Do You Need Blood Tests in Perimenopause and Menopause?
- Dr Shashi Prasad
- Nov 20
- 4 min read
As women move through the menopause transition, one big question comes up again and again:
“Do I need blood tests during perimenopause or menopause?”
It’s a great question, especially because so many women search online for “best blood tests for menopause” or “how to check hormone levels in perimenopause.”
The truth is, whether you need hormone testing (and when) depends on your symptoms, your age, and your medical history.
Many women are refused tests and end up feeling dismissed, so let’s unpack what blood tests can actually help with and when they aren’t necessary.
Why Menopause Blood Tests Aren’t Always Straightforward
Hormone levels in perimenopause can be chaotic. Hormones might be sky-high one week and very low the next. Because of these rapid shifts, a single hormone blood test is just a snapshot. It can miss early perimenopause, show “normal” levels even when symptoms are present or cause confusion or unnecessary anxiety.
This is one reason medical guidelines often say blood tests are not the best way to diagnose perimenopause.
Women Aged 45+: Diagnosis Is Usually Symptom-Based
For most women over 45, perimenopause or menopause is diagnosed clinically, that means based on their symptoms and changes in menstrual cycles.
Typical menopause symptoms include hot flushes, night sweats, period changes, sleep problems, mood swings, low libido, and brain fog. Because hormone levels fluctuate so dramatically, a “normal” FSH or estradiol level does not rule out perimenopause.
So if you’re 45+ and having symptoms, a blood test often doesn’t add useful information. Treatment (including HRT) can be started based on symptoms alone.
When Blood Tests Are Important
There are clear situations when checking hormone levels or other blood tests is essential.
Women aged 40–45 with menopausal symptoms: If symptoms start early or periods become irregular sooner than expected, hormones like FSH may help clarify what’s going on.
Women under 40 with irregular periods or symptoms: Here blood tests are crucial to diagnose Premature Ovarian Insufficiency (POI).
When symptoms could be caused by another condition: Many conditions mimic menopause symptoms, including: Underactive thyroid (Hypothyroidism), Iron deficiency, high prolactin or low Vitamin D. Blood tests ensure nothing important is missed.
Unusual or worrying symptoms: Heavy bleeding, extreme fatigue, or unexplained weight loss require appropriate investigations.
Women Already On HRT: When Blood Tests Are Helpful
A very common question is: “Do I need blood tests if HRT isn’t working well for me?”
Blood testing can be especially useful when symptoms persist despite being on HRT treatment. Some women don’t absorb estrogen or testosterone well through the skin or symptoms may be coming from another cause altogether.
Blood tests may help check if hormones are being absorbed properly and whether dose changes are needed. This may prevent unnecessary dose increases that could push estradiol too high and helps guide safer treatment.
Women With Osteopenia or Osteoporosis
Because estradiol supports bone density, monitoring hormone levels can be helpful for women with low bone density. This ensures that they are receiving enough estrogen for bone protection. Research shows a dose-dependent relationship between estradiol and bone density, meaning higher estradiol levels are generally associated with better bone mineral density.
Women With Premature Ovarian Insufficiency (POI)
For women who go through menopause before 40, testing estradiol can help tailor treatment, even though there is no fixed “target” range. Checking levels helps ensure estrogen doses are adequate and bone and cardiovascular health are protected
Testosterone Therapy: Why Testing Matters
If testosterone therapy is being considered, blood testing is essential. A baseline testosterone test is needed before treatment as not every menopausal woman has low testosterone. Post treatment levels must stay within the female physiological range.
Regular monitoring ensures the treatment is both safe and effective.
The Trend of “Baseline Hormone Testing” From a Young Age
There’s a rising trend, especially in wellness circles recommending that women start hormone testing in their 20s or 30s to “map their normal” and pick up changes early.
The idea is appealing because it gives a sense of certainty when women may feel dismissed by standard medical care. It fits with our culture of tracking everything - steps, sleep, glucose, and now hormones. For some women this may feel reassuring.
However mainstream medical guidelines do not recommend routine baseline hormone testing in younger, symptom-free women. This is because there’s no strong evidence that knowing your hormone levels at 25 or 30 helps diagnose menopause later. It hasn’t been shown to improve symptom control, bone health, cardiovascular risk, or overall quality of life in midlife.
So it’s important to listen to every woman and personalise what they need.
Common Tests and What They Mean
A quick guide to the most relevant tests:
FSH: Rises after menopause; helpful for diagnosis in younger women but not always reliable in perimenopause.
Serum Estradiol: Useful for assessing HRT absorption in some women.
Testosterone: Helpful in women with low libido and considering testosterone therapy.
DHEA: A precursor hormone; sometimes checked for fatigue or low libido.
Thyroid Function Tests: Crucial because thyroid issues mimic menopause symptoms.
General Health Blood Tests (Age 40+): Include cholesterol, diabetes screening, Vitamin D, and full blood count.
DEXA Bone Scan: Important for early or premature menopause and osteoporosis risk.
Mammography: Routine screening for women aged 50+ in the UK.
Conclusion
Blood tests can be very useful in the menopause transition in specific situations. For most women over 45, menopause is diagnosed by symptoms, not bloodwork. But for younger women, those with atypical symptoms, those on HRT, or those with POI or bone health concerns, testing can
provide valuable clarity. Ultimately, the key is individualised, evidence-based care.
As ever, we welcome you to book a personalised consultation if you’d like a full review of your symptoms and investigations.