As the conversation about menopause and perimenopause opens up, we're more alert to potential symptoms. But do we need a test to be sure? We asked specialist doctors
The menopause has gone from a subject discussed only in whispers to one of the hottest topics around. Unsurprisingly, questions abound as to how best to diagnose and treat it. Because so many menopause and perimenopause symptoms – brain fog, aching joints, insomnia – could just as easily be put down to other things, a 'menopause test' sounds, on paper at least, to be a helpful solution.
Certainly, there is no shortage of menopause self-test kits available online as well as in Boots, Holland & Barrett and Superdrug for as little as £9.99. You can even throw them in with your weekly shop at Tesco and Waitrose. But how accurate are they? How do you read a menopause test result results - and should you even try to interpret them yourself? Is asking your doctor for a blood test a better option – and will they even give you one?
We turned to a panel of doctors to get the definitive advice on menopause testing and interpreting the results.
How does your GP diagnose the menopause?
Your GP will not normally test for menopause by taking your blood, says BMS accredited menopause specialist Dr Lindsey Thomas . “Diagnosis of the menopause is made based on clinical symptoms and not blood tests,” she says.
Quick reminder - you have officially reached menopause the day you have not had a period for 12 months. But your doctor will consider consistent symptoms such as night sweats, mood swings, hot flashes and vaginal dryness after the age of 45 as good indicators of that day drawing near, and can prescribe treatment such as HRT.
If you are unsure of your symptoms, menopause symptom tracker apps such as Dr Louise Newson's Balance app can be a good start.
Is there a menopause blood test?
There is a well-known blood test called a Follicle Stimulating Hormone (FSH) test that helps determine menopause: raised levels of FSH can be an indicator. Most of the over-the-counter tests are purely FSH tests. But don’t rush out and buy one just yet as FSH is only one piece of a complex hormonal puzzle. The doctors we spoke to mostly sounded notes of caution.
"The British Menopause Society and NICE guidelines don’t support FSH testing,” says Dr Thomas, “except to confirm early menopause if you’re under 45, or primary ovarian failure [when the ovaries stop working before the age of 40].”
If you are over 45, perimenopausal and are still having periods, she says, FSH testing alone is not helpful in deciding whether treatment is needed because your hormone levels fluctuate so significantly at this life stage.
“If you’re over 45 and your GP diagnoses menopausal symptoms, you can go straight to discussing how to manage them,” says integrative aesthetic and hormone doctor Terry Loong . “FSH testing is a waste of time and money from the point of view of the NHS under these circumstances, as it will be unreliable and can even be misleading.” That is why GPs will often be reluctant to prescribe this test.
When do doctors do an FSH menopause test?
GPs can give you an FSH test to exclude or confirm menopause in unusual circumstances, where high levels of FSH can indicate low levels of oestrogen. This can mean that the ovaries might not be functioning as well. “Under atypical circumstances, an FSH test is helpful to confirm that it is the menopause and not something else causing your periods to stop or menopausal symptoms to develop,” says Dr Thomas.
Is an FSH test at all useful?
Yes, but not in isolation. NICE guidelines stipulate that testing FSH, alongside testing the levels of the hormones estradiol and LH, or luteinizing hormone, can be considered for diagnosing menopause, but only if you are if you are:
- Aged between 40–45 years with menopausal symptoms, including a change in menstrual cycle.
- Younger than 40 years with a suspected diagnosis of premature ovarian insufficiency (POI).
- Aged over 45 years with atypical symptoms.
- Over 50 years of age using progestogen-only contraception
“FSH levels over 25 mIU per ml are a potential indicator of menopause in the above circumstances,” says consultant gynaecologist Dr Tania Adib . “Typically the levels of the reproductive hormones estradiol, progesterone and testosterone will be low as well, as will DHEA, a hormone that helps to produce reproductive hormones.”
But, she and her fellow doctors are at pains to point out, a menopause diagnosis is never made on the basis of FHS or hormone levels alone.
I’m still on the Pill. Will this affect the results of a perimenopause or menopause hormone test?
