How far am I in menopause? Here is how to find out

You probably google it late at night, after yet another half-awake night: how far am I actually in menopause? It is a logical question, because certainty brings calm. But the honest answer is more nuanced than a simple test on a single number can give.

My take: your own cycle is often a better gauge than a one-off blood test. That may sound contrary for a blood-testing company, but it is how it works. Let me explain why, and when a test does help you further.

Why your cycle says more than you think

The most reliable way to gauge where you stand is to look at your menstrual pattern over recent times. The internationally used STRAW staging, which doctors use to place menopause in phases, is based primarily on your cycle, not on a snapshot of your hormones.

That last line is also the official definition of menopause: twelve months without bleeding. Only then do you know for sure that your last period really was the last.

Why a blood test does not always help

In perimenopause your hormones fluctuate strongly. Your oestradiol can be low one day and high again the next week. A one-off measurement therefore captures only a chance moment. The NHG guideline for GPs states that a hormone test in women of normal age with recognisable complaints is usually not needed to establish menopause.

The hormone FSH rises as your ovaries respond less, and stays structurally high in post-menopause. Yet FSH too is erratic in perimenopause: a normal result does not rule out menopause. Thuisarts therefore describes menopause as a diagnosis you recognise mainly from your complaints and your age, not from a single blood result.

So when is testing sensible?

There are situations where a hormone test gives valuable information:

• You are younger than 40 and your periods stop. A raised FSH together with low oestradiol can then point to early menopause. This should always be discussed with your GP.
• You have complaints that also fit another problem. Fatigue, weight gain or mood complaints can also stem from your thyroid. A TSH test helps rule that out.
• You want a broader picture of your health. A Menopause Check brings your hormones, thyroid and cardiovascular values together clearly, as a starting point for the conversation with your doctor.

Practical: here is how to find out

• Track your cycle. Note your periods and any skipped ones for at least a few months. This is your best gauge.
• Watch the pattern of complaints. Hot flushes and sleep problems that move with your cycle fit perimenopause.
• Test purposefully, not just because. Have hormones measured only when there is a clear question behind it, preferably in consultation with your GP.
• Rule out other causes. If the cause of your complaints is unclear, thyroid and iron are valuable additions.

Frequently asked questions

Can a home test tell me where I stand?

There are self-tests that measure FSH in urine or blood. The problem is the same as with a laboratory test: in perimenopause FSH fluctuates, so one measurement gives a snapshot that can easily mislead you. Use such a result at most as a supplement, not as a final verdict.

My periods stopped because of a coil, so how do I know?

With a hormonal coil your periods can stop, independent of menopause. That makes it harder to read your stage from your cycle. In that case your complaints and, in consultation with your GP, a targeted test can give more direction.

How often should I test?

For most women, repeated testing is not needed. If you have a clear question, for example with early menopause, your doctor may advise repeating a measurement after a few weeks, because one value is too much down to chance.

Does a low AMH value say anything about menopause?

AMH gives an impression of your egg reserve and falls as you age. It is used mainly for fertility questions, not to date menopause. A low value fits a declining reserve, but does not precisely predict when your menopause will fall. For estimating your menopausal stage, your cycle and your complaints say more.

Certainty comes in steps

There is no single test that says in one go "you are now here in menopause". But by tracking your cycle, taking your complaints seriously and testing purposefully where it helps, you do gain a grip on where you stand. And that is ultimately what you are after: not a number, but clarity. Read on about the different stages in our guide to perimenopause, or about the five stages of menopause.