Hormone tests in menopause: which ones matter and which do not
The commonest question before an appointment is “which hormones should I test”. The surprising answer is: usually none. At the typical age, menopause is diagnosed from the calendar, not from a result. Here is when tests do matter, which ones, and how not to read more into a single number than it can bear.
When no test is needed at all
Menopause is a diagnosis made in hindsight: twelve consecutive months without a period at around fifty. If the age is typical and there is no other explanation, that is enough. A blood test adds nothing.
The same goes for perimenopause — the years before the last period, when cycles become irregular and hot flushes start. Here tests can actively mislead: FSH and estradiol swing so widely from week to week that a single value can show almost anything. A woman with obvious flushes is handed a “normal FSH” and told everything is fine — when fine has nothing to do with it.
The practical consequence: treatment is decided from symptoms, not from numbers. Hot flushes, night sweats, insomnia, dryness — those are what is treated, and what tells you afterwards whether treatment worked.
When tests do matter
- Under 40. Here it is the other way round: confirmation is essential. This is premature ovarian insufficiency, and it is not “an early menopause, never mind” — it is a condition that needs treating for the sake of bones and blood vessels.
- Between 40 and 45 with periods that have stopped — also confirmed with tests.
- The uterus has been removed and the ovaries left: there are no periods to count, and a blood test is the only way to tell whether the ovaries are still working.
- An intrauterine system or hormonal contraception: periods may be absent because of them, and the calendar says nothing.
- An atypical picture — flushes with no change in the cycle, or an irregular cycle alone at 45. Then the search is for other causes rather than confirmation of menopause.
What each result actually tells you
| Test | What it shows | When to take it |
|---|---|---|
| FSH | the main marker: when the ovaries stop responding, the pituitary raises FSH. Persistently high FSH with low estradiol means the supply is exhausted | days 2–5 of the cycle if periods still occur; if premature insufficiency is suspected, twice at least 4 weeks apart |
| Estradiol | read only alongside FSH: low estradiol with high FSH is the picture of menopause; on its own neither means anything | together with FSH |
| AMH | the remaining supply of eggs. The best marker of reserve, but a poor one for diagnosing menopause: at around fifty it is near zero anyway | any day of the cycle |
| TSH | the thyroid. Untreated hypothyroidism produces exactly the same complaints — fatigue, weight gain, mood swings, cycle disturbance | any day |
| Prolactin | checked as a matter of course when periods stop before 40: raised prolactin is a common and entirely treatable cause | morning, fasting, no exertion the day before |
A word specifically about TSH: it is the one test worth doing in almost everyone. Thyroid disease is common in women over forty and imitates menopause so convincingly that the wrong thing gets treated for years.
What is checked besides hormones
Menopause changes more than how you feel. An appointment at this age usually covers things that have nothing to do with hormones:
- cholesterol and glucose — cardiovascular risk rises noticeably after menopause;
- vitamin D and calcium — for the bones;
- bone densitometry — where indicated, or after 65;
- cervical cytology and mammography — on the usual schedule, which menopause does not cancel;
- a pelvic scan — endometrial thickness matters after menopause, especially with any bleeding.
How to prepare and what to bring
Hormone samples are taken in the morning, fasting. If periods still occur, on days 2 to 5 of the cycle; if they do not, on any day — but where premature insufficiency is suspected the test is repeated a month later, so that no conclusion rests on one chance value.
Worth bringing to the appointment: the dates of your last periods over at least six months, a list of medicines and supplements, and previous results and scan reports. If you use hormonal contraception or have an intrauterine system, please say so — it changes both the interpretation of the tests and whether they are worth doing.
A private appointment needs no referral and no NFZ insurance. Results in Ukrainian or Russian are not a problem.
Short answers
Do I need hormone tests to confirm menopause?
At the typical age, no. Menopause is diagnosed from the fact: twelve consecutive months without a period at around fifty. Tests are needed if periods stopped before 45, if the uterus has been removed, if you use hormonal contraception, or if the picture is atypical.
What FSH level indicates menopause?
Persistently high FSH with low estradiol. Where premature ovarian insufficiency is suspected the test is repeated twice at least four weeks apart — in perimenopause the values swing from week to week, and no conclusion is drawn from a single number.
Which day of the cycle should FSH and estradiol be tested?
Days 2 to 5 of the cycle if periods still occur. AMH and TSH can be taken on any day. Blood is drawn in the morning, fasting.
Will AMH tell me when menopause will come?
No. AMH shows the remaining supply of eggs and is useful when planning a pregnancy, but it cannot predict the date of menopause. At around fifty it is close to zero anyway.
Why is the thyroid checked when menopause is suspected?
Because untreated hypothyroidism causes the same complaints: fatigue, weight gain, mood swings, cycle disturbance. It is a common and entirely treatable cause that can otherwise be mistaken for menopause for years.
This text describes the general picture and does not replace a consultation. Timings and indications differ from woman to woman and are decided at the appointment, from your history and test results.