“Hormonal contraception suppresses ovarian function, so a blood test will show that all the hormones, including FSH, are low and will not give any idea of the menopause,” says Adib. “You’d have to discontinue the pill for six weeks before a test.” It won’t work either if you’re already on HRT, says Dr Thomas, who adds that you can test when you are on progestogen contraceptives such as the Mirena coil or the progestogen-only mini pill.
My GP hasn’t offered me a test – should I get an at-home menopause test kit?
“I totally understand why women would want a test when they’re experiencing upsetting symptoms and want to be sure what’s going on with them,” says Dr Thomas. “But essentially, no one needs to buy an over-the-counter FSH test,” she says
“If you’re under 45, your GP should give you the test to confirm menopause, or investigate what else is going on. If you are over 45 with no periods for 12 months then you are menopausal - you don’t need a test to tell you. If you’re over 45 and suspect you’re nearing menopause, your GP can start you on an HRT trial to see if that alleviates your symptoms.”
Loong can see pros and cons to doing a test yourself: “It feels good to be proactive with your health and give yourself a potential discussion starter with your GP,” she says. “But we know FSH levels can be variable and don’t correlate with the severity of symptoms. So it’s all too easy to make the wrong self-diagnosis,” she warns, “and it may lead to you seeking the wrong treatment.”
One doctor who is not against home testing is hormone and integrative medical doctor Sohere Roked. “So long as it’s a reputable company such as Medichecks ( FSH Blood Test , £52)," she says. "However, it’s best that such tests are analysed by somebody who understands hormones. Many clinics privately won’t see patients who have their own bloods done. But this is never something that I object to, as I don’t want cost to be a barrier to treatment.”
I’m over 45 with menopausal symptoms, but my GP will only prescribe anti-depressants. Do I have a right to ask for HRT instead?
“Yes,” says Roked. “Based on these symptoms, HRT can be appropriate and it’s worth having a trial to see if it sorts you out. This approach is advocated by the British Menopause Society as well.”
“Waiting until a woman’s periods have stopped for a full year misses the perimenopause completely, and it misses a year of her actually being menopausal as you can only make that diagnosis retrospectively,” says Thomas. “So definitely, women should feel they can speak to their GP if they think they are perimenopausal, and discuss HRT.”
It’s often good, she says, to seek out a GP who specialises in women’s health, so find out from your surgery which of its doctors has this interest.
Soon, you may be able to go straight to your pharmacist for HRT. In February the government's health regulator announced plans to make the HRT medication Vagifem (a low-level topical oestrogen to treat vaginal dryness) available over the counter this year. However, this doesn't amount to a full HRT prescription, which usually involves an oestrogen gel (which is absorbed into the body as opposed to treating just one symptom) and progesterone tablets. While it's hoped that more HRT medications will follow, for now, you still need to see your GP.
Is it better to go private for a menopause diagnosis and treatment?
Beyond FSH testing (under the specific circumstances mentioned) the NHS won’t provide comprehensive hormone testing for menopausal symptoms. This is where a private blood test is an alternative.
Seeing a private hormone or menopause specialist can help if you’re struggling to get your GP to listen to you or want to be reassured about your symptoms.
Some women do it to get a full picture of their hormone status via a 'comprehensive hormone panel' blood test. It can get them ‘set up’ on a HRT prescription, which can in due course be taken over by their GP, so long as it is a medication that is prescribed is available on the NHS (known as body identical hormones).
Another reason to go private is for your HRT prescription to be as bespoke as possible. This may come in the form of bioidentical hormones, a custom-made blend for each patient, which is only available privately, not recognised by NICE and is always expensive.
A ‘full hormone panel’ blood test, says Adib, includes FSH, estradiol, progesterone, testosterone, DHEA and SHBG (sex-hormone binding globulin). “It’s often useful as a baseline to check vitamin D, liver function, thyroid function and full blood count as well,” she says, as these could all be involved in menopause-like symptoms, when out of whack.
What are the benefits of a private hormone blood test?
“NICE guidance says that women over 45 don’t need a blood test if they have menopausal symptoms: give them HRT and if they feel better, great,” says Adib. “In private practice, we do things differently, and not because private patients are all entitled or rich!"
“For women who still have periods alongside menopausal symptoms (think fatigue, depression, anxiety and insomnia rather than the classic hot flushes), I find it very helpful to do a full ‘hormone panel’ of blood tests on day 21 of the cycle.” This includes testing hormones the NHS panel doesn’t look at, such as testosterone and DHEA.
