Diagnosing menopause using blood tests

Menopause is usually diagnosed based on a woman’s symptoms, taking into account her age, bleeding pattern and – if appropriate – certain tests.

The current UK guidelines state that if you are over the age of 45 with typical perimenopausal symptoms, blood tests are not required to diagnose menopause or perimenopause. It's worth noting that blood tests are notoriously unreliable, too. It’s possible to have completely normal blood results but extreme symptoms and vice versa, as blood tests are just a snapshot in time whereas your hormones are changing all the time.

If you have symptoms and you’re under the age of 45, blood tests are sometimes recommended. This is usually if the diagnosis is uncertain and to rule out other causes.

For women below the age of 40, blood tests are always recommended. This is normally to exclude other causes, and often a bank of blood will be taken to test things like thyroid function, vitamin D and hormone levels. We look at Follicle Stimulating Hormone (FSH) and oestradiol levels in particular. FSH levels are typically (but not always) high in menopause, and oestradiol levels are typically low (but not always). If your bloods are normal, we may well offer treatment to see if this improves symptoms.

If you are very young (under 40), you may be required to have more extensive blood tests, such as antibody tests and chromosome tests plus screening with bone scans.

Complex tests to diagnose menopause (including urine hormone tests, over the counter tests and saliva tests) are not required or recommended by the British Menopause Society. Contrary to what you may have seen in adverts, the reason they are not recommended is not because they are expensive (although they are), but because they have not been validated independently nor do they add any value towards making a diagnosis.

What is the purpose of blood tests?We may issue blood tests for the following:

1. Hormone levels

Oestradiol is a form of oestrogen produced by the ovaries. Its levels tend to decrease during menopause. Measuring these levels can provide insight into the hormonal changes occurring in your body. Follicle Stimulating Hormone (FSH): FSH is a hormone released by the pituitary gland, and its levels rise as the ovaries produce less oestrogen. Elevated FSH levels can indicate decreased ovarian function, which is typical during menopause.

2. Bone health

Vitamin D and calcium: Menopausal women are at an increased risk of bone density loss. Blood tests can assess your vitamin D and calcium levels, which are essential for maintaining strong and healthy bones.

3. Cholesterol levels

Menopause can influence your cholesterol levels, potentially increasing the risk of heart disease. Cholesterol levels can be monitored and lifestyle adjustments made if necessary.

4. Blood sugar levels

HbA1c is a blood test that measures your average blood glucose (sugar) levels over the past two to three months. It is often used to assess long-term glycaemic control in people with diabetes, or to diagnose prediabetes and diabetes.

5. Thyroid function tests

There can be a crossover between symptoms of thyroid disease and perimenopause. A blood test to check your thyroid function can rule out thyroid dysfunction as a cause.

6. Other blood tests may include

Full blood count to check for signs of infection, anaemia and inflammation Liver function tests Kidney function tests Bone profile Vitamins B12, folate and ferritin ESR/CRP (markers of inflammation) Prolactin

We may use your blood test results to help identify what may be causing your symptoms