If you think you’re pregnant, you can take a test to confirm it. Worried about cholesterol, blood sugar or thyroid levels? Your doctor can order reliable blood tests. But what about menopause?
There is a blood test your doctor can give you for follicle-stimulating hormone (FSH, which is related to ovulation)—and now there is a new FDA-approved home urine test for FSH, which the FDA states “may help indicate” whether you are in menopause or perimenopause. There’s even a home saliva test for estrogen levels. Should you try one of these tests?
The short answer is…no.
To be sure, it’s important to know when you’re in menopause. And it’s easy to be blindsided if you are not anticipating the many changes that take place during the decade or so that lead up to it, called “perimenopause” or “the menopause transition.” But there’s just no reliable single test for it—not even one your doctor could order. So, what to do?
Here’s how to tell where you are on the menopause journey—and when to get help if you need it.
First, a little background. After 12 consecutive months with no menstrual periods or vaginal bleeding, you are officially in menopause (from now on, you’re postmenopausal). And both FSH and estrogen are indeed related to the menopausal transition.
FSH is a hormone that your body produces to stimulate the follicle—a small sac in each ovary—to produce an egg. As the function of your ovaries declines in the menopausal transition, your body compensates by sending out more FSH.
As for estrogen levels, these also fluctuate more than usual in perimenopause, including brief spurts of high estrogen levels. Over time, as you get closer to menopause, estrogen levels decline.
So…why won’t a doctor with expertise in menopause typically do a test for FSH or estrogen to try to figure out whether you are in menopause? The main reason is that neither one is a reliable gauge of whether you are or when you will be!
Let’s start with FSH. One reason FSH is an unreliable measure is that levels may rise three years before you have your final menstrual period. So knowing your FSH levels are high doesn’t really let you know when you’ll be in postmenopause. Even more importantly, FSH levels can fluctuate abruptly—and wildly—during perimenopause. Due to these erratic fluctuations in hormone levels, one day you could have a blood or urine FSH test that suggests you might be in postmenopause and no longer fertile. Then on another day in that same week, your FSH level might show that you still are ovulating, your ovaries still are making estrogen, you still are fertile and you’d better use contraception if you don’t want to get pregnant! So whether it’s the FDA-approved home urine test or a blood test, FSH is just not a reliable measure of menopause status.
The saliva test for estrogen is even more problematic. Like FSH levels, estrogen levels can fluctuate wildly through perimenopause. Here’s the simple truth, which comes as a surprise to many of the women who ask me about this test—saliva levels of estrogen just don’t correlate with either the severity or the frequency of symptoms such as hot flashes and night sweats.
When it comes to perimenopause and the menopausal transition, we treat symptoms, not hormonal levels. And we can’t use either test to help a woman decide on treatment options. While a doctor who specializes in menopause may occasionally order a blood test for either FSH or estrogen, it’s usually for a very specific clinical reason such as assessing the effects of cancer chemotherapy on hormone status.
Bottom line: Tests are not your go-to resource. There are better ways to track where you are in the menopausal transition.
The best way to chart your course through perimenopause (including whether you may still be fertile), and your entry into postmenopause, is to keep track of your vaginal bleeding. Keep a log of any bleeding you experience over time. Episodes of spotting, normal periods, early or late menstrual bleeding and missed menstrual cycles all are important indicators of where you are in the menopause transition. (If you’re having hot flashes, it’s also a good idea to keep a hot flash diary.)
If you have missed several periods, have questions or are bothered by symptoms such as hot flashes, make an appointment with a clinician with expertise in menopause. (You can find one on The North American Menopause Society website.). Together, you and your doctor can discuss your best options for navigating your menopause transition and preparing for postmenopause.
Seeing a menopause expert, though, doesn’t always mean treatment. Menopause is a natural part of aging that doesn’t require treatment unless it’s brought on by surgery, medication or disease…or you have menopausal symptoms that are bothering you and are affecting your quality of life.
For example, if you are having severe hot flashes or night sweats (or both), you deserve a medical evaluation and treatment to obtain relief from the debilitating symptoms. The treatment does not have to involve hormones. There are nonhormonal medications (including paroxetine, an FDA-approved medication for treatment of hot flashes), nutritional approaches and other evidence-based nondrug practices that may substantially relieve your symptoms.
