Most of us are in tune enough with our bodies to recognise when something changes. During perimenopause and menopause, fluctuating levels of the hormones oestrogen and progesterone give rise to a whole host of symptoms that can impact your day-to-day life and may leave you feeling worried about what’s going on.
It’s understandable if you want to know how to test for menopause if you suspect you’ve reached this transitional life stage or are concerned that your symptoms might have a different underlying cause.
Information about tests for menopause can help to manage your expectations and take the next right steps for your own health and well-being.
Is there a test for menopause?
There is no specific blood test for menopause that will definitely indicate you’re in menopause. Instead, diagnosing perimenopause usually involves your doctor reviewing your symptoms, and diagnosing menopause occurs when you’ve not had a period for 12 consecutive months and are over the age of 50, and 24 consecutive months if you are between the ages of 45 and 50
However, there are some blood tests that can check the levels of particular hormones, the results of which may indicate that you are likely perimenopausal. That being said, blood tests can be notoriously unreliable. It is possible to have completely normal blood results but extreme symptoms, and vice versa. This is because blood tests are just a snapshot of time and hormone levels vary enormously from person to person. During the earlier stages of perimenopause, particularly when cycles are still quite regular, blood tests are unlikely to show changes but symptoms may still be impactful.
Symptoms of menopause
There are many different menopause symptoms, and they can vary in severity and duration between individuals. Some women will experience no symptoms at all or just a few mild ones whereas others will experience a variety of symptoms, and some may be debilitating.
Menopause symptoms include:
- Irregular periods: Changes in menstrual cycle length, flow, or frequency.
- Hot flushes: Sudden feelings of warmth, typically in the face, neck, and chest.
- Night sweats: Excessive sweating during sleep, often disrupting rest.
- Mood changes: Increased irritability, anxiety, or depression.
- Sleep disturbances: Insomnia or waking frequently during the night.
- Vaginal dryness: Discomfort or dryness in the vaginal area, sometimes leading to painful sex.
- Decreased libido: Reduced interest in sexual activity.
- Memory issues and brain fog: Difficulty with concentration and forgetfulness.
- Weight gain: Often around the abdomen, due to hormonal changes.
- Joint and muscle pain: Aches and stiffness in the body.
- Hair thinning: Loss of hair volume or thickness.
- Headaches or exasperation of migraines: Due to hormone fluctuations.
- Skin changes: Dry or itchy skin, and sometimes increased sensitivity.
- Heart palpitations: Unusual heart rhythms or the feeling of a racing heart.
- Breast tenderness: Often linked to hormonal shifts.
- Urinary issues: Including increased UTIs, incontinence and more frequent urination.
Many menopause symptoms can be the same as the signs of other conditions. So, if you feel that what you’re experiencing may not be due to perimenopause/menopause, you should speak to your doctor about ruling out other causes.
Can a blood test detect menopause?
The current UK guidelines state that if you are over the age of 45 and showing typical symptoms, then blood tests are not required to diagnose menopause or perimenopause. They are also not recommended for women taking contraceptives as they can alter natural hormone levels, skewing any results obtained.
Before the age of 45, blood tests are recommended to diagnose menopause, but may be unreliable in the perimenopause, and under 40, they can be used to confirm premature ovarian insufficiency (POI). They also help to exclude other causes of symptoms, and often a bank of blood tests will be taken, including thyroid function, vitamin D, screening for anaemia or diabetes and hormone levels.
Follicle stimulating hormone (FSH)
FSH is a hormone produced by the pituitary gland, and it is responsible for stimulating the growth and maturation of ovarian follicles, which are essential for ovulation. As menopause approaches and the ovaries produce fewer eggs, your body compensates by increasing FSH levels in an effort to stimulate your ovaries to release eggs. Therefore, consistently elevated FSH levels can suggest that your ovaries are less responsive, indicating perimenopause.
Many women do not require bloods testing for diagnosis but if your bloods are normal, we may well offer treatment to see if this improves symptoms. If you are younger (under 40), you may be required to have more extensive blood tests, such as antibody tests, chromosome tests plus screening with bone scans.
Estradiol
Estradiol is the primary form of oestrogen in women of reproductive age, and this hormone has a pivotal role in ovulation. As the ovaries gradually reduce their production of oestrogen with age, estradiol levels decline. Low estradiol levels often correlate with menopause (although not always). As estradiol levels can fluctuate, this blood test is usually only used in conjunction with others to confirm a menopause diagnosis and is much less helpful during perimenopause when it goes up and down hugely as a natural part of this stage.
Luteinizing hormone (LH)
LH is also produced by the pituitary gland and is a key hormone within the menstrual cycle. Its main function is to trigger the release of a mature egg from the ovarian follicle.
Similar to FSH, LH levels rise when the ovaries become less responsive. Elevated LH levels can, therefore, suggest that the body is trying to stimulate egg release, although it’s increasingly unsuccessful in women approaching menopause. LH levels are rarely required when diagnosing menopause or perimenopause but may be part of the batch of tests requested.
