Early menopause test: FSH, estradiol and your thyroid

In early menopause your ovaries work less or stop working before you are 40. Your periods become irregular or stop, and you can get the complaints that come with the menopause, such as hot flushes and night sweats. Doctors also call this premature ovarian insufficiency, or POI.

Early menopause is uncommon: about 1 in 100 women has her last period before 40. On average, women in the Netherlands reach the menopause at 50 or 51. A menopause between 40 and 45 is called relatively early, but it does not count as early menopause.

Which complaints can come with it is in our article on the symptoms of early menopause.

The answer depends on your age. From 40, the menopause is recognised from your complaints and your cycle, once other causes have been ruled out. A blood test cannot settle it. Your FSH swings so much in the years before your last period that a normal result does not rule the menopause out.

If you are under 40 and your periods stop or become irregular, a blood test is part of the investigation. A raised FSH with a low estradiol then fits early menopause. One measurement is not enough for that diagnosis: a doctor repeats it after 4 to 6 weeks.

If you first want to list the complaints you have, take the free menopause check. It is a set of questions about your complaints, with no blood draw.

The test measures four values in your blood.

• FSH (follicle-stimulating hormone) comes from your pituitary, a gland under your brain. It tells your ovaries to ripen eggs and make oestrogen. When your ovaries respond less well, your pituitary makes more FSH. A high FSH therefore means your body has to work harder to get your ovaries going.
• Estradiol is the main form of oestrogen, the female sex hormone your ovaries make. It changes over your cycle and falls as your ovaries start to work less.
• TSH (thyroid-stimulating hormone) is the signal your pituitary uses to drive your thyroid. If your thyroid works too slowly, your TSH rises. If it works too fast, your TSH falls.
• Free T4 is the thyroid hormone that circulates freely in your blood and that your body can use straight away. Together with TSH it shows whether your thyroid works too slowly or too fast.

A thyroid that does not work properly causes complaints that are hard to recognise and can look like the menopause. If your thyroid works too fast, you can lose weight while eating normally, and get palpitations, shaky hands, restlessness, heavy sweating and trouble with heat. If it works too slowly, you can gain weight, feel cold easily, feel tired and slow, and become constipated.

That is why a GP measures your TSH when needed if you have menopausal complaints. If you only want your thyroid measured, the thyroid function test fits. If you also want your iron, vitamin B12 and vitamin D measured, look at the tiredness panel.

• You are under 40, and your periods have stopped or come irregularly.
• You have complaints that look like the menopause and you want to know whether your thyroid plays a part.

If your periods have stopped, the first question is whether you are pregnant. If you are unsure, a pregnancy blood test or a pregnancy test from the pharmacy answers that first.

Do you use the pill, a hormonal IUD or other hormones? They can mask your cycle and your menopausal complaints, and they can change your FSH and estradiol. Keep that in mind when you read your result.

You see each value with its unit and the laboratory's reference range. Those ranges differ between laboratories, and FSH and estradiol also change over your cycle. A BIG-registered doctor assesses your result.

A raised FSH with a low estradiol fits ovaries that are working less. If you are under 40, discuss the result with your GP. Your GP repeats the measurement and refers you if needed so the cause can be investigated. If you are 40 or older, a normal FSH does not rule out the menopause.

An abnormal TSH or free T4 can point to a thyroid that works too slowly or too fast. You discuss that result with your GP as well.

After your order we arrange your referral through ZorgDomein, which takes one business day. Orders placed in the evening or at the weekend start on the next business day. The ZorgDomein email carries a barcode, which you show on your phone at the draw location. Without a BSN there is no barcode: you then print your referral form through the link in the email and bring it to the draw location.

You choose a draw location near you. Many have walk-in hours, others take an appointment. You do not need to fast for this test.

Our indicative planning, counted from the draw, is about 48 hours for FSH, estradiol and TSH, and about 96 hours for free T4. A doctor then assesses your result and you can see it online.