are aged 40-45 and have symptoms that suggest menopause.
How do I know if I have been through the menopause?
If you previously had regular periods, you can usually tell if you are postmenopausal based on your symptoms and if you:
- Have not had a period for at least 12 months and are aged over 45
Most will also notice typical signs, including hot flashes, disturbed sleep and mood changes among others. If this is the case, you generally do not need an FSH or other hormonal test to confirm menopause.
While this makes it sound straightforward, things can be more complicated. For example, you may be on a type of contraception that stops your periods, or you may have a medical condition (such as polycystic ovarian syndrome – PCOS) that makes your periods infrequent. For this reason, it is important to be certain that you have been through menopause before stopping contraception. Pregnancy is rare as you get into your late 40s and 50s, although it can happen. It can even be easy to confuse the symptoms of early pregnancy with menopause in some cases.
Your healthcare provider will be able to advise you if you are unsure and may suggest testing. They can also advise if you are seeking help for your symptoms. This may involve lifestyle changes or HT.
How to test for early menopause?
FSH testing is sometimes recommended if premature menopause is suspected. Premature menopause, sometimes called primary ovarian insufficiency or POI, happens under the age of 40. In this situation, FSH testing is part of a more involved testing plan so that you can get an accurate diagnosis, and ensure you are receiving appropriate treatment.
While HT is not recommended for everyone, it is usually prescribed for those who go through premature menopause. This is because HT has been shown to protect women from cardiovascular disease and osteoporosis, with the benefits outweighing the risks for most people.
See your healthcare provider if you think you may fall into this group. Look out for clues, such as experiencing a change in your periods or other typical menopause symptoms.
Do home menopause test kits work?
Home saliva testing kits are not currently recommended by the North American Menopause Society for several reasons:
- Hormone levels vary widely, especially if you are still having periods. The test kit may give you an incorrect result. It is easy to wrongly conclude that you have gone through menopause when this is not necessarily the case or vice versa
- Common medications, including contraceptives, can make the results unreliable
- If you are unsure or struggling with symptoms, a healthcare provider is still the best person to advise you. They may want to examine you or check other blood tests to ensure that you have no other conditions that could mimic menopause, including thyroid issues and anemia
Menopause can be difficult to diagnose. Rather than spending your money on a home test saliva kit, speak to your healthcare provider for advice specific to your medical history. They will be able to ensure that you have an accurate diagnosis and let you know whether you need further testing.
How can a menopause blood test help me decide about contraception?
It can be surprisingly tricky to decide whether you have been through menopause.
Periods often give you the biggest clue, but this is not always reliable. Many types of contraception cause your periods to become less frequent or even to stop. This is common with the:
- Progesterone-only pill
- Intrauterine system, better known as IUD, such as Mirena
- Contraceptive injection
If you are aged 50, on a contraceptive and have no periods, it can be tricky to decide whether you need to continue taking contraception or are postmenopausal and can safely stop.
In these circumstances, a hormone blood test for FSH may be recommended. If the level is in the premenopausal range (below 30IU/L), you are not yet menopausal and need to continue your contraception.
An FSH level above 30 can mean that you have gone through menopause – but just one test is not enough. As hormones can fluctuate, you need two raised FSH levels 4-6 weeks apart to confirm menopause.
Learn more about symptoms in our symptoms library or read more on our blog.
- NICE, When should I suspect a diagnosis of menopause or perimenopause?
- North American Menopause Society, How do I know when I am in menopause?
- The Faculty of Sexual & Reproductive Healthcare, (2022) Menopause practice standards
- Wikipedia, Follicle-stimulating hormone
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