Before you use this guide
This is general information, not a diagnosis or a substitute for care from a clinician who knows your medical history. Seek urgent help for severe or rapidly worsening symptoms.
Menopause is usually identified clinically after 45
NICE recommends identifying perimenopause or menopause without laboratory tests in otherwise healthy people aged 45 or over who have typical symptoms and cycle changes. This is because hormone levels fluctuate and a snapshot may not add useful certainty.
Perimenopause may be identified from newly occurring symptoms such as hot flushes or sweats together with changes in the menstrual cycle. Menopause can usually be identified after 12 months without a period when hormonal contraception is not being used.
When an FSH test may be considered
NICE advises considering serum FSH to confirm menopause in people aged 40 to 45 who have menopause-associated symptoms and a change in their cycle, and in people under 40 when menopause is suspected.
Premature ovarian insufficiency must not be diagnosed from a single blood result. It requires appropriate clinical assessment and confirmation according to guidance.
When testing can mislead
FSH should not be used to identify menopause in people taking combined oestrogen and progestogen contraception or high-dose progestogen. Hormonal treatments can alter both hormone levels and bleeding patterns.
NICE also advises against using tests such as anti-Müllerian hormone, oestradiol, inhibin levels or ovarian imaging to identify menopause in people aged 45 or over. A commercial panel should not be used to override a careful history.
Blood tests may still investigate other causes
Not every symptom in midlife is caused by menopause. Depending on the clinical picture, a clinician may consider tests for thyroid disease, anaemia, diabetes or another condition. The purpose is to investigate a specific alternative—not to prove menopause through a large panel.
Seek medical advice for symptoms that are severe, atypical or affecting daily life, and for unexpected bleeding. Do not delay assessment while waiting for a private hormone result.
Prepare for a useful conversation
- Track cycle changes and symptoms, including their effect on sleep and daily life.
- List contraception, HRT, supplements and other medication.
- Mention relevant medical and family history.
- Ask what decision a proposed test will change.
- Discuss symptom management even when a blood test is not indicated.
Common questions
Questions about this topic.
Usually not if you are otherwise healthy and have typical menopause-associated symptoms. NICE recommends a clinical approach in this group.
Sources and further reading
We use authoritative UK guidance and patient information. External sources may be updated after this guide is published.
