Blood tests can reveal a lot about our health by checking hormone levels and other markers. They can be used to confirm certain conditions and monitor how your body is responding to particular medications.
If you’re considering starting hormone replacement therapy (HRT) to help alleviate your menopause symptoms, you may be wondering whether blood tests will be a part of the process.
In most instances, blood tests aren’t needed for HRT to be prescribed but there are some situations where they are beneficial. Sometimes they are used for monitoring HRT or if testosterone is being prescribed.
Do you need a blood test before taking HRT?
A blood test isn’t usually required to start HRT as perimenopause and menopause can typically be diagnosed by their symptoms alone. However, there are some situations where blood tests may be necessary before HRT is prescribed:
If you’re under 40
If under 40 and experiencing menopause symptoms, including irregular periods or the complete stoppage of your menstrual cycle, blood tests are used in the diagnosis of premature ovarian insufficiency (POI) before beginning HRT. A single test alone is not sufficient but elevated FSH levels on two blood samples taken 4-6 weeks apart suggest that POI is likely.
In people with POI, the ovaries are not functioning as they should, and oestrogen, Follicle stimulating hormone (FSH) and luteinizing hormone (LH) blood tests can indicate if this is the case. In these cases, oestrogen levels would typically be low and FSH/LH levels would be high.
Learn more about primary ovarian insufficiency.
If you’re between 40 and 45
Menopause typically occurs between the ages of 45 and 55. The National Institute for Health and Care Excellence (NICE) guidelines state that a follicle-stimulating hormone (FSH) blood test could be considered to confirm menopause in people aged 40-45 who have menopause symptoms and a change in their menstrual cycle if the diagnosis is uncertain or to rule out other causes.
Blood tests to check oestrogen levels can also be used, however it can be difficult to interpret due to the fluctuations. Oestrogen is typically lower in perimenopause and menopause (although not always).
If you want to include testosterone in your HRT regimen
If you feel like you might need testosterone supplements, then it is important for your total testosterone and sex hormone binding globulin (SHBG) baseline levels before starting and as part of ongoing monitoring. These are British Menopause Society guidelines, which we have to follow and ensure that your testosterone levels stay within a safe range.
There may be other causes for your symptoms
Menopause symptoms include night sweats, sleep issues, anxiety, brain fog, urinary incontinence, skin dryness and weight changes, amongst other things. However, some symptoms can be caused by other conditions such as an underactive thyroid or autoimmune disorders.
If there’s the possibility that your symptoms may not be a result of menopause, blood tests may be conducted to rule out or confirm other causes.
Do you need blood tests while taking HRT?
The good news is that if you’re feeling well and your symptoms are improving on HRT, there is normally no need for further blood monitoring.
There are no guidelines regarding oestrogen replacement, but we repeatedly see women on relatively high doses of transdermal oestrogen who remain symptomatic. Monitoring oestradiol levels can help to establish whether you are absorbing the oestrogen adequately and whether you may benefit from dose alterations or an alternative preparation.
If testosterone is part of your regimen, you will need regular monitoring blood tests to ensure your testosterone levels remain within the safe normal range.
If symptoms persist and this is not what you would expect, blood tests may be recommended to look for other underlying causes.
In some instances, other forms of monitoring may be appropriate after commencing HRT, particularly to assess overall health and well-being. Monitoring after starting HRT may include:
- Reviews: To discuss any side effects, such as breast tenderness or enlargement, nausea, headaches, or changes to vaginal bleeding and to determine if dosages need amending or if the type of HRT you are on needs to be switched.
- Blood pressure: Some forms of HRT can raise or lower your blood pressure. Having it checked annually can ensure it stays within healthy limits.
- Weight: It’s common for women in midlife to gain weight (particularly around the abdomen), whether on HRT or not, but this can increase the risk of cardiovascular disease. Monitoring your weight can help you to make positive lifestyle changes that can further help with the management of menopause symptoms.
- Bone density: A DEXA scan during menopause can assess your bone mineral density, which naturally declines with age. HRT can help prevent osteoporosis by raising oestrogen levels but monitoring bone density can assess your risk of breaks or fractures.
- Breast and cervical screening: HRT can slightly increase the risk of breast and ovarian cancer, and oestrogen-only HRT increases the risk of womb cancer. This elevated risk doesn’t require specific monitoring, but women are encouraged to attend screenings when invited.
What to expect when having HRT blood tests
Any blood tests related to starting or monitoring the effects of HRT should be done by a healthcare specialist. While at-home finger prick tests may seem convenient, they are expensive and unreliable.
HRT blood tests are typically carried out like any other blood test, where a small needle is inserted into the vein in the crook of the elbow before being sent to a laboratory to be analysed.
Being well hydrated can help in finding a vein so try to drink plenty of water before your appointment. You don’t need to fast before your blood tests, and you can take your HRT as usual. However, if you use a transdermal form of HRT (gel, spray or cream), you’ll want to avoid applying it to the area where the blood will be taken from as it could contaminate the sample.
If you are using testosterone then it is recommended not to use it in the morning of or the night before the blood test.
How we can help you at Menopause Care
Menopause can be a challenging time and knowing where to start when looking for support can feel overwhelming, especially when you are trying to understand your symptoms, learn the difference between body and bioidentical hormone replacement therapy, and explore your treatment options.
Menopause Care is here for you. You can see a doctor who knows and understands the nuances of this life stage, as well as when blood tests will be helpful.
When appropriate, we will arrange for you to have these blood tests carried out privately at a time and place that’s convenient for you.
We are happy to accept blood tests from another provider if they are clearly identifiable as yours and have been carried out in the UK. We are unable to accept finger-prick blood test results as these can be unreliable when checking hormones.
We will see you for a follow-up appointment to discuss the result of your tests and make an appropriate, tailored plan for your treatment. To get started, book a consultation with a menopause doctor.
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