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!

4 Comments

  • 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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