Blood Test To Check For Menopause: Hormone Tests

Is there a blood test to check for menopause? Sort of….

In this article, Dr. Sabrina Sahni, Board Certified Physician and NAMS provider explains what laboratory tests in menopause may look like. 

Blood Test To Check For Menopause: Background

Before we get into menopause testing, let’s understand what happens to your body and hormones during menopause.

What Is Menopause?

Menopause is a natural process in a woman’s life. It marks the end of a woman’s reproductive years, which typically occurs in her late 40s to early 50s. The menopause transition, referred to as perimenopause, is often the most symptomatic time for women and can include a range of symptoms such as hot flashes, night sweats, mood changes, and irregular periods, among others.

In addition to symptoms, menopause can also impact other parts of your health. It can contribute to cardiovascular disease, increase blood pressure, impact insulin resistance, as well as cause mental health issues. 

Hormone Levels During Menopause

Hormone levels in the female body begin to change during menopause.

The primary hormones affected are:

• Estrogen: This is the most significant change during menopause. Estrogen levels decline significantly as the ovaries reduce their production. This decrease in estrogen is responsible for many of the symptoms associated with menopause, such as hot flashes, night sweats, mood swings, and vaginal dryness.
• Progesterone: Levels of progesterone also drop during menopause because this hormone is primarily produced in the ovaries during ovulation, which ceases with menopause.
• Follicle-Stimulating Hormone (FSH): As the ovaries produce less estrogen and progesterone, the levels of FSH increase. This hormone is involved in controlling the menstrual cycle and stimulates the growth of eggs in the ovaries. High levels of FSH are indicative of reduced ovarian function and are often used as a marker to diagnose menopause.
• Luteinizing Hormone (LH): Similar to FSH, levels of LH typically increase during menopause. LH helps regulate the menstrual cycle and triggers the release of an egg during ovulation.
• Androgens: The ovaries continue to produce testosterone, though in reduced amounts. The balance of estrogen to testosterone shifts, which can sometimes lead to changes such as increased facial hair or decrease in muscle mass. 
• Anti-Müllerian Hormone: AMH is related to menopause, particularly as a marker of ovarian reserve and the timing of menopause. AMH levels reflect the quantity of remaining egg follicles in the ovaries, and as women approach menopause, these levels typically decrease. 

Blood Test To Check For Menopause: Potential Options

In menopause, there is a decline in ovarian function and reproductive hormones, which leads to irregular periods and eventually the end of menstruation. 

While there is no one specific menopause blood test, there are some different hormones that can be evaluated through blood testing. These are often not needed routinely, however there are certain instances in which a physician may want to order blood work to confirm menopausal status. Let’s take a look at the different options when it comes to taking a blood test to check for menopause.

FSH (Follicle Stimulating Hormone) Testing

The FSH test is commonly used to assess the function of the ovaries. FSH is a hormone produced by the pituitary gland. FSH has an important role because this hormone stimulates the growth and maturation of follicles in the ovaries. 

As a woman approaches menopause, the number of functioning follicles decreases, leading to a higher level of FSH in the blood. FSH testing may be helpful and can be done by your doctor.

• High FSH Levels: A consistently high FSH level (typically above 30 IU/L) might indicate that a woman is in the menopausal transition. Higher levels of FSH, such as above 40 IU/L are more suggestive of menopause.
• Low FSH Levels: A low FSH level could indicate ongoing ovarian function and might not be indicative of menopause.

Estradiol Levels

Estradiol is produced primarily in the ovaries and plays a role in regulating the menstrual cycle. During menopause, ovarian estrogen production declines, and estradiol levels decrease.

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Levels of estradiol below 25 pg/mL are often associated with menopause. On the other hand, levels above 25-30 pg/mL might suggest that the ovaries are still functioning.

Anti-Müllerian Hormone 

While not typically used to diagnose menopause, AMH can provide information about ovarian reserve and help predict how close a woman is to menopause. Very low or undetectable AMH levels suggest that the ovaries are nearing or have ceased their function.

It is important to remember that these blood tests are only one component of diagnosing menopause. 

Let’s take a look at what else a healthcare provider would typically use to check for menopause in their patient. 

Blood Test To Check For Menopause: Is It Useful?

While there are blood tests to help confirm menopause, in most patients, it is not necessary. 

Menopause Symptoms In Age Appropriate Females

For a patient going through the uncomfortable symptoms of menopause and is in their late 40s and 50s, usually hormone tests do not need to be done. Your healthcare professional will likely be able to determine whether or not you are in menopause based on the consecutive months that you have not had a period.

Menopause Symptoms In Women Younger Than 40

In younger women, doing a blood test for certain hormone levels can be helpful. This is more likely the case if it is suspected that the patient is going through the stages of menopause earlier than normal. However, since menopause is a normal occurrence in a person’s life, in older women a blood test may not be necessary.

Blood Test To Check For Menopause: Alternatives

The first step in evaluating if you have menopause is to get your doctor involved. Let’s take a look at how your healthcare provider can make a diagnosis of perimenopause or menopause without testing hormone levels. 

Monitoring Periods

Menstrual periods begin to have more irregularity as a person enters perimenopause. Cycles may become shorter or longer, and the time between periods can vary significantly. The number of days of bleeding can also change.

It is common to skip periods during perimenopause. These gaps can last a month to several months.

Cessation Of Periods

Eventually, periods stop altogether marking menopause. Once a woman has gone 12 consecutive months without a menstrual period, she is considered to have reached menopause.

Evaluating Symptoms

Your health care provider will also take a thorough medical history to evaluate your menopausal and perimenopausal symptoms. During perimenopause and menopause, many patients experience vasomotor symptoms as well as other symptoms due to hormonal changes. Let’s take a look at some of the symptoms that can affect the quality of life in postmenopausal women.

