Perimenopause testing
Private perimenopause blood test in London
A bespoke panel covering the hormones (FSH, LH, oestradiol), the thyroid markers that commonly mimic perimenopause, and the nutritional markers (ferritin, vitamin D) you will want a baseline of before any HRT conversation. Reviewed by a GMC-registered doctor. One blood draw at 134 Harley Street.
Comprehensive perimenopause review from £425. NICE NG23 aligned.
Quick answer
A private perimenopause blood test typically combines hormone markers (FSH, LH, oestradiol, total testosterone, SHBG), thyroid markers (TSH, free T4, sometimes free T3 and TPO antibodies), and nutritional markers (ferritin, vitamin D). In women over 45, NICE NG23 treats perimenopause as a clinical diagnosis rather than a laboratory one; bloods are most useful for excluding thyroid dysfunction and establishing a baseline before any HRT decision. In women under 45, FSH is the most useful single hormone marker per NICE NG23.
When perimenopause bloods are most useful
- You are under 45 with menopausal symptoms. FSH and oestradiol are most useful in this group, particularly where premature ovarian insufficiency is being considered. NICE NG23 supports testing here.
- You are 40 to 45 with new cycle changes and symptoms. Testing helps distinguish perimenopause from thyroid dysfunction and from iron-driven fatigue.
- You are considering HRT and want a clinical baseline. Liver function, lipids, ferritin and vitamin D are routinely useful before starting transdermal oestradiol or any combined HRT.
- Your NHS bloods came back "normal" but symptoms persist. NHS panels typically test TSH alone for thyroid; private panels add free T4, free T3 and antibodies, plus the wider hormonal context.
- You want to monitor response to HRT or to lifestyle changes. A documented pre-treatment baseline makes the next conversation a clinical one, not a guess.
What is included
A typical comprehensive perimenopause panel. Your final markers are tailored around your case and reviewed by a GMC-registered doctor before booking.
FSH (follicle stimulating hormone)
Rises as ovarian reserve falls. Per NICE NG23, not used routinely to diagnose menopause in women over 45 (clinical diagnosis), but is the most useful single hormone marker in women under 45 with equivocal symptoms or suspected premature ovarian insufficiency.
LH (luteinising hormone)
Pituitary signal that triggers ovulation. Used alongside FSH to characterise the menopausal transition.
Oestradiol
The principal ovarian oestrogen. Cycle-stage dependent in cycling women; suppressed in established menopause.
Total testosterone
Sometimes added when symptoms include low libido or persistent fatigue not explained by oestrogen alone.
SHBG (sex hormone binding globulin)
Calculates the bioavailable testosterone fraction and gives early signals of insulin resistance.
TSH and free T4
Thyroid dysfunction commonly masquerades as perimenopause (weight gain, fatigue, mood changes, hair changes). Excluding it is essential.
Ferritin
Heavy or irregular bleeding can deplete iron stores. NICE CKS Anaemia (2024) treats ferritin under 30 ug/L as iron deficient.
Vitamin D (25-OH)
Bone-health context, especially relevant when HRT decisions are upcoming.
Timing and preparation
Cycling women
Ideally cycle days 2 to 5 (day 1 = first day of bleeding) for cleanest baseline FSH, LH and oestradiol.
Irregular or no cycle
Single morning draw. Timing is less critical when periods have stopped or become unpredictable.
Fasting
Overnight fast (8 to 12 hours, water only) gives the cleanest free T4 reading. Other markers not fasting-sensitive.
Hormonal contraception
If you use the combined pill, mini-pill, IUD, implant or injection, tell us at booking, it changes how the result is interpreted.
B-vitamin supplements
Hold B-complex / multivit for 24 to 72 hours before testing. For B12 specifically, ideally pause for several weeks for a true baseline.
Biotin supplements
High-dose biotin interferes with thyroid immunoassays. Stop for at least 48 to 72 hours before draw.
What happens if you want HRT
If your results, history and symptoms support a case for HRT, our sister service WMG Meds offers a transdermal HRT pathway under our prescribing clinicians, with transdermal oestradiol (patches, gel or spray) per NICE NG23 and British Menopause Society guidance. The transdermal route is associated with a lower risk of venous thromboembolism than oral oestrogen.
The prescribing decision is made by the GMC-registered clinician after a full menopause-focused assessment, including review of contraindications and a discussion of benefits, risks, monitoring cadence and the duration of therapy. We are honest about when HRT is and is not the right answer.
FAQs
Should I get a blood test for perimenopause if I am over 45?
NICE NG23 advises that perimenopause and menopause in women over 45 with typical symptoms is a clinical diagnosis, not a laboratory one. A blood test is not required for diagnosis. Many women still choose private testing for a different reason: to exclude thyroid dysfunction (which mimics perimenopause), to check ferritin and vitamin D before HRT decisions, and to establish a clinical baseline against which to measure response to any treatment. Our clinicians will discuss whether testing is the right next step for your case.
What about under 45 with suspected perimenopause?
In women under 45, FSH is the most useful single hormone marker per NICE NG23, particularly where premature ovarian insufficiency is being considered. A targeted bloods workup is genuinely useful in this group.
When in my cycle should I get tested?
If you are still cycling, the cleanest baseline for FSH, LH and oestradiol is on cycle days 2 to 5 (counting day 1 as the first day of bleeding). If your cycles have become irregular or stopped, we will draw at a time that gives the most useful single snapshot. We will discuss timing when designing your panel.
Do I need to fast?
An overnight fast (8 to 12 hours, water only) gives the cleanest free T4 reading and is recommended. Other markers in the panel are not fasting-sensitive.
What about HRT, can you prescribe?
WMG Meds (our sister site) offers a transdermal HRT pathway under development with our prescribing clinicians, with transdermal oestradiol (patches, gel or spray) per NICE NG23 and BMS guidance. If your bloodwork supports the case for HRT, we can refer you into that pathway directly. The decision is made by the prescribing clinician after full menopause-focused assessment.
How much does this cost?
A comprehensive perimenopause review typically lands in the £425 to £525 range depending on which adrenal, metabolic and nutritional layers we add. We confirm the exact price in writing before you book.
How long do results take?
Most markers within 4 hours of your appointment. The full hormone panel including SHBG can take up to 48 hours before clinician release.
Ready to book?
A GMC-registered doctor designs your perimenopause panel and confirms the price within 1 working day. Same-day appointments at 134 Harley Street usually available.
From £425 · NICE NG23 aligned · Quote within 1 working day