You were Googling "perimenopause test" again. Seventeenth time this fortnight (you've counted). Before that it was "can blood test confirm perimenopause" and "how do you know for sure" and "what if it's not perimenopause what if it's something worse." Your periods went weird six months ago. One came three weeks late, the next three weeks early, the one after that five days of proper bleeding then nothing for six weeks. Yesterday you stood outside in your T-shirt in November because you were so hot you thought you might pass out. A woman asked if you were alright. You nearly cried. Your brain feels like someone's stuffed it with cotton wool and you forgot your colleague Sarah's name on Thursday and you've worked with her for four years. You've convinced yourself it's your thyroid. Then early menopause. Then something worse you haven't let yourself Google yet.
The not-knowing is worse than any answer would be.
We see you. We get it.
Testing for perimenopause should be straightforward. You're experiencing symptoms. Surely a blood test could tell you yes or no?
Doesn't work like that. Honestly.
Can You Actually Test for Perimenopause?
Sort of. But not really.
Perimenopause blood tests exist. They typically measure follicle-stimulating hormone (FSH), which your brain produces to try to stimulate your ovaries. During perimenopause, your ovaries become less responsive. Your FSH rises. High FSH suggests perimenopause.
Except your hormone levels during perimenopause fluctuate. Massively.
One week your FSH might be sky-high. Two weeks later completely normal. Then high. Then normal. Then somewhere in between. Your oestrogen does the same thing, up and down like it can't decide what it's doing. This is perimenopause. Erratic, unpredictable hormone chaos.
A blood test captures one moment. Like taking a single photo of a roller coaster and trying to work out if it's going up or down. The test might show elevated FSH today. Doesn't tell you where you are in the process. Doesn't predict when your periods will stop. Doesn't confirm you're definitely in perimenopause rather than having a particularly dramatic month.
UK guidelines from NICE state that if you're over 45 and experiencing typical perimenopause symptoms, you don't need blood tests for diagnosis. Your symptoms and age tell the story.
We know that feels unsatisfying when you want concrete proof. The test genuinely won't give you the certainty you're after.
Why Perimenopause Tests Don't Give You Clear Answers
Tests exist but they're not recommended for most women. Why?
Hormone levels during perimenopause are chaotic. Your FSH fluctuates wildly from day to day. Week to week. Month to month. Sometimes hour to hour.
Your ovaries are basically having this conversation with your brain:
Brain: "Release an egg!" Ovaries: "Can't. Running low." Brain: "RELEASE AN EGG!" (Sends more FSH) Ovaries: "Fine, here's one." Brain: "Oh. Right." (Reduces FSH) Ovaries: "..." Brain: "Actually, RELEASE ANOTHER!"
This back-and-forth creates massive hormone swings. Your FSH could be 40 one week (high, suggesting perimenopause) and 12 the next week (normal, suggesting you're not). Both readings are accurate snapshots. Neither tells you the full picture.
Even specialists acknowledge that diagnosis is clinical, not laboratory-based. Your doctor looks at your symptoms, your age, your menstrual pattern. Not a number on a test result.
And you're probably thinking: "But surely it's useful to have some data?"
Except the test result won't change what happens next. If you're experiencing symptoms, treatment options are the same whether your FSH is high or normal on the day of testing. The number doesn't tell your doctor anything they don't already know from listening to you.
When Blood Tests Might Actually Help
Blood tests aren't recommended for most women over 45. But there are times when they're useful.
If you're under 45 and experiencing symptoms, NICE recommends FSH testing. Perimenopause before 45 is less common. Your doctor wants to confirm what's happening. Under 40, testing becomes even more important because early menopause needs specific management.
If your symptoms could be something else, blood tests help rule out other conditions. Which is probably what you're worried about, right?
Thyroid problems cause exhaustion, brain fog, irregular periods, mood changes. Vitamin B12 deficiency causes fatigue and cognitive issues. Iron deficiency causes tiredness. Low vitamin D affects mood and energy.
These conditions can look exactly like perimenopause. Testing for them makes sense, particularly if your symptoms don't quite fit the typical pattern.
This is where our midlife blood test can help. It's not designed to diagnose perimenopause (because as we've explained, that's based on symptoms). But it checks thyroid function, vitamin levels, cholesterol, and other markers to rule out conditions that might be causing your symptoms or contributing alongside hormonal changes. Think of it as eliminating other suspects rather than confirming the main one.
If you're on hormonal contraception, hormone tests won't be reliable because the contraception affects your hormone levels. Your doctor would need to take you off contraception for at least six weeks before testing. Not always practical or advisable.
For most women over 45 with typical symptoms, testing won't add clarity. Your lived experience of symptoms matters more than a number on a lab report.
Frustrating, we know.
What About At-Home Perimenopause Tests?
You've seen them advertised. At-home tests promising answers from a finger-prick blood sample or urine test.