“It means I can tailor the hormone treatment accordingly,” says Adib, who offers a customised approach centred on mediation available on the NHS. “I believe this helps me balance the hormones more effectively compared to just giving a standard HRT prescription."
“If symptoms improve with hormone treatment, then they are likely to be menopause-related, and if they don’t improve then that’s reason to have them investigated by the appropriate speciality.”
“In menopausal women who have stopped having periods, comprehensively measuring hormone levels is helpful as I can make sure patients take therapeutic amounts of hormones that are not too high and are precisely balanced,” she continues. “We are mainly guided by symptoms, but the blood levels help fine-tune our prescriptions."
A test might reveal that you don’t need hormones at all but need to explore other reasons why you are not feeling so good, says Roked. “I’m a strong believer in looking for other imbalances and addressing issues that could be negatively impacting someone’s wellbeing with supplementation, nutrition and lifestyle tweaks.” The whole process can be up to £898 plus medication,” says Roked, who practices at the central London Omniya Clinic.
Do you need regular blood tests in menopause?
Many people feel absolutely fine on their ‘standard’ HRT without regular monitoring,” says Roked. “But one of the reasons I check hormone levels is so that upon starting treatment, I can see if the hormones I prescribe are being absorbed well, and make adjustments if needed. It’s a different level of healthcare that allows you to balance your levels on an ongoing basis for optimal health and wellbeing.”
Price-wise, says Adib, you’re looking at an average of £300 for the test itself, but that does not include consultancy fees or the cost of analysing the results. “My female hormone profile is £298, and generally patients come for an initial appointment with a follow-up for the results. Its results give a full picture of how your hormones might affect you, irrespective of whether any imbalance is due to menopause or other factors like stress or underlying disease.”
What is the DUTCH test?
An alternative to menopause blood testing is the DUTCH test (Dried Urine Test for Comprehensive Hormones). “It gives clues as to sex hormone production and metabolism, detoxification pathways, adrenal health and nutrient deficiency,” says Loong. “So it helps with holistic management of menopause - but it’s not necessary for diagnosing it.”
Roked loves the test for those “having issues with their cycles or mood around the time of their periods.” Pricing is roughly the same as for blood testing. You need to have this done and interpreted by a doctor.
Are there any comprehensive hormone tests you can do at home?
With prices like these, it’s understandable many women would welcome an at-home alternative. But as we’ve seen, a simple DIY FSH test isn’t comprehensive or always particularly useful.
One option for a fuller hormone profile is the Hertility Test , £149. It’s a hormone and fertility test that’s not specifically geared towards menopause, but “it assesses the most common menopausal symptoms and can tell you whether you are undergoing menopause as well as indicate whether you are perimenopausal,” says Dr Helen O’Neill, Hertility’s CEO.
Hormones including FSH, estradiol, and LH are screened, via a fingerprick blood test, alongside thyroid function and other hormones that signpost reproductive health conditions. “We also test biomarkers of diseases menopausal women are more prone to (with a view to taking preventative steps) and do a full symptom evaluation to identify healthcare needs,” says O’Neill.
Both the blood and health assessment are individually interpreted and explained by a team of consultant reproductive medicine doctors and appear on your online dashboard with suggested next steps. You can book a video or clinic consultation with a specialist too. “Understanding your hormones is the first step in seeking appropriate HRT dosage,” says O’Neill.
A menopause-specific test kit is around the corner launching this summer and will have a teleconsultation and tailored HRT prescription.
The bottom line
If you are over 45, your doctor won’t need blood tests to determine whether you are menopausal or perimenopausal, even if you are still having periods. Your symptoms are the standard guide. Download a perimenopause/menopause app such as Balance to find out more about these. If you’re under 45, your GP may do a test to determine whether your symptoms are menopausal, or are caused by something else.
At-home FSH menopause tests are available, but you still need a menopause specialist or doctor such as Dr Roked or your GP to help you understand what it means for you. By itself, an FSH test is not a reliable indicator of menopause. As Dr Terry Loong says, your GP may view an FSH test as a conversation starter, but don’t expect them to prescribe medication off the back of this alone.