Menopause Blood Tests: FSH, Oestradiol & Hormone Levels

What Is Menopause?

Menopause is defined as the permanent cessation of menstruation, confirmed retrospectively after 12 consecutive months without a period. The average age of menopause in the UK is 51, but it can occur naturally between 45 and 55. Premature menopause (before age 40) affects approximately 1% of women and is also known as premature ovarian insufficiency (POI).

The years leading up to menopause are called perimenopause, during which hormone levels fluctuate unpredictably. Symptoms can include hot flushes, night sweats, mood changes, brain fog, joint aches, vaginal dryness, and irregular periods. These symptoms are caused by declining oestrogen levels as the ovaries gradually reduce their hormone production.

When Are Blood Tests Needed?

According to NICE guideline NG23 (Menopause: diagnosis and management), blood tests are not routinely neededto diagnose menopause in women over 45 who have typical symptoms. The diagnosis is clinical — made on the basis of symptoms and menstrual history.

However, blood tests are recommended in the following situations:

• Women under 40 — To investigate possible premature ovarian insufficiency (POI). An FSH test should be taken on two separate occasions, 4 to 6 weeks apart.
• Women aged 40 to 45 — If they have menopausal symptoms, irregular periods, or if the diagnosis is uncertain.
• Women taking hormonal contraception — The pill, patch, or hormonal coil can mask menopausal symptoms and make clinical diagnosis difficult.
• Women who have had a hysterectomy — Without periods to track, blood tests may be the only way to confirm hormonal status.

FSH (Follicle-Stimulating Hormone)

FSH is the primary blood test used to assess menopausal status. As ovarian function declines, the pituitary gland produces more FSH in an attempt to stimulate the ovaries. This means FSH levels rise as menopause approaches.

• Pre-menopausal — FSH typically 3.5 to 12.5 IU/L (early follicular phase).
• Perimenopausal — FSH can fluctuate widely, sometimes above 25 IU/L.
• Post-menopausal — FSH consistently above 30 IU/L (often much higher, 40 to 100+ IU/L).

During perimenopause, FSH can swing between normal and elevated levels from one month to the next. A single raised FSH does not confirm menopause — this is why NICE recommends two tests 4 to 6 weeks apart for women under 40.

Oestradiol (Estradiol / E2)

Oestradiol is the primary form of oestrogen produced by the ovaries. During perimenopause, oestradiol levels fluctuate unpredictably, which is why symptoms can come and go. In established menopause, oestradiol falls to low levels (typically below 100 pmol/L).

Oestradiol testing is not routinely used to diagnose menopause because of its variability. However, it can be useful for monitoring HRT, particularly for women using transdermal (patch or gel) oestrogen, where a target level of 250 to 500 pmol/L is sometimes cited.

LH (Luteinising Hormone)

LH, like FSH, rises during menopause as the pituitary responds to declining ovarian hormones. LH is not routinely tested for menopause diagnosis as FSH is more clinically useful, but it is sometimes included in a comprehensive hormone panel.

Other Tests to Consider

Many symptoms attributed to menopause — fatigue, low mood, weight gain, brain fog, and joint pain — can also be caused by other conditions. Your GP may request additional tests to rule out:

• Thyroid function (TSH, Free T4) — Hypothyroidism shares many symptoms with menopause. See our guide on thyroid blood tests.
• Full blood count — To check for anaemia.
• Vitamin D — Deficiency is common and causes fatigue and aches. See our vitamin D guide.
• Iron studies and ferritin — Low iron can cause fatigue even when haemoglobin is normal.
• HbA1c — To screen for type 2 diabetes, which becomes more common around menopause.

HRT Monitoring

If you are taking hormone replacement therapy (HRT), blood tests are not always required but can be helpful in certain situations. Your GP or menopause specialist may check:

• Oestradiol levels — to ensure adequate absorption, particularly with transdermal preparations.
• FSH — to assess whether oestrogen replacement has adequately suppressed pituitary drive.
• Liver function — before starting oral HRT, as it is metabolised by the liver.
• Lipid profile — as HRT can influence cholesterol levels.

Getting Tested at Home

Whether you are investigating perimenopausal symptoms, confirming your menopausal status, or monitoring HRT, a home blood test through Lola Dispatch makes the process straightforward. A qualified, DBS-checked phlebotomist will visit your home at a convenient time, take the necessary blood samples, and send them to an accredited laboratory.

This is particularly convenient for women who want a comprehensive menopause and wellness panel without waiting for a GP appointment. Book a home blood test and get your results within 24 to 48 hours.