Menopause

Blood tests and the menopause

I regularly see women in my clinic asking for a ‘menopause test’. Or, even worse, women who have had a test and told they can’t possibly be menopausal because their blood tests are normal.

For most women, menopause occurs after the age of 45, with the average age being 51. Blood tests in this group of women are not required to diagnose menopause or menopausal symptoms. In fact, during the perimenopausal phase, blood tests can often vary significantly from one day to the next, and as a result can often be falsely interpreted.

The FSH (follicle stimulating hormone) test is what is usually being performed to ‘diagnose’ menopause. It starts to rise during the perimenopause as ovarian function starts to decline, in a bid to keep the ovaries ovulating. However, this rise does not follow a nice gradual pattern – there are often significant peaks and troughs, which means blood test results can often vary. One high reading does not necessarily mean you are post menopause, and, likewise, a low reading does not mean things are not changing.

As the results can be so difficult to interpret, the NICE guidelines do not recommend its use in the diagnosis of menopause in women over 45 years. The test may have a role in some situations (eg when a woman does not have periods for other reasons – eg contraception or previous hysterectomy), and it is still an important test for women who may be going through premature menopause. However, for the majority of women, diagnosing menopause should be based on their symptoms.

Interestingly, it has been estimated by NICE that unnecessary FSH testing in women over 45 years costs the NHS £9.6million! So, don’t ask your GP to do a menopause blood test just to check – it might not give you the right answer!

15 Comments

  • Anonymous

    Hi, i am 52 and have been going through menapause for about 2 years now. however, i have started to suffer from what i think are allergies, my face is extremely itchy, my eyebrows, eyelids, and i have scaly itchy patches. also, i have started to break out in something like prickly heat, on my body. can this be down to the menapause?

    • admin

      Thank you for your question. There is a good chance this is a condition known as histamine intolerance, which can often be linked to hormonal changes associated with menopause. Dietary changes and appropriate use of HRT can be beneficial

  • Lynn

    Hi i recently had bllod test taken to see if i was in menapause but they came back clear. i Went to the doctores because i was suffering quite severely with memory loss and they said menapause woudnt cause memory loss to that extream so they sent me to a memory clinic who also said menapause woudnt cause memory loss this bad and i scored very low in all their test so they sent me for a brain scan to check for alzheimers and a brain tuma and they came back clear so they then said it must be meapause sent me back to the GP to tested for that and they came back clear so now i feel i dont know what to do. i would say my symptoms are memory loss struggle to stat a sleep at night and get sweaty at night in bed i have gaind about 3 stone in the last year i am very angry and emotional and very lethargic. I feel so lost and confused i dont know what to do from this point.

    • admin

      Many thanks for your post. From your description, it does sound very much like you are experiencing symptoms of perimenopause. Blood tests are notoriously unreliable during this phase, and can often come back normal. This sadly often results in women, like yourself, being told that their symptoms are not related to the menopause. You may find this article helpful:

      https://patient.info/news-and-features/can-blood-tests-help-to-manage-menopause-and-hrt

      Generally, I would suggest you consider a trial of HRT to see if this will help.

      I would make another appointment at your GP surgery, and ask if you can see a doctor in the practice who has an interest in menopause. A 3-6 month trial of HRT would confirm whether these issues are menopause related, as they will likely improve significantly with the HRT if they are!

  • Claire

    I am 45 and have had a mirena coil fitted for for the last 8 years with no periods. I recently had a small bit of bleeding and contacted my gp who told me my coil is out of date and I have probably gone through the menopause unknowingly , Is this correct, how do I check this?

    • admin

      Thank you for your question. It can be difficult to know where you are in the menopause transition when you are using hormonal contraceptives that affect your bleeding pattern. It is very common to stop having periods with the Mirena coil, which does not necessarily mean you have gone through the menopause. Any new bleeding after a number of years of no bleeding should be investigated, although this can be due to the coil being beyond its normal duration of use.

      If you wish to know whether you have gone through menopause when you have a Mirena, you can have a blood test to check FSH (follicle stimulating hormone). I would normally check this twice, 6 weeks apart. If both blood tests come back with an elevated level, this suggests you have gone through the menopause.

  • Michelle

    I’m 53 and have not had a period for 18 months. My doctor wants me to have an FSH blood test to confirm menopause. I have explained that I am experiencing all the symptoms of menopause, hot flashes, anxiety, lack of motivation, fatigue, brain fog, and low mood/mood swings. Is this normal to still request I have an FSH blood test before discussing possible HRT?

    • admin

      Many thanks for your question. At the age of 53, with no periods for over a year and with the symptoms you describe, there is definitely no need to check an FSH blood test. It is unnecessary. Menopause can be clinically diagnosed based on your symptoms. An FSH blood test is not required before discussing HRT. I would suggest going back to speak to your GP, or ask to speak to another GP in the practice who has an interest in menopause. I hope that is of some help.

  • Clare

    I’ve just had a test and my results were in the normal range of 8. My GP has told me in not perimenousal. However I’ve got so many symptoms of ensure in like walking cliche. Feeling lost now and no idea what to do now as I feel awful

    • admin

      Sorry to hear you are struggling. Blood tests taken in perimenopause can often come back as ‘normal’ – but this DOES NOT mean you are not perimenopausal. The hormones fluctuate significantly from day to day, so the results are almost impossible to interpret (this is why they are generally not recommended). Generally, the diagnosis of perimenopause is made on symptoms rather than blood tests. If you feel you have symptoms of perimenopause then I would recommend asking to see a doctor in your practice who has an interest in menopause to help you. If you are still struggling, I do run a private menopause and perimenopause clinic where you can seek help:

      https://cambridgewomenshealth.co.uk/menopause-and-perimenopause-clinic/

  • Gillian

    I had to have an internal scan I was 41 and in peri a scan showed everything was shrinking so a scan is best to decide if menopausal or peri as bloods not accurate my bloods showed things were normal but symptoms were horrendous

    • admin

      It is true that you can be having horrendous symptoms and your bloods tests may still be normal. At 41 a scan is a sensible idea if there are lots of bleeding or pelvic pain symptoms, in order to exclude any physical problems, but I wouldn’t recommend it to diagnose menopause or the perimenopause.

  • Helen

    Hi I recently got FSH came back normal my gp done estrogen test it came back extremely low he also done thyroid and CA125 bloods b4 he decided to put me on HRT

    • admin

      If there is no clinical indication, there is no evidence to support the testing of thyroid function or Ca125 in women with menopausal symptoms who are over 45 – it can just lead to unnecessary further tests when the results come back inconclusive!!

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