Is there a menopause test? What FSH and AMH show

Is there a menopause test? In short: no single test

Perimenopause is the transition before your last period. These are the years when hormones rise and fall unevenly and periods become irregular. There is no single blood test, urine test or scan that can definitively show you are in this phase. The NHS says it plainly: there is no routine test for perimenopause or menopause; a doctor will usually assess you based on your age and your symptoms (NHS, What are menopause and perimenopause).

This doesn’t mean “no tests are ever done.” In some situations a hormone test is ordered. In others, tests are needed to rule out other conditions. Below you’ll find what each test shows, why a single result can’t be trusted, and when testing is genuinely useful.

What does a menopause blood test look at?

These are the three hormones most often discussed when the question of menopause comes up:

• FSH (follicle-stimulating hormone): Released by the pituitary gland in the brain, it stimulates the ovaries. As the ovaries respond less, FSH tends to rise.
• Estradiol: The main type of estrogen made by the ovaries. During the transition it can be low in one measurement and normal in the next.
• AMH (anti-Müllerian hormone): Released by the small follicles (egg sacs) in the ovary. It gives an idea of your remaining egg reserve and is mostly used in fertility assessments.

In the international staging system called STRAW+10, these hormones appear only as “supportive” criteria. The main criterion that defines the stages is your bleeding pattern. The working group stresses that supportive criteria should be used only when needed and are not required for a diagnosis. Because methods for measuring AMH are not standardized, no numerical cut-off was given for it either (Harlow et al., 2012).

Why can’t a single test confirm perimenopause?

In perimenopause, hormones don’t fall in a straight line; they fluctuate. FSH that is high one month may be back to normal the next. The NICE guideline (the UK’s National Institute for Health and Care Excellence) notes that in the years leading up to menopause FSH can change markedly even over short periods, so blood levels don’t add useful information to the clinical assessment (NICE NG23). The Menopause Charity in the UK also writes that hormone levels can change from hour to hour, which is why hormone testing is often unnecessary.

Medication matters too. If you use a combined birth control method containing estrogen and progestogen, or high-dose progestogen, your FSH result will not be reliable. In that case NICE advises against assessing menopause with FSH (NICE NG23).

The bottom line: a one-off “normal” result does not mean you are not in perimenopause. And a one-off “high” value doesn’t prove you have reached menopause.

How is menopause assessed over 45?

According to NICE NG23, women over 45 who are otherwise healthy and have menopausal symptoms do not need laboratory tests:

• Perimenopause is considered if you have vasomotor symptoms (heat-related symptoms linked to blood vessels widening), such as hot flashes (hot flushes) and night sweats, plus irregular periods.
• Menopause is considered in a woman who isn’t using hormonal contraception and hasn’t had a period for at least 12 months.
• In people who have had their uterus removed, the assessment is based on symptoms.

The same guideline says the following tests should not be used to assess menopause in this age group: AMH, inhibin A and B, estradiol, antral follicle count (counting the small follicles in the ovary by ultrasound) and ovarian volume measurement (NICE NG23). So if you are 47, your periods have become less frequent and you wake up sweating at night, your clinician can assess you by listening to you. They don’t have to wait for a lab result.

NICE also points out that menopause can be harder to recognize in women using a hormonal treatment, for example medication for heavy menstrual bleeding (NICE NG23). If that applies to you, be sure to tell your clinician.

When is a menopause test ordered?

NICE recommends considering an FSH test in only two situations (NICE NG23):

• Between 40 and 45: if you have menopausal symptoms, including a change in your menstrual cycle.
• Under 40: if menopause is suspected.

The under-40 situation deserves special attention. Here the question is premature ovarian insufficiency, meaning the ovaries largely stop working before age 40. NICE recommends that this should not be assessed on the basis of a single blood test. Along with symptoms, raised FSH is looked for in two blood samples taken 4–6 weeks apart. The same guideline also says AMH should not be used routinely for this purpose (NICE NG23).

The Menopause Society recommends that women younger than 40 who have missed three or more periods see a healthcare professional (The Menopause Society, Premature Menopause). We cover this separately on the early menopause page.

What other tests might be ordered?

Even if a hormone test isn’t needed, your clinician may order tests to rule out other causes. Fatigue, palpitations, weight changes and irregular periods are not unique to menopause. The Menopause Charity notes that a doctor may order a blood test to rule out, for example, an underactive thyroid gland, and may check your blood pressure.

If there’s a chance you could be pregnant, a pregnancy test may also come up. In perimenopause ovulation becomes less frequent, but it hasn’t stopped completely.

You have the right to ask which test is being ordered and why. Asking “What is this test meant to rule out?” helps you interpret the result correctly.

Are home menopause tests reliable?

The urine FSH tests sold in pharmacies face the same limitation: they reflect only that day’s hormone level. Because FSH fluctuates in this phase (NICE NG23), a single positive or negative result cannot, on its own, tell you whether you are in perimenopause. The result needs to be considered alongside your age, your bleeding pattern and your symptoms. The best way to do that is with your clinician.

Can an ultrasound show perimenopause?

A gynecological ultrasound gives information about the uterus and ovaries. It may be ordered to look for other causes, such as a cyst, fibroid or polyp. But over 45, an antral follicle count and ovarian volume measurement by ultrasound are not recommended for assessing perimenopause or menopause (NICE NG23). So neither a “clear” ultrasound nor ovaries that look small can tell you, on their own, which stage you are in. If an ultrasound has been ordered, asking what it is meant to look for will help you understand the result.

What can you observe yourself?

Since the assessment rests on your bleeding pattern and symptoms, the most valuable data is in your hands. STRAW+10 staging highlights two signs in the bleeding pattern. In the early transition, a difference of 7 days or more between the lengths of consecutive cycles becomes persistent. In the late transition, gaps of 60 days or longer without a period begin (Harlow et al., 2012). The only way to notice these is to write the dates down.

Things worth noting:

• The start and end date of each period, and how heavy the bleeding is.
• How often and how intensely you get hot flashes and night sweats.
• Changes such as sleep, mood and forgetfulness.
• Any medications you take, and any hormonal methods.

This record shows the picture your clinician can’t see in a single blood test. We explain how to prepare for the appointment on the before you see your doctor page.