Menopause: which hormones can you have tested?

What happens to your hormones during the menopause

The menopause is not a moment but a period. Your ovaries respond less well to the instructions coming from the pituitary gland, so fewer ovulations take place and oestrogen production becomes irregular.

The pituitary tries to compensate and raises its signal. That is why FSH moves upwards during this phase, while oestradiol swings back and forth: high one month, low the next.

Those swings explain why the symptoms are so erratic. Your hormones do not simply fade away gradually, they first become unpredictable. The menopause itself is by definition a look back: it is your final period, and you only know that once twelve months have passed.

The years before that are called the perimenopause. That period can last several years and starts for many women between the ages of forty-five and fifty, sometimes earlier.

Symptoms that can belong to the menopause

The symptoms vary widely. Commonly mentioned are:

• hot flushes and night sweats
• a cycle that becomes shorter, longer, heavier or lighter
• difficulty staying asleep and little energy during the day
• mood swings, irritability or low mood
• trouble concentrating or losing your words
• vaginal dryness and pain during sex
• joint complaints and a changing fat distribution

Some women barely notice anything, others lie awake for years. Both pictures fit the same life stage, and the severity of your symptoms says nothing about how far along you are.

What a blood test can and cannot say

This is the honest answer: in practice the menopause is established from your age, your symptoms and the pattern of your cycle. Not from a blood result.

A hormone measurement is a snapshot of something that is moving back and forth. A result that looks very different two weeks later is the rule rather than the exception during the perimenopause.

That does not make testing pointless. It is mainly valuable where there is doubt: with symptoms below the age of forty, with a cycle that stops without a clear reason, or when your symptoms could just as easily have another cause.

Which hormones are measured

A female hormone profile usually contains these tests:

• FSH: the hormone the pituitary uses to drive your ovaries. Moves upwards during the menopause.
• Oestradiol: the main oestrogen. Fluctuates strongly during the perimenopause and falls afterwards.
• LH: drives ovulation together with FSH and helps complete the picture.
• Progesterone: the hormone of the second half of the cycle, which disappears once ovulation stops.
• Prolactin: belongs here because a raised level can be another explanation for absent periods.
• TSH: the thyroid causes symptoms that closely resemble the menopause and therefore belongs in the same list.

AMH, which says something about your egg reserve, is mainly used for fertility questions. For the question of whether you are in the menopause, it adds little.

Timing: when should you have blood drawn?

If you still menstruate, even irregularly, the early half of the cycle is the usual moment: day three to five, counted from the first day of your period. That makes results easier to compare over time.

If you want to know whether ovulation still takes place, progesterone makes more sense about a week before your expected period. If your periods stopped long ago, the moment no longer matters.

Preferably have blood drawn in the morning and always mention whether you use hormonal contraception. The pill, a hormonal coil or a patch drive these values, so you are mainly measuring the effect of the medication rather than your own cycle.

Symptoms that resemble the menopause but are not

This is the strongest reason to have blood drawn after all. A number of conditions produce almost the same pattern of symptoms and are readily measurable:

• an underactive or overactive thyroid: fatigue, palpitations, sweating and mood complaints
• anaemia or low iron stores, certainly with heavy periods during the perimenopause
• a deficiency of vitamin B12 or vitamin D
• a raised blood sugar, which can cause thirst, fatigue and night-time urination
• prolonged overload, sleep apnoea or depression

If such a cause is found, something can be done about it. If nothing is found, you know that too, and it makes the conversation about your menopausal symptoms with your GP a good deal more focused.

After the menopause the focus shifts

Once the menopause is behind you, the question changes. The loss of oestrogen is associated with a less favourable cholesterol profile and with bone loss in the longer term.

Valuable tests in this phase are therefore more likely to be:

• a full cholesterol profile, possibly with ApoB alongside it
• glucose and HbA1c for your sugar metabolism
• vitamin D and calcium in relation to your bones
• thyroid function, because abnormalities become more common with age

This is not a gloomy story, but a shift in the question. During the perimenopause you want to know where your symptoms come from. Afterwards you want to know how you stand for the years ahead.

When to contact your GP

See your GP if your periods are heavy enough to make you anaemic, if you bleed between periods, or if your symptoms clearly get in the way of daily life. Hormone therapy requires a conversation with a doctor; a blood result does not replace that.

If your periods stop before the age of forty, always report that to your GP. Different considerations apply there, including for your bones and your heart in the long term.