The BMS says they don't recommend these tests. The BMS chair explained that the tests are "limited by only measuring FSH, rather than looking at the wider clinical picture."
At-home tests have the same fundamental problem as clinic blood tests. They're capturing one moment when your hormones are constantly changing. Some measure FSH in urine (even less reliable than blood FSH). Others measure multiple hormones. Doesn't solve the fluctuation issue.
The tests might show elevated FSH. Might show normal FSH. Either result is possible in perimenopause. Neither tells you definitively where you are in the process.
One reproductive endocrinologist called these tests "gimmicky," explaining that even clinicians shouldn't rely on lab tests alone for diagnosis. If specialists with years of training don't use them for diagnosis, the at-home version isn't going to give you the clarity you need.
We get why they're tempting. When you're feeling rubbish and confused, having something concrete feels better than nothing. Spending £50-150 on a test that might show "elevated FSH" or might show "normal FSH" (and both could be perimenopause) doesn't actually move you forward.
The money is better spent on an appointment with a menopause specialist who can assess your full picture.
So How Do You Know If It's Perimenopause?
For women over 45, perimenopause diagnosis comes down to three things and even then they might not all exist at the same time:
Your age. Perimenopause typically starts in your mid-40s. If you're experiencing symptoms, perimenopause is likely.
Your symptoms. Hot flushes, night sweats, brain fog, mood changes, sleep problems, irregular periods. More than 75% of women experience symptoms during perimenopause. Several of these happening together tells the story.
Changes in your cycle. Periods closer together, further apart, heavier, lighter, unpredictable. This menstrual chaos combined with symptoms and being in your 40s is perimenopause.
No test required. The diagnosis is clinical, based on what you're experiencing.
We know this feels unsatisfying when you're used to medical tests confirming diagnoses. You want someone to say "Yes, definitively, this is perimenopause."
The diagnosis is actually about recognizing the pattern of your experience.
A menopause specialist can help you put the pieces together. They'll ask about your symptoms, how long you've had them, how they affect you, what your periods are doing. They can confirm that what you're experiencing fits the perimenopause picture. That confirmation, from someone who knows what they're looking for, often provides the clarity you need.
Even without a blood test.
And if you're worried about missing something else? Testing to rule out other conditions makes sense. Thyroid function, vitamin levels, other blood markers can help eliminate other causes of your symptoms. Makes it clearer that hormones are the main factor.
Your Next Steps If You're Experiencing Symptoms
So you can't get a definitive test. The uncertainty is doing your head in.
Track your symptoms. Write down what you're experiencing, how often, how it affects your day. Hot flushes at night? Brain fog at work? Mood swings before your period? The pattern helps. Apps for this exist. Or just use notes on your phone. This information is gold when you speak to a specialist.
Book with a menopause specialist. Not your GP (though they're lovely). Menopause specialists have specific training in hormone health that many GPs don't. They understand the fluctuating nature of perimenopause. They can assess whether your symptoms fit the pattern and discuss treatment options if you need them.
Consider testing to rule out other causes. If you're worried your symptoms might be thyroid-related, or you're low in certain vitamins, testing for those specific things makes sense. Our midlife test checks the conditions that commonly mimic or coexist with perimenopause symptoms. Won't diagnose perimenopause, but can give you peace of mind that you're not missing something else.
Treatment doesn't require test confirmation. If a menopause specialist confirms your symptoms fit perimenopause, you can start treatment (like HRT) without needing blood test proof. Treatment is prescribed based on symptoms and suitability, not hormone levels.
The not-knowing is tough. But you don't need a blood test to move forward. Your symptoms, your pattern, and an expert assessment are enough.
Most women feel relieved when they realize they don't have to wait for test results before getting help for symptoms that are making life harder.
¹- NHS. Menopause. https://www.nhs.uk/conditions/menopause/
²- NICE. Quality statement 1: Diagnosing perimenopause and menopause. https://www.nice.org.uk/guidance/qs143/chapter/quality-statement-1-diagnosing-perimenopause-and-menopause
³- British Menopause Society. BMS statement on over-the-counter menopause tests. https://thebms.org.uk/2022/06/bms-statement-on-over-the-counter-menopause-tests/
⁴- Cleveland Clinic. Perimenopause. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
⁵- Cedars-Sinai. Should You Take an At-Home Menopause Test? https://www.cedars-sinai.org/blog/should-you-take-an-at-home-menopause-test.html
⁶- NICE. Menopause: identification and management. https://www.nice.org.uk/guidance/ng23/chapter/recommendations
⁷- NHS England. Diagnosing menopause. https://remedy.bnssg.icb.nhs.uk/adults/menopause/diagnosing-menopause/
⁸- British Menopause Society. Menopause Practice Standards. https://thebms.org.uk/wp-content/uploads/2022/07/BMS-Menopause-Practice-Standards-JULY2022-01D.pdf
⁹- Voy. Midlife Women's Health Blood Test. https://menopause.joinvoy.com/midlife-womens-blood-test