Is There a Test for Perimenopause?

You may have reached the point where you want a clearer answer. Your periods may have changed, your sleep or mood may feel different, or several smaller symptoms may have started to add up. You want to know whether perimenopause explains what is happening.

Wanting a test makes sense. A result can feel more definite than a list of symptoms, especially if you are worried that you are too young, that something else may be causing how you feel or that your concerns will not be taken seriously. 

Can You Test for Perimenopause?

There is no single test that can confirm perimenopause for every woman, but testing can still be useful. It may help investigate symptoms that begin earlier than expected or check for other possible causes, such as anaemia or a thyroid problem. However, no result can provide a reliable yes or no answer on its own.

Perimenopause is a gradual transition. The ovaries begin to work less predictably, causing hormone levels to rise and fall. A blood test only shows your hormone levels at the moment your sample is taken.

For many women, their symptoms and changes to their periods provide more useful information than one hormone result. For others, testing can support a diagnosis, investigate possible early menopause or help rule out another cause.*

How Is Perimenopause Usually Identified?

Perimenopause is the time leading up to menopause. It most often begins in your forties, although symptoms can start earlier.

Menopause is reached when you have not had a period for 12 months and your periods have not stopped because of hormonal contraception, medication or another health condition.*

A doctor will usually ask about:

• Changes to the timing, length or heaviness of your periods

• Symptoms such as hot flushes, night sweats, sleep problems, mood changes, brain fog, headaches, joint pain or vaginal dryness

• When the symptoms began and how they affect your daily life

• Any contraception, hormone replacement therapy or other medication you use

• Your medical history, family history and pregnancy plans

Some women notice symptoms before their periods change. Hormonal contraception, a hormonal coil or a hysterectomy can also make changes to your periods harder to recognise. In these situations, a doctor will consider the wider pattern of symptoms.

When Can a Perimenopause Blood Test Help?

Not everyone with possible perimenopause needs a blood test. Testing can be particularly helpful if your symptoms begin before 45, your periods cannot be used as a guide or your doctor wants to check for another possible cause.

Hormone levels can change considerably during perimenopause. This means one normal result cannot reliably rule it out.*

Which Blood Tests Might Be Considered?

Blood tests may be useful if symptoms begin before 45 or to check if another health condition could be causing them. Follicle stimulating hormone, usually shortened to FSH, may be measured in certain situations. Other tests can help check for pregnancy, anaemia or a thyroid problem.

Some perimenopause blood tests that you can pay for and order online also measure oestradiol, which is the main form of oestrogen produced by the ovaries. However, oestradiol levels can change considerably during perimenopause, and NICE advises against using this test to identify perimenopause or menopause in women aged 45 or over.*

You will not necessarily need every test mentioned in this section. A clinician will decide which tests could provide useful information based on your age, symptoms, periods, medical history and any hormonal contraception or medication you use.

Follicle stimulating hormone test

Follicle-stimulating hormone is usually shortened to FSH. It is produced by the pituitary gland, a small gland at the base of the brain, and sends signals to the ovaries.

As the ovaries become less responsive, the body may produce more FSH. A doctor may consider an FSH test if you are aged 40 to 45 and have menopause symptoms alongside changes to your periods. It is also used when premature ovarian insufficiency is suspected in women under 40.

FSH levels can change throughout perimenopause. Your result may be raised on one day and within the usual range on another. A normal result does not rule out perimenopause, while a raised result cannot show exactly where you are in the transition.

If you are under 40, 1 raised result is not enough to diagnose premature ovarian insufficiency. 2 raised FSH results taken 4 to 6 weeks apart are normally needed.*

Oestradiol test

Oestradiol is the main form of oestrogen produced by the ovaries before menopause. Some perimenopause blood tests that you can pay for and order online measure it alongside other hormones.

Oestradiol levels can rise and fall considerably during perimenopause. This means one result cannot confirm or rule out perimenopause. NICE advises against using an oestradiol test to identify perimenopause or menopause in women aged 45 or over.*

A doctor may occasionally measure oestradiol as part of a wider investigation, particularly when symptoms begin earlier than expected. The result needs to be considered alongside your age, symptoms, periods and any other test results.

