The perimenopause is a complex transition, and there is not a single menopause blood test that provides an accurate diagnosis. The hormonal patterns during perimenopause are very dynamic, making it difficult to establish what hormone levels to expect and when.[13]

According to the NICE guidelines, perimenopause can be diagnosed in women over 45 if they have irregular periods and menopausal symptoms.[11]

For the rest of women (under 45 years or without typical symptoms), FSH levels may be useful for determining if you are perimenopausal,[1] but you should still contact your GP to rule out other conditions that may alter the levels of this hormone.
 

[1] Nelson HD. Menopause. Lancet. 2008;371(9614):760-770. doi:10.1016/S0140-6736(08)60346-3. Available from: https://doi.org/10.1016/s0140-6736(08)60346-3

[2] Takahashi TA, Johnson KM. Menopause. Med Clin North Am. 2015;99(3):521-534. doi:10.1016/j.mcna.2015.01.006. Available from: https://pubmed.ncbi.nlm.nih.gov/25841598/

[3] Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015;57(Suppl 2):S222-S232. doi:10.4103/0019-5545.161483. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539866/

[4] Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14(4):199-215. doi:10.1038/nrendo.2017.180. Available from: https://pubmed.ncbi.nlm.nih.gov/29393299/

[5] National Health Service (NHS UK). Hormone Replacement Therapy (HRT). Accessed 2 August 2021. Available from: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/

[6] Bruce D, Rymer J. Symptoms of the menopause. Best Pract Res Clin Obstet Gynaecol. 2009;23(1):25-32. doi:10.1016/j.bpobgyn.2008.10.002. Available from: https://pubmed.ncbi.nlm.nih.gov/19056320/

[7] El Khoudary SR, Greendale G, Crawford SL, et al. The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN). Menopause. 2019;26(10):1213-1227. doi:10.1097/GME.0000000000001424. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784846/

[8] Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011;38(3):425-440. doi:10.1016/j.ogc.2011.05.002. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3285482/

[9] NHS. Menopause. Accessed 2 August 2021. Available from: https://www.nhs.uk/conditions/menopause/

[10] NHS. Early menopause. Accessed 3 August 2021. Available from: https://www.nhs.uk/conditions/early-menopause/

[11] National Institute for Health and Care Excellence. Menopause: diagnosis and management [Internet]. [London]: NICE; Nov 2015 [updated 2019 Dec; cited 2021 Aug 3]. (Clinical guideline [NG23]). Available from: https://www.nice.org.uk/guidance/ng23.

[12] NHS. How do I know I've reached menopause if I'm on the pill?. Accessed 4 August 2021. Available from: https://www.nhs.uk/conditions/contraception/menopause-contraceptive-pill/

[13] Hall JE. Endocrinology of the Menopause. Endocrinol Metab Clin North Am. 2015;44(3):485-496. doi:10.1016/j.ecl.2015.05.010. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6983294/

[14] Lab Tests Online UK. LH Test. Accessed 4 August 2021. Available from: https://labtestsonline.org.uk/tests/lh-test

[15] Ruggiero RJ, Likis FE. Estrogen: physiology, pharmacology, and formulations for replacement therapy. J Midwifery Womens Health. 2002;47(3):130-138. doi:10.1016/S1526-9523(02)00233-7. Available from: https://doi.org/10.1016/s1526-9523(02)00233-7

There are many ways to diagnose menopause, as recommended by the National Institute for Health and Care Excellence (NICE).[11] 

Women aged under 45 years

The NICE guidelines recommend that a menopause blood test measuring FSH should be used to diagnose menopause in women aged 40 to 45 years that present typical menopausal symptoms, including irregularities in their cycles. FSH may be employed for diagnosing early menopause in women under 40 years of age.[11]

FSH levels can be correlated to levels of oestrogen and LH to aid in the diagnosis of menopause and other reproductive conditions. It may also be relevant to test for thyroid disease because it may mimic various menopausal symptoms.[3]

Women aged over 45 years

In most situations, your doctor will be able to diagnose menopause based on your symptoms if you are over 45 years old and you have spent at least 12 months without having menstrual bleeding. Similarly, a professional should be able to diagnose menopause in women over 45 without a uterus.[11] Laboratory blood tests (such as FSH, LH, or oestrogens included in a menopause test kit) are not routinely required for these women unless another condition is suspected.

Women using hormonal contraception

If you are receiving hormonal contraceptives (contraceptive pill, patch, implant, among others), you may not have menstruations. This makes it difficult to tell whether or not you have reached the menopause. If you are using a combined pill (oestrogen plus progestogen), you will probably present a monthly bleeding, even after running out of oocytes (menopause). On the other hand, women using a progestogen-only pill may have irregular or absent menstruations. In this instance, the NHS suggests that measuring FSH levels witha menopause test kit may be useful for women over 50, but this is not a reliable indicator.[12] 

The NHS also recommends that women over 50 change from a combined to a progestogen-only pill. When a woman is 55, getting pregnant is very unlikely and it is safe to stop using hormonal contraception. However, it is still necessary to use condoms or other barrier methods to prevent sexually transmitted infections.[12]
 

Symptoms may begin a couple of years before the menopause, turning heavier as a woman approaches her last menstruation. Before and after the menopause, women may experience symptoms associated with hormonal imbalances, such as:[2][6][7]

• Hot flushes.
• Night sweats.
• Irregular menstruations (before menopause).
• Breast tenderness.
• Sleeping problems.
• Mood changes.
• Palpitations.
• Nervousness.
• Headaches.
• Memory loss.
• Depressive symptoms.

