Are there tests for perimenopause or menopause, and how reliable are they?

Wondering if there’s a test to tell you whether you’re in perimenopause or have reached menopause? The answer is not a simple yes or no.

There are a variety of blood and urine test kits on the market that claim to help you understand your menopause status by measuring levels of certain hormones, including one called follicle-stimulating hormone (FSH).

Doctors can also carry out these tests. However, because your levels of FSH fluctuate so much, tests are not seen as particularly helpful and are generally only used if your doctor thinks you may have early or premature menopause.

In this article, we’ll look in more detail at some of the different kinds of menopause tests available, what they measure and what test results are seen as significant. We’ll also explain the other signs to look out for if you think you may have begun the menopause transition, including the most common symptoms. 

What do menopause tests measure?

The majority of perimenopause and menopause tests measure your levels of a hormone called follicle-stimulating hormone (FSH), which helps to control your menstrual cycle.

Your FSH levels are linked to your levels of the main reproductive hormone, oestrogen – as oestrogen drops, FSH increases. During your menstrual cycle, and during perimenopause and beyond, your levels of both oestrogen and FSH fluctuate. That’s why doctors don’t generally use a single measurement of FSH to diagnose menopausal status.

Some tests also measure levels of other hormones, including oestrogen and luteinizing hormone (LH), which, like FSH, goes up as oestrogen goes down. More expensive commercial tests may even look at your levels of vitamins, minerals and blood fats like cholesterol as a way of assessing other aspects of your health.

Stages of the menopause transition

There are three main stages of the menopause transition:

• Perimenopause: the years leading up to menopause when your reproductive hormone levels are in a state of flux, gradually starting to stabilise as you approach menopause.
• Menopause: the point in time 12 months after your last period.
• Postmenopause: the life stage after menopause, when hormones like oestrogen and progesterone tend to settle at their lowest levels, and FSH at higher levels.

Confusingly, the terms menopause and perimenopause are sometimes used interchangeably. Doctors may also refer to ‘early perimenopause’ and ‘late perimenopause’ as different stages.

Home test kits

There are a variety of commercial home test kits that claim to help you understand where you are in the menopause transition. They include blood tests that you send to a lab and urine tests where you can see the results straight away.

Blood tests

With most home menopause test kits, you take a small sample of blood by pricking your finger. Some kits use a device that attaches to your upper arm and uses vacuum-assisted suction to draw out the blood after pricking your skin with a needle.

You post your blood sample to a lab to be tested and the results are sent to you a few days later.

These tests generally provide a single one-time measurement of your FSH levels. More expensive tests may also test levels of other reproductive hormones, including oestrogen and LH.

Urine tests

Home urine menopause tests tend to work like pregnancy tests, where you wee on a device that then gives an immediate result. You don’t need to send these tests off to a lab.

Some test kits give you a one-off reading, telling you whether your FSH is above a certain level.

Other more expensive tests involve testing multiple times over several days and may give you a broad overall FSH result such as ‘low’, ‘high’ or ‘variable’. With some of these tests you also download an app where you input details of your menstrual cycle and menopause symptoms. The app uses this information together with your test results to calculate your likely menopause stage, such as ‘premenopause’, ‘early perimenopause’, ‘late perimenopause’ or ‘postmenopause’.

Commercial clinical tests

Rather than have you take a blood sample yourself and send it off for testing, some commercial health clinics offer in-person appointments where your blood sample is taken by a professional. You’ll then get the results in a day or so.

You may be asked to fast for a number of hours before your test and to avoid taking certain supplements.

These tests are more expensive than home tests but often test for a wider variety of health markers, including a range of hormones, vitamins and minerals, and indicators of bone, nutrition, heart and thyroid health. These extra measurements may be useful if you want a fuller heath check but it’s debatable whether they’ll help you understand your menopausal status.

NHS tests

If you’re aged 45 or over, are otherwise healthy and are experiencing common menopause symptoms, the UK National Health Service (NHS) does not generally consider FSH testing a useful way of diagnosing whether you’re going through perimenopause.

