Blood testing for menopause: which hormones are tested?

You sit with your result in front of you and see four abbreviations that mean nothing to you: FSH, E2, LH, TSH. Next to each is a number and a reference range, but what they say together stays unclear. That is exactly the problem with menopause blood testing: the numbers only gain meaning once you know how they interact. We will walk you through it.

Why test blood for menopause?

Menopause is usually a clinical diagnosis, based on your symptoms and cycle pattern. The NHG-Standaard De overgang advises against routine testing in women from around 45. Still, a blood test can be valuable if:

• You are younger than 45 and suspect early menopause
• You use hormonal contraception and cannot judge your cycle
• You want a baseline before starting hormone therapy
• Your doctor wants to rule out other causes, such as a thyroid problem

Which hormones are tested?

Menopause blood testing usually brings these values into view. The table shows per marker what an abnormal value can mean.

Depending on your situation, your doctor may determine additional values, such as progesterone, testosterone or AMH. Our view: let TSH almost always be part of the picture. An underactive thyroid causes symptoms that strongly resemble menopause, and you do not want to wrongly attribute them to your hormones.

How does menopause blood testing work?

The process is straightforward:

• You choose a hormone test that fits your question, via your GP or independently
• You have blood drawn at a collection location, preferably in the morning
• The laboratory analyses your blood
• You receive your results digitally, usually within a few working days

There are hundreds of certified collection locations in the Netherlands, so you can often go the same week. At Lunara nothing is shipped: you book, you have blood drawn at a location nearby, and you see your result digitally. That makes it low-threshold to look at your values at a calm moment.

Timing: when to test

Hormone values relate to your cycle, so timing can affect the result:

• Still menstruating somewhat regularly? Then days 2 to 5 of your cycle compare best with reference values for FSH and estradiol
• Is your cycle irregular or have you stopped menstruating? Then blood can be drawn any time, but note your last period
• For TSH the cycle does not matter, but a morning draw gives the most stable value

What does your result mean?

Your result shows your values next to reference ranges. For menopause, focus on the combination:

• FSH above 25 IU/L: fits menopause, but one reading is not definitive
• Estradiol low: points to a decline that fits (peri)menopause
• TSH out of range: can point to a thyroid problem that needs separate attention

Hormones fluctuate strongly in perimenopause, so a normal result does not necessarily rule out menopause. Always discuss your results in consultation with a doctor. A targeted menopause blood test brings the relevant values into view at once. To place the result in a broader context, read our pillar on perimenopause.

Looking beyond the hormones alone

Blood testing around menopause is not only about the question "am I in menopause". It is also a good moment to look at your long-term health. After menopause, the protection estrogen gives to your bones and your cardiovascular system declines. The Gezondheidsraad (Health Council of the Netherlands) advises women in this life stage to pay attention to sufficient vitamin D and calcium to maintain strong bones. A value like vitamin D says nothing about menopause itself, but it does say something about how well you support your bones in the years after.

Our view: use the moment you are testing anyway to look a little broader than FSH alone. A vitamin D value, your cholesterol and your thyroid together often tell a more useful story about your health than the sex hormones on their own.

Frequently asked questions

Can my GP order a menopause blood test?

Yes, your GP can order a blood test. Not every GP does this routinely for menopause symptoms, since the diagnosis is often made from symptoms. Ask specifically if you want to remove doubt.

Is a single blood test enough to confirm menopause?

Not always. Especially in perimenopause, hormone values fluctuate strongly. Sometimes a repeat after a few months is needed to confirm the picture.

Can I test for menopause if I use the pill?

The pill suppresses your own hormone production, so FSH and estradiol cannot be measured reliably. Discuss the options with your doctor, such as a supervised pill break.