Menopause Blood Test: What FSH Levels Can Tell You

From 45, most women do not need a blood test to know they are in perimenopause. Doctors go by symptoms and periods. Before 45, an FSH test can help, and home urine tests measure the same hormone but answer a narrower question. If you have a test, keep your own copy of the report in the Health Vault in Sam, apart from your clinic's records.

How to log symptoms and bleeding days over weeks is in Menopause symptom diary: what to track. Who to see, and how referrals work, is in Which doctor for menopause. What Sam keeps through menopause, and what it does not, is in the menopause overview.

Do you need a hormone test from age 45?

Usually not. NICE is the guideline body for England. It recommends identifying perimenopause without lab tests in otherwise healthy women aged 45 or over who have symptoms: hot flushes or sweats that have recently started, plus any change in their periods. Menopause is identified after at least 12 months without a period, if you are not using hormonal contraception. After a hysterectomy, NICE goes by the type and combination of symptoms.

The German S3 guideline on peri- and postmenopause says the same. It dates from 2020 and was valid until the end of 2024; a revised version may change the advice on hormone tests.

The NHS puts it plainly. There is no routine test for perimenopause and menopause, and a doctor may base it on your age and symptoms. MedlinePlus, the US National Library of Medicine's health site, says that from 45 testing usually isn't needed.

None of this means nobody examines you. It means a lab value does not replace the conversation. What makes sense for you is your doctor's call.

How can you tell it is perimenopause without a test?

Your periods and symptoms carry most of the answer. The German S3 guideline describes perimenopause in women over 45 as irregular cycles, possibly with hot flushes and sweats. The NHS says menopause usually happens between 45 and 55, but it can come earlier.

Menopause itself can only be named looking back. The NHS defines it as 12 months without a period while not using hormonal contraception. Some contraceptive methods make periods irregular or stop them altogether, which is why contraception blurs the picture.

Those are the details your doctor asks about. Written down, they are easier to give than from memory. What an Apple Watch adds, and what it does not, is in Apple Watch and perimenopause.

When is an FSH test worth doing?

Mainly before 45. FSH is follicle-stimulating hormone. The pituitary gland makes it, and each month it rises to stimulate the ovaries. NICE names two groups where a doctor may consider an FSH blood test:

• Women aged 40 to 45 with menopausal symptoms, including a change in their cycle.
• Women under 40 in whom menopause is suspected.

The German S3 guideline draws similar lines.

Under 40, doctors look at premature ovarian insufficiency (POI). Guidelines differ on how many results are needed. NICE asks for raised FSH on two blood samples taken 4 to 6 weeks apart. The German S3 guideline from 2020 names an FSH above 30 mIU/ml, measured twice, 4 to 6 weeks apart. The 2024 international guideline from ESHRE, ASRM and IMS accepts one raised result when periods have been irregular or absent for at least 4 months. It repeats the test after 4 to 6 weeks only when in doubt.

These are criteria doctors work with: not a test to run on yourself, and not a number to judge your own report by. A normal-looking result is no all-clear, and neither is a missing criterion.

Is it possible to reach menopause at 40?

Yes. The NHS calls it early menopause when regular periods stop before 45, and premature menopause before 40. If you are under 45 with menopause symptoms, a GP may sometimes do blood tests, the NHS says.

Missed periods have other causes too. The NHS lists, among others:

• Pregnancy.
• Stress, sudden weight loss, being overweight or a lot of exercise.
• Hormonal contraception and breastfeeding.
• Conditions such as diabetes or thyroid problems.

The NHS says to see a GP if you have missed three periods in a row or your periods have become irregular. The GP will ask about your health and may do some blood tests to find the cause. Which tests is their decision.

Why does one FSH result say so little?

Because FSH moves. As you get older, it may rise and fall during your cycle, the FDA says. MedlinePlus adds that if you still have periods, you may need the test at a set point in your cycle.

High FSH is common in perimenopause and menopause. MedlinePlus also lists other causes, including ovarian and thyroid conditions. What a result means is for your doctor to say. IQWiG, Germany's Institute for Quality and Efficiency in Health Care, notes that a hormone level does not tell you whether you can still get pregnant. Nor does it tell you whether treating your symptoms makes sense.

So your doctor reads the number together with your age, cycle and symptoms. If a test is planned, ask which cycle day the blood should be taken. Note the first day of your last period.

What if you use hormonal contraception or have no uterus?

Then the picture is harder to read. The NHS says hormonal contraception can make it harder to tell whether you have reached perimenopause or menopause. NICE advises against using an FSH blood test to confirm menopause with certain hormonal contraceptives. If you take hormones, the S3 guideline notes that your status can be hard to define.

