Perimenopausal Period & Diagnosing Menopause: At-Home Hormone Testing

By age 40, most women will experience menopause. Perimenopause signals the beginning of menopause and postmenopause covers the period after menopause occurs. Hormonal testing is one of many tools healthcare providers can use to diagnose each menopausal stage, which may be necessary for ruling out health conditions or providing treatment to alleviate symptoms.

Commercially available kits are also available for at-home hormone testing to identify menopause status. But should women rely on these kits to self-diagnose themselves?

Defining menopause, perimenopause, and postmenopause

Perimenopause is when a woman's ovarian functions decline, and she is transitioning into menopause. Women may reach perimenopause anywhere from the early 40s or as late as their 60s, with menopause occurring 8 to 10 years later. Premature menopause is defined as experiencing menopause before aged 40. Postmenopause refers to the period after menopause and when a woman hasn't had her period for at least a year. A woman entering the postmenopausal phase will remain there throughout the rest of her life.

There is no single definitive test for diagnosing menopause. However, in a clinical setting, healthcare providers will consider various factors to determine if a woman has reached her menopausal period. An evaluation may include assessing a woman's age, symptoms, medical history, and using blood tests to check reproductive hormone levels. Also, as the risk of osteoporosis and gynecological cancers increases after menopause, bone density scans to screen for bone mineralization level and pelvic ultrasounds may be used to identify possible signs of uterine or ovarian pathologies.

Hormonal testing and menopause

Hormonal testing is available to measure reproductive hormone levels, which change significantly after menopause, helping healthcare professionals determine a menopausal diagnosis. As women approach menopause, levels of estradiol (a type of estrogen) begin to decrease and women start to experience menopausal symptoms. After a woman has experienced menopause, the ovaries no longer release eggs and levels of reproductive hormones continue to decline.

Along with estradiol, progesterone, DHEA, and DHEA-S continue decreasing, while testosterone levels may either decrease or remain stable. On the other hand, high levels of follicle-stimulating (FSH) and luteinizing-hormone (LH) can indicate that ovarian functions decline. Healthcare providers may also check thyroid-stimulating hormone (TSH) levels to rule out thyroid issues, which may mimic menopause.

Clinically available menopause tests provide reliable results when conducted by qualified medical professionals and interpreted correctly. For self-testing using over-the-counter (OTC) or at-home kits, some limitations may include questionable accuracy, and user error and sample degradation if it is not collected or stored properly. In general, the results of hormonal testing may be affected by various factors such as medications (such as estrogen supplements or hormone replacement therapy), underlying health conditions, and individual variations in hormone levels. For example, FSH levels can fluctuate daily and may be influenced by certain medications or medical conditions.

Commercially available menopausal tests

OTC test kits that are available for menopausal testing have an average pricing of between $99 to $299. The over-the-counter kits work by testing for various reproductive hormones (shown in the table below). These kits may either request a finger prick for a blood sample or a saliva test sample, with the latter typically being the most preferred by testers. If considering this option, be sure to review the shipping timeframes, the collection process, and the overall client satisfaction with the service.

While the overall ease of use and privacy factor is applauded, there have been some past concerns with the sample collection process (particularly when using the blood vs. saliva test kits) or long wait times for results. Women experiencing concerning symptoms or those who obtain abnormal test results with an OTC menopause test kit should always seek professional medical advice from their healthcare provider for proper evaluation and guidance on next steps.

Hormone tests to diagnose menopause are designed to provide valuable information about a woman's health status, helping to identify and manage any health issues that may arise. Not all women need menopause testing, and it may not be a necessary or cost-effective option for those who are generally healthy and have no significant risk factors. Also, while commercially available tests may be inexpensive and convenient, women considering menopause testing should always discuss their concerns with a qualified healthcare provider. By working closely with a healthcare provider, women can take proactive steps to maintain their health and well-being before, during, and after menopause.