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 proven menopause blood test to answer one simple question, “Are you menopausal or not?”
Menopause testing can be a complicated and frustrating business. Quite simply, there are limited circumstances in which tests for menopause are accurate or useful. Read on to find out why.
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What hormones are tested for at menopause?
Menopause is when your body experiences a number of hormonal changes. These eventually lead to the end of your periods, and can cause a whole host of menopause symptoms, such as hot flushes, mood changes and sleep problems.
Low or fluctuating levels of oestrogen are responsible for most menopause symptoms, and hormone replacement therapy (HRT) works by replacing oestrogen. However, oestrogen is not generally recommended as a test for menopause. This is because oestrogen levels can be highly variable even after menopause, and are therefore not thought to be 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 is a good sign that you have been through menopause, although the test should be interpreted by your doctor 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. 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 flushes
- Mood changes, including low mood, anxiety, 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 doctor 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 organisations including the National Institute for Health and Care Excellence (NICE) and the Faculty of Sexual and Reproductive Healthcare (FSRH) 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. Current recommendations suggest testing FSH levels if you are:
- 45+ and having symptoms which are not typical of menopause
- Between 40 and 45 years old and have symptoms which suggest menopause
- Under 40 with suspected premature menopause
- 50+, using progesterone-only contraceptives (like the mini-pill, contraceptive injection or hormonal coil) and want to know whether you need to continue
- Perimenopause is based on hot flushes and/or night sweats and irregular periods
- You’re in menopause, if you have your ovaries, not using hormonal contraception and have not had a period for a year.
How do I know if I have been through the menopause?
If you previously had regular periods, you can usually tell if you are postmenopause 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 flushes, 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 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 doctor will be able to advise you if you are unsure and may advise testing. They can also advise if you are seeking help for your symptoms. This may involve lifestyle changes or HRT.
How to test for early menopause?
FSH testing is sometimes recommended if early or premature menopause is suspected.
Early menopause happens if you have your last period between ages 40 and 45. Premature menopause (sometimes called primary ovarian insufficiency or POI) happens under the age of 40.
In these situations, FSH testing can give you an accurate diagnosis, and ensure you are receiving appropriate treatment. While HRT is not recommended for everyone, it is usually prescribed for those who go through early or premature menopause. This is because HRT has been shown to protect these groups from cardiovascular disease and osteoporosis, with the benefits outweighing the risks for most people.
See your doctor if you think you may fall into either of these groups. Look out for clues, such as experiencing a change in your periods or other typical menopause symptoms.
Do home menopause test kits work?
These are not currently recommended by the British Menopause Society for a number of 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 doctor 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. These could include thyroid issues, anaemia and many others
Menopause can be difficult to diagnose. Rather than spending your money on a home test kit, speak to your doctor 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 the 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 (Mirena, Kyleena, Levosert or Jaydess)
- Contraceptive injection
If you are aged 50, on a contraceptive and having 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 is 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.