Without a uterus, there are no periods to go by. After a hysterectomy, in women over 45 with hot flushes, the S3 guideline and NICE go by symptoms.

So before any test, tell your doctor which hormones you take or have recently stopped. They can change the result.

Are at-home menopause tests worth it?

They measure FSH in urine and show only whether it is raised. The FDA says this about home tests cleared in the US:

• They pick up FSH correctly about 9 times out of 10.
• They do not show whether you are in menopause or perimenopause.
• The result depends on whether you used first-morning urine, drank a lot beforehand, or use or recently stopped hormones such as contraceptives.
• A negative result does not mean you have not reached menopause.

If the result is positive, or you have symptoms, the FDA says to see your doctor. MedlinePlus adds that these tests should not be used to check whether you can get pregnant. A home test can be a reason to book; it is not the answer.

How do you keep the result for the next appointment?

Keep the value, the date and the circumstances of the blood draw together. In Sam, you file the lab report in the Health Vault as a scan, photo or PDF. After you give consent, Sam reads the rows.

Sam knows about 33 lab values by name, such as TSH and ferritin. FSH is not one of them, so it stays as printed. If Sam can read the printed reference range, it shows high, low or in range for each value. If the lab prints several ranges, for example by cycle phase, Sam uses only one. That label can be wrong. The original report is what counts. Sam does not say what your FSH result means for you.

You can add your own note to the document. An invented example: "Blood taken on cycle day 3, no hormones." Bleeding days, flow and spotting go into cycle tracking in the same app. If you need copies from your practice first, see Getting a copy of your medical records.

What needs a doctor, whatever a test says?

Bleeding needs a check, whatever any hormone level shows:

• Any bleeding after 12 months without a period, even if it is light or happened once. Get it checked soon.
• Bleeding that is heavier than before, between periods or after sex.
• Heavy periods: changing a pad or tampon every 1 to 2 hours, needing two products at once, or bleeding for more than 7 days.

If you take hormones, ask your doctor which bleeding to expect.

Have palpitations checked before you put them down to menopause; see Menopause: palpitations, anxiety and blood pressure.

Chest pain, shortness of breath or fainting are an emergency even without palpitations: call your local emergency number (112 in the EU, 999 in the UK, 911 in the US). The same goes for palpitations that do not go away or come with feeling faint. Do not wait for it to pass. If you had such symptoms and they have stopped, get an urgent appointment the same day; when your practice is closed, use the urgent care service where you live (111 in the UK).

Keep your hormone test report in Sam for the next visit

At your next appointment the lab report is at hand, together with what belongs to the blood draw.

• Instead of a folder: you scan the report or import it as a PDF into the Health Vault. After your consent, Sam reads the rows; FSH stays as printed, and a high or low label can be wrong when your lab prints several ranges.
• Instead of a sticky note: you note the cycle day and any hormones at the draw on the document itself.
• Instead of a calendar in your head: bleeding days, flow and spotting go into cycle tracking, in the same app. You can share the original report straight from the app.

Sam does not say what your FSH result means or whether you are in perimenopause. More: menopause overview.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Menopause symptom diary: what to track and for how long
• Which doctor for menopause: GP, gynecologist or specialist
• Menopause: palpitations, anxiety and blood pressure
• Apple Watch and perimenopause: what it shows and what it doesn't
• Getting a copy of your medical records when changing doctor

Sources

Updated: October 2026

• DGGG and OEGGG: S3 guideline Peri- and Postmenopause - Diagnosis and Interventions (AWMF 015-062), English short versions: Ortmann O et al., Arch Gynecol Obstet 2020;302:763-777 and Inwald EC et al., Geburtshilfe Frauenheilkd 2021;81:612-636 (January 2020 with a September 2020 addendum; validity stated until 31 December 2024)
• ESHRE, ASRM, CRE-WHiRL and IMS: Evidence-based guideline: premature ovarian insufficiency, Hum Reprod Open 2024;hoae065
• NICE: Menopause: identification and management (NG23), recommendations 1.3 and 1.7 (last updated 15 April 2026)
• NHS: What are menopause and perimenopause? and Symptoms of menopause and perimenopause (page last reviewed 19 May 2026)
• NHS: Early menopause (page last reviewed 11 March 2025) and Stopped or missed periods (page last reviewed 12 June 2026)
• NHS: Heavy periods (page last reviewed 19 September 2024) and Heart palpitations (page last reviewed 17 March 2026)
• U.S. Food and Drug Administration: Menopause (Home Use Tests) (content current as of 27 September 2018)
• MedlinePlus (U.S. National Library of Medicine): Follicle-Stimulating Hormone (FSH) Levels Test (last updated 4 December 2023)
• IQWiG (gesundheitsinformation.de): Wechseljahrsbeschwerden (updated 2 January 2023, in German)