Tests for other possible causes

Several health conditions can cause symptoms that are similar to perimenopause. These conditions can also occur at the same time as perimenopause.

Depending on your symptoms, a doctor may consider:

1. A pregnancy test if your period is late and pregnancy is possible

2. Thyroid tests if you have tiredness, weight changes, heart palpitations or changes to your periods

3. A full blood count and iron tests if heavy periods, tiredness or breathlessness could be signs of anaemia

4. Other tests based on your symptoms, health and medication

These tests do not diagnose perimenopause. They help check whether something else may be causing or contributing to how you feel.*

Testosterone test for women

A testosterone blood test is not a standard test for perimenopause. It cannot confirm that symptoms such as low sexual desire, vaginal dryness, tiredness or brain fog are caused by low testosterone.

Testosterone testing may be considered if persistent low sexual desire is being investigated and testosterone treatment is an option. Treatment is usually only considered when other possible causes have been addressed and hormone replacement therapy has not helped.*

A blood test is taken before treatment to check that your testosterone level is not already high. Further tests are then used to make sure it remains within the usual female range during treatment. The results are used to support safe prescribing rather than to diagnose perimenopause.**

When Is the Best Time to Take a Perimenopause Blood Test?

There is no single best time for every perimenopause blood test. The right timing depends on which markers are being measured, whether you still have periods and how regular they are.

What Do Perimenopause Test Results Mean?

A perimenopause blood test does not provide a simple positive or negative result. Its meaning depends on your age, symptoms, periods, medication and the reason the test was arranged.*

If your test includes oestradiol, a low, normal or raised result cannot confirm or rule out perimenopause. Oestradiol is a form of oestrogen, and its level can change considerably during the menstrual cycle and throughout perimenopause. A doctor will consider the result alongside your age, symptoms, periods, medication and any other test results.**

When you review your results with a doctor, it is important to understand why each test was arranged and what the findings mean for you. You may want to ask:

1. What was each test checking for?

2. Could my menstrual cycle, contraception or hormone replacement therapy have affected the result?

3. Does any test need to be repeated?

4. Have other possible causes of my symptoms been checked?

5. What can I do if my results are normal but my symptoms continue?

Are Home Perimenopause Tests Accurate?

It depends on the type of test. The Royal College of Obstetricians and Gynaecologists does not recommend shop bought menopause self tests for identifying perimenopause or menopause. Home blood samples sent to a laboratory can accurately measure certain hormones or health markers, but the results cannot diagnose perimenopause on their own.*

Shop bought urine tests

Many menopause tests sold in shops or online measure follicle stimulating hormone, usually shortened to FSH, in urine. FSH is a hormone produced by the brain that sends signals to the ovaries.

The Royal College of Obstetricians and Gynaecologists does not recommend these tests for identifying perimenopause or menopause. FSH levels can rise and fall during the menstrual cycle and throughout perimenopause. A raised result does not confirm perimenopause, while a result within the usual range does not rule it out.*

These tests are also not useful if you take hormonal contraception that suppresses FSH, such as the combined contraceptive pill.*

Home blood tests sent to a laboratory

Some testing services and online clinics allow you to collect a small blood sample at home and send it to a laboratory. The sample may be collected from your finger or with a small device placed on your upper arm.

A laboratory may accurately measure the hormones or health markers in your sample. However, an accurate measurement is not the same as a diagnosis. Hormone levels can change during the menstrual cycle and throughout perimenopause, so the results need to be considered alongside your age, symptoms, periods, medical history and medication.*

Some home blood tests measure FSH and oestradiol. Oestradiol is the main form of oestrogen produced by the ovaries before menopause. Neither result can confirm or rule out perimenopause on its own.*

Before choosing a home test, check:

1. How the sample is collected

2. Which hormones or health markers are measured

3. Whether the laboratory and collection method are suitable for those tests

4. Whether a doctor will review the results alongside your symptoms

5. Whether you can ask questions or access further support

Can You Test While Using Contraception or HRT?

Hormonal contraception can change or stop your periods. This can make it harder to recognise perimenopause from your usual bleeding pattern.

