In short
- After 45, menopause is diagnosed clinically — by symptoms and the pattern of your cycles, not by a blood test (NICE NG23).
- FSH makes sense between 40 and 45 with unclear symptoms, and under 40 when premature ovarian insufficiency is suspected.
- AMH is not a test for menopause. It estimates ovarian reserve when planning pregnancy and does not tell you when menopause will come.
- In the transition, a panel of “mimics” tells you more: thyroid, iron with CRP, complete blood count, sugar, lipids, vitamin D. The symptoms overlap heavily.
- After menopause the risk changes: heart risk levels with men (ApoB, Lp(a) once), bones lose density (calcium with albumin, ALP, vitamin D).
- Hormonal contraception invalidates hormone results — a measurement is meaningful only 3 months after stopping.
The market offers hormone panels as the answer to perimenopause. The guidelines say otherwise. After 45, hormones do not make the diagnosis. During the transition they swing so much that the same week can show “normal” and “postmenopausal”. That does not mean a blood test has no value. It only means it has to measure the right things.
Why a hormone test after 45 does not tell you whether you are in menopause
In perimenopause the ovaries work in bursts. FSH jumps one week and falls back the next. Estradiol can climb higher than in the reproductive years and then drop sharply. So one measurement only tells you what was happening that day.
The British NICE guideline (NG23) is explicit about this. In women over 45 with typical symptoms, FSH is not needed. AMH, estradiol and inhibin are not used to diagnose menopause at any age. The diagnosis is clinical: irregular cycles, no period for 12 months, hot flushes, insomnia.
What this means in practice. If someone sells you a “menopause hormone panel” at 49, they are selling a test that, by the guidelines, changes no decision. The money is better spent on a panel that rules out other causes of the symptoms.
When hormones still make sense
| Situation | What to measure | Why |
|---|---|---|
| Under 40, missed cycles | FSH (twice, 4–6 weeks apart), estradiol, prolactin, TSH | Suspected premature ovarian insufficiency — a diagnosis that changes management. |
| 40–45, unclear symptoms | FSH on day 2–5 of the cycle, TSH, ferritin with CRP | Guidelines allow FSH as a help, but not as proof. |
| Over 45, typical symptoms | Hormones are not needed | The diagnosis is clinical; hormones do not change the decision. |
| Planning pregnancy | AMH, FSH, estradiol, prolactin, TSH | Assessment of ovarian reserve — but AMH does not predict conception in a given cycle. |
| On hormonal contraception | Hormones are useless | External hormones suppress the axis; a measurement is meaningful 3 months after stopping. |
What most often mimics perimenopause symptoms
Tiredness, insomnia, mood swings, weight gain and hair loss have several possible causes at this stage of life. Before you blame hormones, it makes sense to rule out:
- Thyroid (TSH, and if abnormal fT4 and anti-TPO). Autoimmune thyroid disease in women often appears in exactly this period.
- Iron deficiency (ferritin with CRP, complete blood count). Periods are often heavier in perimenopause, and stores quietly empty.
- Sugar (glucose, HbA1c). Energy swings after meals are easily blamed on hormones.
- Vitamin D and B12. Common, correctable causes of tiredness and poorer concentration.
- Sleep and stress load. Insomnia is often the result of hot flushes — but also of sleep apnoea, which a blood test cannot see.
Already have a report with these values? Upload it to Blood Lab 360 and get every value explained.
What changes after menopause
| Area | What changes | What to monitor |
|---|---|---|
| Heart & vessels | The protective effect of oestrogen fades; risk approaches that of men. | Lipid panel with ApoB, Lp(a) once in a lifetime, blood pressure. |
| Bones | Loss of bone density speeds up after menopause. | Calcium with albumin, ALP, phosphate, vitamin D; bone density scan (DXA) at your doctor's discretion. |
| Metabolism | Insulin resistance and weight gain around the waist become more common. | Glucose, HbA1c, triglycerides. |
| Iron | After periods stop, iron use falls. | Iron deficiency after menopause is not “normal” — it needs an explanation (BSG 2021). |
When and how to measure, if you decide on hormones
- FSH, LH and estradiol on day 2–5 of the cycle, if you still have one. If not, any time, with the date of your last period noted.