This is partly because hormone levels fluctuate so much during perimenopause that it’s very hard to draw any conclusion on the basis of a single measurement. If you’re using combined oestrogen and progesterone contraceptive treatment, or hormone replacement therapy (HRT), this also means the results of an FSH test would be very difficult to interpret.

Your doctor is more likely to make a diagnosis based on whether you have certain menopausal symptoms, which are the most reliable indicator of whether you’ve entered perimenopause.

Similarly, when it comes to postmenopause, your doctor will ask how long it is since your last period. If it’s been 12 months or more, you have reached postmenopause.

Tests for early menopause

If you’re aged 40–45, are not taking combined hormone contraception or HRT, and have menopause symptoms including changes to your period, your doctor may test your FSH levels to see if you have early menopause. In this case, the British Menopause Society (BMS) recommends that doctors test two separate blood samples taken 4 to 6 weeks apart.

Tests for premature menopause

If you’re under 40 and have menopause symptoms, your doctor may test your FSH levels to see if you could have premature menopause, also known as premature ovarian insufficiency. 

Menopause blood test results

If you do have a blood test, the following result is considered an indicator of perimenopause or postmenopause without the need for a further test:

• FSH level of >30 U/L, also written as IU/L (30 or more universal units per litre)

If your FSH level is less than 30 U/L that doesn’t mean you’re not going through perimenopause as FSH levels can fluctuate widely during this time.

This can even be true of postmenopause as many women’s FSH levels don’t become stable until several years after they reach menopause.

In these cases, it’s likely to be the symptoms you’re experiencing that are the best indicator of whether you are menopausal.

If you’re under 40 and are being tested for premature menopause, the British Menopause Society recommends that your doctor only makes a positive diagnosis if you’ve had two tests 4 to 6 weeks apart, both with the following result:

• FSH >40 U/L

Other ways to tell if you are in menopause

Your doctor is more likely to use your symptoms to diagnose whether you are in the menopause transition than to suggest an FSH test.

The first signs that you have entered perimenopause are usually changes to your period. This could include lighter or heavier periods, irregular periods, with a longer or shorter duration, or spotting in between your periods. You may even skip a period.

Common symptoms of perimenopause and menopause include:

• changes to your periods
• hot flushes or night sweats
• poor sleep
• mood swings and anxiety
• brain fog
• weight gain or changes to your body shape
• heart palpitations
• dry or itchy skin
• muscle aches and joint pain
• reduced sex drive
• vaginal dryness
• urinary infections

There are many other symptoms of menopause too. You can see a checklist of these here.

If you have some of the most common symptoms, a test to diagnose your menopausal status is usually not necessary. If you don’t have symptoms and are not seeing changes to your periods, it's unlikely you have begun perimenopause.

If you haven't had a period for 12 months, you have reached menopause and are now in postmenopause.

Probiotics for menopause symptoms

If you're experiencing menopause symptoms like those mentioned above, the right probiotic supplement could help.

Probiotics are friendly bacteria that can improve your gut health and have benefits all around your body, including by boosting the functioning of your estrobolome, the part of your gut microbiome that processes oestrogen.

The specially chosen probiotic strains in Better Gut have been shown in studies to help with a whole range of menopause symptoms, including hot flushes, poor sleep, anxiety, brain fog, bloating and constipation, and healthy weight management.

Summary

There are a variety of commercial test kits that claim to help you understand your menopause status. You can get both blood tests that you send to a lab and urine tests where you get the results immediately. You can also visit a clinic to have a blood test taken.

These tests usually look at your levels of follicle-stimulating hormone (FSH), and may also test for other hormones, as well as wider health indicators like blood fats, vitamins and minerals.

However, experts don’t consider FSH tests a very reliable or helpful way of diagnosing menopause status. Doctors generally only use these tests if they think you may have early or premature menopause. They’re much more likely to use your symptoms to decide whether you’ve started the menopause transition.