Hot flushes at work, nights broken by sweats, a memory that suddenly feels less reliable. For many women in their forties, these changes raise a simple question: is this the menopause? A blood test seems like the obvious way to find out. Sometimes it is. Often, though, the answer comes from your symptoms and your cycle rather than from a lab result. This guide explains when menopause hormone tests are useful and what they measure.
Menopause and perimenopause in brief
Menopause is a natural stage of life when periods change and eventually stop because hormone levels fall. The NHS notes that it usually happens between 45 and 55, though it can come earlier (NHS, Menopause and perimenopause). The years of change before the last period are called perimenopause.
A 2023 review in JAMA estimates that 50% to 75% of women have hot flushes, night sweats or both during the transition, and that these symptoms often last more than seven years (Crandall et al., 2023). LML lists many other possible symptoms in its description of the Menopause Hormones Profile, including mood changes, brain fog, poor sleep, palpitations, joint aches, vaginal dryness and recurrent urinary infections.
Do you need a blood test?
The NICE guideline on menopause is clear on this point. For people aged 45 or over with typical symptoms, menopause and perimenopause are usually identified without laboratory tests. NICE advises against using tests such as AMH, inhibin and oestradiol to identify menopause at this age (NICE NG23). Hormone levels swing widely during perimenopause, so a single result can mislead.
When testing is more useful
- Between 40 and 45, NICE says an FSH test can be considered to help confirm menopause when there are symptoms and cycle changes.
- Under 40, when early menopause (premature ovarian insufficiency) is being considered, NICE uses FSH measured on two samples taken 4 to 6 weeks apart, together with symptoms.
- When symptoms are unclear, for example when a thyroid problem could explain similar changes.
NICE also notes that FSH should not be used to identify menopause in people using combined hormonal contraception or high-dose progestogen, because these change the result.
What the Menopause Hormones Profile measures
The Menopause Hormones Profile in the BPR catalogue includes:
- FSH and LH, the pituitary hormones that rise as the ovaries slow down;
- Oestradiol (E2), the main oestrogen, whose fall LML links to most menopausal symptoms;
- Testosterone;
- TSH, included because, as LML notes, thyroid problems can cause symptoms similar to the menopause.
LML states that this profile can be done on a finger-prick home sample as well as on a venous sample.
Monitoring HRT
Hormone replacement therapy (HRT) is one of the main treatments for menopausal symptoms. The JAMA review describes oestrogen-based therapy as the first-line treatment for bothersome hot flushes and genitourinary symptoms, with non-hormonal options for women who cannot or prefer not to use it (Crandall et al., 2023). The NHS has detailed pages on the types, benefits and risks of HRT (NHS, HRT).
For many women on HRT, the dose is guided by how symptoms respond rather than by blood levels. Some doctors still find it useful to check hormone levels, for instance when symptoms persist or after the ovaries have been removed. The HRT Profile 1 in the catalogue measures FSH, oestradiol and progesterone, and LML describes it as a profile to monitor HRT in women who are going through menopause or have had their ovaries removed.
