Jennis Fitness

Have your periods started to change? Noticed some new symptoms? Physiologist Dr Emma Ross explains how you can find out if it’s perimenopause

Reviewed by: Dr Emma Ross

If your periods have become erratic, your moods are all over the place and your body doesn’t seem to respond to alcohol, fitness, diets and bedtime in the way it used to, you may be looking to find out if perimenopause is responsible. But, how can you find out for sure?

In an ideal world, there would be a simple perimenopause test, like a pregnancy test, to give you the answer. “But unfortunately, there’s no recognised, definitive test that can diagnose perimenopause,” says Jennis physiologist Dr Emma Ross.

Although a blood test can test for several key hormones to get an ‘indicator’ of what’s going on inside your body, it won’t give you the full picture of the hormonal spikes and crashes that may be responsible for symptoms if you are perimenopausal.

What does a blood test for perimenopause look for?

“A blood test can certainly check for levels of oestrogen and progesterone, which decline as you head towards menopause,” says Dr Emma, “and it can also check for levels of luteinising hormone and follicle-stimulating hormone (FSH), which are the hormones that are transmitted by your brain to tell your ovaries to produce oestrogen and progesterone.”

In theory, raised levels of follicle-stimulating hormone or declining oestrogen or progesterone would indicate perimenopause. 

A blood test will give you a glimpse of what’s going on, but it won’t give you the bigger picture of what’s really happening

However, because perimenopause is a transitory time where you’re on a hormone roller coaster, a single blood test capturing a single day of hormone activity won’t tell the whole story.

Why is one test is not enough?

“In perimenopause, your hormones don’t slowly rise or decline in a predictable way that you can tick off against a chart,” says Dr Emma. “Instead, your hormones become unsynchronised and hectic, with levels spiking one day and plummeting the next. 

“FSH is the signal to the ovaries to get an egg ready, and it’s this process that releases oestrogen. As we age, because we have fewer eggs left to release, some months you’ll get a situation where FSH is desperately trying to signal to the ovaries, but not a lot is happening down there. This will then lead to high levels of FSH, but low levels of oestrogen,” explains Emma. 

“On another day, the ovaries may have made enough oestrogen to switch off FSH production, so FSH will be low and oestrogen high."

The tests sold in chemists are yet another thing monetising women’s insecurities around their health

Because of this, a blood test will only give you a glimpse of what is going on inside your body on any one given day – but it won’t give you the bigger picture of what’s really happening across a number of cycles, months or years.

“From one day to the next, your hormones may be doing very different things. And from one month to the next, they may change completely,” says Emma.

What about the menopause tests sold in pharmacies?

“When it comes to the tests you see in your local pharmacy, I would say: save your money and go and speak to your GP instead,” says Emma. 

“The tests sold in chemists are yet another thing monetising women’s insecurities around their health, when the reality is that there is no one-day hormone test using blood or saliva that will tell you definitively whether or not you’re perimenopausal.

“My other big concern is that these tests might mean that you self-diagnose, and don’t see your GP about what you are feeling. The risk here is that you won’t receive the perimenopause or menopause support that you need.”

What does your doctor look for when diagnosing perimenopause?

Your doctor will talk to you about a number of key areas before making a diagnosis, with your age, symptoms and menstrual cycle-history all having an influence. Here’s why:

Your age: It might sound obvious, but it’s more likely that you’re experiencing the perimenopause if you’re aged in your early to mid 40s onwards.

Your menstrual cycle: A menstrual cycle that is no longer regular or has become consistently shorter with heavier bleeding than usual is another tell-tale sign.

Your symptoms: Physical and emotional symptoms of perimenopause , such as hot flushes, night sweats, insomnia, brain fog and anxiety, are big clues.

“The thing that makes some of these symptoms complicated,” says Emma, “is that they are also symptoms of a stressful mid-life. For example, you could be anxious because you are juggling lots of commitments and your job is full-on. 

“Your doctor will find out more about your lifestyle, lifestage and symptoms, then weigh up the whole picture.”

What can help you spot perimenopause?

If you’ve not yet entered perimenopause , it’s a good idea to start tracking and mapping your menstrual cycle now so you can stay on top of the hormonal and physical changes going on inside your body. 

“By logging the date you start your period each month, and then tracking the phases of your cycle, you’ll get a clear map of your normal menstrual rhythm and your symptoms when it’s regular,” explains Dr Emma. “This will help you stay in tune with it.”

The pay-off is that when perimenopause hits, you’ll quickly identify any changes. “For example, you’ll spot if your periods become heavier, your cycle gets longer or shorter, or you start getting new symptoms , like fatigue or hot flushes, at different points in your cycle,” explains Dr Emma.

“This means it’s easier for you to present your symptoms and experience to your doctor and should make it easier for you to quickly get the support you need.”