Testing for menopause: How does it work?

Healthcare providers can often determine if you're in perimenopause or menopause based on your age, symptoms you describe and whether you have regular menstrual periods. However, checking hormone levels may help to confirm a diagnosis or rule out other potential causes of irregular periods or bothersome symptoms. There are a few menopause and perimenopause test options that a healthcare professional may order in some cases.

To test for menopause, healthcare providers may order blood work. Certain hormone levels can be measured in a blood test to reveal any changes due to menopause transition. There are four blood tests medical providers may order: follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH) and thyroid-stimulating hormone (TSH).

Follicle-stimulating hormone (FSH)

The pituitary gland releases FSH to regulate the menstrual cycle and encourage the growth and maturation of eggs in the ovaries. FSH levels in menopause are higher than in people who are still ovulating. For those who still menstruate, normal levels range from 4.7 to 21.5 mIU/mL (4.7 to 21.5 IU/L). After menopause, levels rise to 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L).

Estradiol (E2)

The hormone E2 is a type of estrogen. During puberty, E2 helps the uterus, fallopian tubes, breasts and vagina grow and develop. In pre-menopausal females, levels of E2 increase to an average range of 30 to 400 pg/mL (110 to 1468.4 pmol/L). Estradiol levels in menopause fall sharply and are usually 30 pg/mL  (110 pmol/L) or less.

Luteinizing hormone (LH)

The pituitary gland is responsible for manufacturing LH. With an increase of levels mid-menstrual cycle, this hormone triggers the release of an egg from the ovaries and remains elevated until the end of the cycle. In addition, LH stimulates the production of the hormone progesterone, which the body needs to support pregnancy.

If conception doesn't occur, LH levels fall and the menstrual cycle repeats. During weeks one and two of the menstrual cycle, LH levels are normally between 1.37 to 9 IU/L. At the time of ovulation, levels are usually around 6.17 to 17.2 IU/L, and they hover at 1.09 to 9.2 IU/L during the last two weeks.

After menopause, levels of LH rise dramatically. The average range is 19.3 to 100.6 IU/L.

Thyroid-stimulating hormone (TSH)

Thyroid hormones (T3 and T4) are produced by the thyroid gland and help regulate your body temperature, weight, muscle function, mood and many other processes and functions in the body. TSH is the hormone secreted by the pituitary gland that regulates thyroid function and is a useful blood test to assess thyroid function.

Hypothyroidism is a condition where your body doesn’t produce enough thyroid hormones and can cause symptoms similar to perimenopause, like weight gain, mood changes and menstrual irregularities. Your healthcare provider may order a TSH test and other thyroid lab tests to determine if your perimenopausal symptoms are due to thyroid dysfunction.

It’s not always necessary to test for menopause or perimenopause. Many people will go through the stages of menopause without ever undergoing tests. However, your healthcare provider may order a test if you're experiencing symptoms early or if you have unexplained symptoms. 

If you're curious or concerned about your symptoms, you can purchase home menopause test kits. These tests usually require you to urinate on a testing strip or dip a testing strip into a urine sample. They typically measure FSH levels. Since you may experience fluctuations in FSH levels in perimenopause due to your menstrual cycle, these tests aren't always a reliable indicator. Full hormonal blood work ordered by your healthcare provider may provide a more accurate picture of your clinical situation. However, blood work to check hormones is not routinely needed.

If you're concerned about symptoms of menopause or perimenopause, talk to your healthcare provider. They can help you decide if hormonal testing would be beneficial. They can also discuss treatment options, lifestyle changes and other interventions to alleviate hot flashes, night sweats, vaginal dryness and other signs of menopause that interfere with your daily life. Over-the-counter menopause products may also be helpful.

Published January 2023.