- Progesterone about 7 days before the expected period — that is a second blood draw, not the same one.
- AMH any time; on contraception it is about a third lower.
- Do not stop contraception for a test. Stop it only if you decide to for other reasons.
Stages of the transition: where you are
The transition is not a switch but a sequence of stages. Specialists describe them with the STRAW+10 system. Each stage has its own features, and testing is useful in a different way at each.
| Stage | How it shows | Does testing add anything |
|---|---|---|
| Late reproductive years | Cycles are still regular but shorter; conceiving is harder. | AMH only when planning pregnancy. |
| Early perimenopause | Cycle length varies by seven days or more. | Little. FSH swings with the cycle and proves nothing. |
| Late perimenopause | Two or more missed cycles in a row; hot flushes are at their strongest. | Little. It makes sense to rule out thyroid and iron. |
| Menopause | Twelve months without a period. | The diagnosis is made with a calendar, not a test. |
| After menopause | Symptoms settle, but heart and bone risks grow. | Yes — but different tests: lipids with ApoB, sugar, bone minerals. |
The average age at menopause in Europe is about 51, and the transition lasts four years on average. Menopause before 40 is not part of the usual course and needs medical assessment.
How hormone treatment changes your results
If you take hormone replacement therapy or contraception, some values change because of the therapy and not because of your body. This is a common source of wrong conclusions.
| Value | What happens | How to read it |
|---|---|---|
| SHBG | Oral oestrogen raises it markedly. | Calculated free testosterone is therefore falsely low. |
| Triglycerides | Oral oestrogen raises them; a skin patch much less. | A rise is not necessarily a metabolic worsening. |
| FSH and estradiol | The external hormone suppresses your own axis. | The measurement does not reflect ovarian function. |
| Thyroid hormones | Oestrogen raises the binding protein. | TSH remains reliable; on levothyroxine treatment a higher dose is often needed. |
| Ferritin | After periods stop, it rises over time. | Low ferritin after menopause needs an explanation, not a supplement. |
So with every report, tell the app whether you take hormone therapy or contraception — the explanation adjusts to it.
Frequently asked questions
Can a blood test tell me whether I am in menopause?
After 45, no. The diagnosis is clinical — by symptoms and the pattern of your cycles. Hormones swing so much during the transition that one measurement proves nothing (NICE NG23).
What about AMH — does it predict menopause?
No. AMH estimates ovarian reserve when planning pregnancy. It is not used to predict the timing of menopause or to diagnose it.
I am 43 with unclear symptoms. What makes sense?
FSH on day 2–5 of the cycle can help. But definitely check thyroid, iron with CRP and sugar. These often explain the symptoms better than hormones.
I am on hormonal contraception. Can I measure hormones?
The results will not be meaningful, because external hormones suppress your own axis. Thyroid, iron, vitamins and metabolic markers do make sense, though.
How long does perimenopause last?
About four years on average; for some only a few months, for others ten years. Menopause is official only after twelve months without a period.
I take hormone therapy. Are my results readable at all?
Yes, but the therapy changes some values. SHBG and triglycerides are higher on oral oestrogen. FSH and estradiol do not reflect ovarian function. So always state your therapy with the report.
What should I monitor after menopause?
Lipids with ApoB (and Lp(a) once), sugar, bone minerals with vitamin D and thyroid. After menopause, heart risk is comparable to that of men.
Sources: NICE NG23 (Menopause: diagnosis and management) — the diagnosis is clinical, no FSH over 45, AMH never · ESHRE — premature ovarian insufficiency · ESC/EAS 2019 and EAS 2022 — heart risk after menopause, ApoB and Lp(a) · IOF/ESCEO 2019 — bone management · BSG 2021 — iron deficiency after menopause · Endocrine Society 2014 — androgens in women.