Hot Flashes

Hot flashes are one of the most commonly reported symptoms of menopause. Hot flashes or sometimes called hot flushes can affect nearly 80% of women. They involve sudden feelings of warmth or intense heat that starts in the chest and then may spread upward toward the face and neck. 

These episodes can last from a few seconds to several minutes and might be accompanied by sweating, redness of the skin, and a rapid heartbeat. The exact cause of hot flashes is not fully understood but is believed to be related to changes in circulation and the body’s thermoregulation that occur due to decreased estrogen levels.

Night Sweats

Night sweats are essentially hot flashes that occur at night and are severe enough to disrupt sleep. They involve excessive sweating and can often necessitate changing nightclothes and bed linens. Night sweats can significantly impact sleep quality, leading to fatigue and irritability during the day.

Irregular Periods

As women approach menopause, their menstrual cycles typically become irregular. Periods may come more frequently or less so, last longer or end sooner, and the flow can vary from light to heavy. These changes are due to fluctuating levels of estrogen and progesterone as the ovaries gradually decrease hormone production.

Vaginal Dryness

Reduced estrogen levels during menopause can cause the vaginal walls to become thinner, less elastic, and poorly lubricated. This condition, known as vaginal atrophy, leads to dryness, itching, and discomfort during intercourse. Vaginal dryness can also increase the risk of vaginal and urinary tract infections. 

The most common cause of vaginal dryness are the normal changes that happen with menopause. In some cases other medical conditions like PCOS can have associated vaginal dryness but this is less commonly seen.

Mood Changes

Many women experience mood swings during menopause, which can manifest as irritability, anxiety, sadness, or depression. These mood changes are partly due to the hormonal adjustments the body is undergoing. Sleep disturbances caused by night sweats can also contribute to mood instability. Moreover, the emotional response to the physical changes of menopause can affect a woman’s psychological state.

Dry Eye

During menopause, hormonal fluctuations, particularly the decrease in estrogen, can affect the body’s ability to produce tears. This reduction in tear production can lead to dry eye syndrome. Symptoms of dry eye include:

• Irritation or a gritty sensation in the eyes
• Redness
• Blurred vision
• Increased sensitivity to light
• Fatigue of the eyes

Dry Skin

Similarly, as estrogen levels decline during menopause, it affects the skin’s ability to retain moisture and produce natural oils, leading to dryness. The skin may also become thinner and less elastic. Symptoms of dry skin include:

• Flaking, scaling, or peeling
• Rough texture
• Itchiness
• Cracks that can sometimes bleed
• A feeling of skin tightness, especially after showering, bathing, or swimming

Sleep Disturbances

Sleep disturbances are common during menopause.n.This is in part due to certain vasomotor symptoms that may influence sleep. Additionally, women are more vulnerable to sleep disorders during the menopausal transition. 

Decreased Libido

Unfortunately, low libido is a common symptom of menopause and has the ability to impact a woman’s relationship. 

• Estrogen and Testosterone Decline: The most significant impact comes from the decrease in estrogen and testosterone levels. Estrogen is crucial for maintaining sexual health and arousal, and its reduction can diminish sexual desire and slow physical arousal. Testosterone, although typically regarded as a male hormone, also plays a vital role in female libido.
• Vaginal Changes: Lower estrogen levels lead to vaginal dryness and atrophy (thinning of the vaginal walls), which can make sexual intercourse painful. This discomfort can naturally lead to a decreased interest in sex.

What Other Health Conditions Can Mimic Menopause?

It is important that your independent physician also checks for other conditions especially if you are not in the correct age range for menopause. 

Here are some key health issues that can present with menopausal-like symptoms:

Thyroid Disorders

Hypothyroidism (underactive thyroid) is a medical condition that can cause symptoms such as fatigue, weight gain, dry skin, and irregular menstruation, which are also common in menopause.

Hyperthyroidism (overactive thyroid) may lead to symptoms like increased heart rate, anxiety, sleep disturbances, and irregular periods.

Hormonal Imbalances

Polycystic Ovary Syndrome (PCOS) can lead to irregular menstrual cycles, which might be mistaken for the perimenopausal transition.

Prolactinoma, a benign tumor of the pituitary gland that produces high levels of prolactin, can disrupt menstrual cycles and mimic menopause.

Adrenal Disorders

The adrenal glands can have issues that can mimic certain symptoms of menopause. For example, adrenal insufficiency can cause fatigue, joint pain, and mood changes similar to menopause.

Psychiatric Conditions

Depression and anxiety can lead to sleep problems, fatigue, and mood swings, which are commonly reported by menopausal women.

Chronic Fatigue Syndrome

Characterized by severe, prolonged tiredness that is not relieved by rest, along with other symptoms similar to menopause such as joint pain and headaches.

Medication Effects

• Certain medications can cause side effects that mimic menopausal symptoms, such as hormonal therapies, antidepressants, and other drugs.

Premature Ovarian Insufficiency (POI)

Also known as premature menopause, POI involves the early depletion of ovarian follicles before the age of 40. This condition leads to typical menopausal symptoms and is often misinterpreted as natural menopause.

Blood Test To Check For Menopause: Summary

A blood test to check for menopause is more likely to be done when a patient is suspected of having early menopause. In this case, test results from levels of FSH, AMH and Estradiol levels can be helpful to your doctor. Menopause home tests are not necessary as it is generally a clinical diagnosis for most patients. 

It is also important that if you think you are experiencing menopause earlier than you should be, talk to your doctor. Other conditions like thyroid dysfunction can mimic menopause symptoms. Not only can your doctor order blood tests if needed, but they can also perform a proper exam and discuss treatment options like hormone replacement therapy with you.