How to read menopause blood test results
Interpreting menopause blood test results isn’t always easy, especially as ‘normal’ levels vary between individuals. Normally, blood tests need to be carried out more than once to detect changes as a singular test doesn’t tell us much on its own.
Further, measurements and normal value ranges can differ between testing laboratories so you should always discuss what your results mean with your doctor.
Generally speaking, the level of hormones before and at menopause are as follows:
- FSH: 4.5 to 21.5 IU/L in women who are still menstruating, 25.8 to 134.8 IU/L after menopause.
- Estradiol: 110 to 1468.4 pmol/L before menopause, 0 to 110 pmol/L after menopause.
- LH: 5 to 25 IU/L before menopause, 14.2 to 52.3 IU/L after menopause.
Other tests
Complex tests to diagnose menopause including urine hormone tests, over-the-counter tests and saliva tests are not required or recommended by the British Menopause Society.
Contrary to what you may have seen in adverts, the reason they are not recommended is not because they are expensive (although they are) it is because they have not been validated independently nor do they add any value towards making a diagnosis.
Aside from doctor-recommended blood tests, other tests can be conducted in mid-life if you have symptoms of menopause that can be caused by other conditions. These include:
Thyroid function
It is not uncommon for perimenopausal and menopausal women to also have an underactive thyroid. Thyroid and menopause symptoms, such as fatigue, weight changes, mood swings, irregular periods, hot flushes and changes in skin or hair can overlap.
The thyroid is a butterfly-shaped gland in your neck which is involved in controlling your metabolism.
Blood tests assess levels of thyroid hormones (like TSH, T3, and T4) to determine if the thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism).
Alongside testing of your thyroid, it’s often beneficial to also test vitamin B12, vitamin D, folate and ferritin levels as these can be impacted by poor thyroid function or show changes in isolation.
DEXA scan
Menopause can increase the risk of osteoporosis because of lower oestrogen levels but after the age of 35, people gradually lose bone mass, with the rate increasing after the age of 50. Moreover, other conditions, such as rheumatoid arthritis, anorexia nervosa, coeliac disease and inflammatory bowel diseases can also elevate the risk of osteoporosis and broken bones. Life risk factors include being sedentary, lower than ideal weight, smoking and alcohol consumption.
If there’s concern about bone density loss, particularly in those at higher risk for osteoporosis, or if you’ve experienced fractures or bone pain, a DEXA scan can assess bone health by measuring bone mineral density in areas prone to fracture like the hips and spine. This helps identify osteoporosis risk early and allows for preventive measures. Increasingly women are choosing to opt for a baseline DEXA around the age of menopause to better understand their current bone health and make plans to support it for the future.
Pelvic exam
A pelvic exam, such as an ultrasound, assesses the health of the reproductive organs, such as the uterus, cervix, and ovaries, to detect abnormalities.
This type of test is particularly important if there’s new discomfort, abnormal vaginal bleeding, pelvic pain or irregular or a change in discharge, as although these can be symptoms of menopause, they can also be signs of other conditions including:
- Fibroids
- Polyps
- Ovarian cysts
- Endometrial hyperplasia
- Cancer
Colposcopy
Being in mid-life increases the risk of cervical and other gynaecological issues, but changes in vaginal health during menopause may obscure these risks.
Irregular bleeding, which is also a key symptom of perimenopause, unusual vaginal discharge, or abnormal cervical smear results may prompt a colposcopy for a closer look at the cervix. A colposcopy helps distinguish between menopause symptoms and other cervical health issues.
During a colposcopy, the cervix and vaginal tissues are examined under magnification, often with a biopsy if abnormalities are seen and the results can help determine a diagnosis and appropriate care.
Do I need blood tests to monitor hormone replacement?
If you are doing well on HRT and your symptoms improve, there is no need for further monitoring of bloods.
If you feel like testosterone may be indicated (see our testosterone guide for more information) then it is important to check total testosterone and SHBG baseline levels before starting and as part of ongoing monitoring. This is as per British Menopause Society guidelines.
There are no guidelines regarding oestrogen replacement, but we repeatedly see women on relatively high doses of transdermal oestrogen who remain symptomatic. Levels can show if their oestradiol levels remain low and monitoring oestradiol levels can be useful in these cases.
If symptoms persist and this is not what is expected clinically, blood tests may be recommended to look for other underlying causes.
Getting a menopause diagnosis
Knowing when to seek professional help and even which doctor to consult for menopause is a personal decision. If your symptoms are affecting your life or are concerned about them, it may be time to speak to someone.
The experienced menopause specialists at Menopause Care are here for you. If deemed appropriate, we can arrange testing at a clinic near you, with transparent blood testing pricing that includes sample collection and processing. One of our menopause doctors can then discuss the results with you and recommend the best next steps. To get started, book a consultation with a menopause doctor.
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