Menopause blood tests: when they help and when they don't

Many women expect a blood test to confirm whether they are in the perimenopause or menopause. In practice, a hormone test often can't give a clear answer, and for most women over 45 it isn't needed. But blood tests can still be very useful around this time.

Why hormone tests can mislead

In the perimenopause, hormone levels such as FSH (follicle stimulating hormone) and oestradiol can go up and down from one day to the next. A single result can look "normal" one week and "menopausal" the next. That is why, in the UK, NICE guidance says that for women over 45 with typical symptoms, perimenopause and menopause should be recognised from symptoms, without an FSH test.

Hormonal contraception, such as the combined pill, also affects these hormones, so FSH results aren't reliable while you are taking it.

When a hormone test can help

• Aged 40 to 45 with menopausal symptoms, including changes to your periods, an FSH test may help.
• Under 40, if the menopause is suspected, blood tests are important. Early menopause (premature ovarian insufficiency) is usually confirmed with two FSH tests taken 4 to 6 weeks apart, and you should see a doctor.
• If your symptoms are unusual, or your doctor wants to rule out other causes.

What a blood test can still tell you

Tiredness, low mood, brain fog, palpitations and weight changes can all happen in the perimenopause, but they can also have other causes. A blood test can check for:

• Thyroid problems, which can cause very similar symptoms.
• Low iron or anaemia, especially if your periods have become heavier.
• Low vitamin D or B12.
• Blood sugar and cholesterol. The risk of heart disease rises after the menopause, so this is a good time to check.

Our Menopause Check combines hormone tests with these other markers, and our doctors read the results alongside your symptoms rather than on their own.

Blood tests on HRT

Most women on HRT don't need regular hormone blood tests. Tests can be helpful if your symptoms aren't improving, if you use testosterone, or for a general health check while on treatment. Our HRT Check-up is designed for this.

What happens with your results

A GMC-registered doctor reviews every result before you see it and explains what it means in the context of your symptoms. You can book a consultation to talk through your options.