As years go by and hormone levels drop definitely, postmenopausal women may develop:[2][6][7]

• Vaginal dryness.
• Vaginal irritation.
• Painful urination.
• Urinary incontinence.
• Frequent urination at night.
• Pain during sexual intercourse.
• Decreased sexual desire.
• Undesired weight gain.
• Depressive symptoms.
   

The Vitall Female Hormones (Menopause) Home Test Kit includes the essential hormones required for helping women and doctors during the assessment of menopausal status.

Follicle-stimulating Hormone (FSH):

This hormone is produced by the pituitary gland, located in the brain. As the name implies, FSH promotes the development of ovarian follicles and works alongside LH during the cycle. In the first half of the reproductive cycle, FSH prompts oestrogen production in the follicles; in the second half (after ovulation), it stimulates progesterone. At the same time, oestrogen and progesterone levels help to regulate FSH. As a woman approaches the menopause, the ovaries reduce oestrogen production and FSH levels increase.[13]

Luteinising hormone (LH):

Just like FSH, LH is produced in the pituitary gland. While LH promotes the production of oestrogen and progesterone, its main mission is to trigger ovulation. Oestrogen levels help to regulate how much LH is produced in the pituitary gland;[14] this means that LH levels may increase during perimenopause,[3] but usually to a lesser extent when compared with FSH.[13]

Oestrogen (E2):

Oestrogen is a group of hormones that help the body to develop female characteristics. The most important and potent oestrogen is oestradiol (also called E2), which is produced in the ovaries of premenopausal women. Oestradiol levels are the ones that decrease during the menopause. Postmenopausal women keep making a less potent oestrogen called oestrone (E1), which is produced in the fatty tissue.[15]

Taking the Vitall menopause home test ensures accurate measurement of these essential biomarkers, giving you a comprehensive overview of your menopausal status.

The menopause is the moment of a woman’s life when menstrual cycles come to an end, which usually occurs after 45 years of age. As a result, natural pregnancy is no longer possible.

This transition constitutes a deeply personal experience: some women may think of it as a liberating moment in their lives, while others find it troublesome and disruptive.

Most women will experience menopause symptoms with varying degrees of intensity; in certain cases, these symptoms may be too burdensome and some women may feel prompted to seek medical advice.[1]

Understanding the Reproductive Cycles

The hallmark of menopause is the depletion of oocytes (immature or unfertilised eggs). During each ovarian cycle, a group of oocytes grows in the form of ovarian follicles. The best oocyte from the group is released during ovulation, and the rest are discarded.

While the ovarian cycle prepares the best oocyte for ovulation, the menstrual cycle prepares the lining of the uterus (endometrium) for receiving and implanting a fertilised egg. These reproductive cycles work continuously under the regulation of oestrogen, progesterone, follicle-stimulating hormone (FSH), and luteinising hormone (LH).[2]

Since there is a fixed number of oocytes, the reproductive cycles stop functioning when the ovaries run out of them. The production of female hormones is reduced, and menopause ensues.

However, this process does not occur drastically, from one day to the other. Rather than that, it is a natural transition that is marked by various phases.[2]

Perimenopause, menopause, and postmenopause

Perimenopause, also known as menopausal transition, marks the beginning of hormonal fluctuation. Female hormone levels begin to decrease, which results in menopausal symptoms and disruption of the menstrual cycle. During this phase, the female body prepares for menopause and is expected to last for 4-8 years in most women.[3]

As women approach menopause, they may spend 60 days or more without menstrual bleeding (missing two menstrual cycles or more), and their symptoms may become more intense.[1]

The menopause represents the last menstrual period and is usually diagnosed after 12 consecutive months without menstrual bleeding if you are over 50 or after 2 years if you are under 50.

This final menstruation is followed by the postmenopause. During this stage, most women will present menopausal symptoms for one or two years; for some women, the symptoms may continue for more than ten years.[3]

Postmenopausal women have a higher risk of developing multiple diseases; the most important examples include osteoporosis, arthritis, sarcopenia, diabetes, and cardiovascular disease.[4]

To reduce the risk of these conditions and alleviate menopausal symptoms, women may receive hormone replacement therapy (HRT). The goal of HRT is to recover the normal hormone levels your body had before menopause. A menopause test kit can be used to establish your current baseline before proceeding with appropriate HRT[5]
 

Under normal circumstances, it may be difficult for anyone to accurately point out the start of her perimenopause without a menopause blood test.

Some premenopausal women may present mild menopause symptoms and some menopausal women may not necessarily show evident signs, making it difficult to trace the beginning of the perimenopause with accuracy. 

Scientific evidence from industrialised countries reflects that the onset of perimenopause frequently occurs around the age of 47 years and most women reach the menopause when they are 50-52 years old.[8]

These findings are consistent with data from the United Kingdom, where women experience the menopause between 45 and 55 years of age, with an average age of 51 years.[9] Some studies have also shown that women are entering the menopause later in life when compared to previous generations.[8]

Various factors influence the onset of perimenopause and menopause. These include race, education, use of oral contraceptives, weight, diet, and genetic factors. The best predictors of early menopause are smoking and low parity (giving birth to few or no children).[8]

While the menopause is a natural and expected process, it should not occur in women younger than 45 years of age. If a menopause test indicates premature ovarian insufficiency or early menopaus, this may be related to a health disorder and should be studied by a professional.

If you experience menopausal symptoms before the usual age, you should contact your GP for medical guidance and assess your hormone levels using a menopause blood test.[10]

You can take a menopause home test if you present menopausal symptoms. The most important signs to look for are those related to irregular cycles, such as having prolonged or absent menstrual cycles without any evident reason.

If you are still menstruating, remember to collect your sample on the third day of your cycle (which would be the third day after beginning your period). Doing so is very important because hormone levels may vary considerably across the menstrual cycle. Taking your menopause home test at the right moment is essential to provide an accurate measurement.