The short answer is no.
There are no tests to determine if you are in perimenopause.
Still, I hear a lot of women do tests just to “check their hormone levels”. Yes, it is true that the closer we get to menopause (your final period), the higher the levels of FSH (Follicle Stimulating Hormone).
By the time a woman is in postmenopause, the estradiol levels are usually <25 pg/ml and FSH >30 IU/ml, but this does not mean that if your tests come out as per above, your body has nothing more in store for you.
The problem with those blood tests, which to start with can be expensive, is that when the test results come out, they often are ‘in the range’. That can be confusing if the woman in question also is bleeding for two weeks straight each month, or is not sleeping, or just simply feeling something is off.
Remember, we do not need to check hormone levels if a fourteen-years old girl is growing in height and developing breasts in puberty.
Equally, if a woman in her forties is having heavier and/or shorter cycles, tender breasts (early stages of perimenopause can really feel like puberty), night sweats etc., we do not need tests for that.
Testing hormones to ‘check’ will not indicate how far into menopause transition we are in or how long we have till our final period (aka: graduation to menopause).
The hormone levels will also NOT indicate eligibility for Hormone Therapy as we use therapy for managing symptoms, not trying to adjust the levels of hormones per se. What we use therapy for is to manage symptoms during that transition, not to ‘replace’ them.
And for that reason, it is not helpful to test the hormone levels as they fluctuate erratically and vary day to day. In fact, estradiol levels can be exceptionally high, for example: the very last ovulation can produce levels of estradiol and FSH that could be seen in a thirty-five-year-old.[1]
Also, you might have two regular cycles and then skip a couple.
There is this idea that estrogen goes low in perimenopause, but it can actually go exceptionally high.
Perimenopause is like the Vivaldi ‘Four Seasons’ in terms of hormones. Everything goes up and down. It’s a bit as if the conductor’s gone a little bit haywire and all the instruments are struggling to follow. The ovaries are out of sync, and this can be reflected in the higher levels of estradiol, temporarily.
Also, the pituitary gland gets a little bit ‘crossed’ with the ovaries, so it increases the production of FSH. It's like: Come on ovaries, what are you doing? You are slacking. So, the ovaries respond: all right, fine, we’ll make an effort. And this is the early part of perimenopause.
But this would also account for why lots of perimenopausal women often have very heavy periods and often very long bleeding. It is because they are not ovulating and that puts them in the space of estradiol excess (due to anovulation and lack of progesterone) with an additional untethered estradiol as discussed above. Lack of ovulation contributes to shortening of the cycle. It’s a bit like in that analogy: we haven’t ovulated so let’s close the shop earlier and try again as soon as possible.
However, we are all different and therefore for some women it might just be a slow gradual decline like a slope.
So, it is really in the subtleties as the test might be in the range but if a woman is not feeling great, it is a clear indication that we need to dig deeper. Unfortunately, we are often gaslit into believing that since the tests results are ‘normal’ then it must be in our heads.
Now, what about those women who have a history of irregular periods? There are many different reasons why that could be. It is important to exclude those first before we jump to a conclusion that it is indeed perimenopause. And for some of these, blood testing might be appropriate, especially if a woman is still in the middle of her reproductive years.
These are:
Thyroid disorders
Polycystic Ovarian Syndrome or PCOS
Primary Ovarian Insufficiency.
Women who have had endometrial ablation or those with a hormonal IUD (intrauterine device) and are not menstruating, will not be able to tell where they are on their journey to menopause or the date of their menopause.
If hormone therapy is needed, it can be based on their symptoms or risk factors.
**Note on salivary hormone testing, as opposed to blood testing. These should never be offered as they are unreliable and do not reflect what is in the blood.
Conclusion:
1. Perimenopause is determined based on symptoms not on blood tests.
2. Reproductive hormones fluctuate erratically during the menopause transition and for that reason blood tests and consequently the hormone levels are not a reliable tool to diagnose menopause.
3. For now, the diagnosis of menopause is based on age, a history of menstrual irregularity followed by twelve months of no menstrual periods (provided no other medical conditions).
4. Women who go for more than sixty days between periods are in the late phase of perimenopause and most likely around 3 years or less away from their final period.
Thoughts? Questions? Let me know in the comments below.
[1] The Menopause Manifesto, Dr Jen Gunter
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