The combined pill, contraceptive patch and vaginal ring suppress FSH and oestradiol. Testing these hormones while using combined hormonal contraception cannot reliably show whether you are perimenopausal.

Some progestogen-only methods can stop bleeding without completely stopping ovarian activity. In certain women aged over 50, an FSH test may help a doctor decide when contraception can be stopped. This is different from using FSH to diagnose perimenopause.*

If you use hormone replacement therapy, usually shortened to HRT, a blood test may measure both the oestradiol produced by your body and the oestradiol from your treatment. Routine hormone testing is not usually needed to check whether HRT is working. Your symptoms and any side effects generally provide more useful information.**

Do not stop contraception or HRT before a blood test unless the doctor arranging it tells you to.

Can a Test Show How Close You Are to Menopause?

No blood test can reliably predict when your final period will happen. Perimenopause can last several years, and your hormone levels cannot show how long your symptoms will continue.

Anti-Mullerian hormone, usually shortened to AMH, provides information about the number of follicles remaining in the ovaries. It is sometimes used during fertility investigations, but it is not recommended as a routine test for perimenopause. It also cannot predict the exact age at which you will reach menopause.*

A hormone test cannot confirm that you can no longer become pregnant. Ovulation may still happen during perimenopause, even when your periods are irregular or your FSH level is raised.

Continue using contraception until a doctor advises that it is safe to stop.**

How to Prepare for an Appointment

You do not need to wait for a blood test before asking for help. Keeping a short record of what has changed can help your doctor understand the full picture.

Try to note:

1. Any changes to the timing, length or heaviness of your periods

2. Which symptoms you experience and when they began

3. How often the symptoms happen

4. How they affect your sleep, work, relationships or daily life

5. Any contraception, HRT, supplements or other medication you use

6. Any family history of early menopause

7. Whether you are planning a pregnancy

Your doctor can then decide whether your symptoms are enough to identify perimenopause, whether blood tests could add useful information or whether another cause needs to be investigated.

When Should You Speak to a Doctor?

Arrange an appointment if:

1. You have possible menopause symptoms before the age of 45

2. Your symptoms are affecting your sleep, work, relationships or quality of life

3. You are unsure whether your symptoms could have another cause

4. Your periods have become much heavier or last considerably longer than usual

5. You bleed between periods or after sex

6. You have any vaginal bleeding after going 12 months without a period

Changes to bleeding should be assessed rather than automatically assumed to be part of perimenopause. Any bleeding after menopause should be discussed with a doctor promptly.*

Perimenopause Tests: The Bottom Line

There is no single test that can give every woman a definite answer about perimenopause. However, this does not make testing pointless.

Blood tests can be valuable when symptoms begin earlier than expected, when another health condition may be involved or when a treatment needs to be monitored.

The clearest answer comes from looking at the full picture. Your age, symptoms, periods, medical history and any relevant test results all matter.

A normal hormone result does not mean that nothing is happening, and you do not need a positive test before asking for help.

FAQs

Can you be perimenopausal while your periods are still regular?

Yes. Some women notice symptoms before changes to their periods become obvious.

However, tiredness, mood changes, poor sleep and brain fog can also have other causes. A doctor will consider your age, symptoms, periods and medical history together.

Can I start HRT without a blood test?

Women aged 45 or over with typical symptoms do not usually need a hormone blood test before discussing HRT.

A doctor will consider your symptoms, periods, medical history and whether HRT is suitable for you.

Is there a best time in my cycle to take a perimenopause test?

There is no single day that makes a perimenopause hormone test definitive.

If a doctor arranges a test for a particular reason, follow their instructions about timing. You do not need to delay asking for help while waiting for a specific point in your cycle.

Does an FSH test show whether I can still get pregnant?

No. An FSH result cannot reliably tell you whether you can still become pregnant or whether you still need contraception.

Ovulation can happen unpredictably during perimenopause.

Can a blood test tell me whether my symptoms are caused by perimenopause?

Not on its own. A blood test may provide useful information, but your age, periods, symptoms and medical history are also important.

Testing may be particularly helpful when symptoms start before 45 or when another health condition could be causing them.