Hormones . Symptoms guide
Menopause: Symptoms and Bloodwork Context
Quick answer
Menopause itself is a clinical diagnosis: 12 consecutive months without a period in a woman over 45. In women under 45, FSH (not oestrogen) is the primary serum diagnostic marker for premature ovarian insufficiency (POI) or early menopause. Under NICE NG23, the diagnosis requires two separate elevated FSH readings taken 4 to 6 weeks apart, to prevent a false diagnosis based on a temporary cyclic FSH spike. BMS and NICE actively advise against using serum oestradiol to diagnose or rule out menopause, because residual ovarian follicles can produce variable oestrogen surges even in POI; oestrogen testing has a role for monitoring HRT or assessing baseline health, not for diagnosis. Thyroid, iron and vitamin D testing remains useful in all women as the symptoms overlap.
This patient information is being clinically reviewed by our team. The factual content draws on UK guidance (NHS, NICE, British Association of Dermatologists, and other specialist society guidance where cited).
Clinical classifications & mimics
- Natural menopause. Average UK age is 51.
- Premature ovarian insufficiency (POI). Menopause before 40. Diagnosis under NICE NG23 requires two elevated FSH readings 4 to 6 weeks apart, not a single test.
- Surgical or medical menopause. After oophorectomy, chemotherapy, or specific medications.
- Symptom mimics. Thyroid disease, anaemia (iron deficiency) and depression can present similarly; fatigue and mood profiles overlap closely with the menopausal transition.
Common features that suggest this
- No period for 12 or more months
- Hot flushes or night sweats
- Vaginal dryness or urinary changes
- Mood and sleep changes
- Bone or joint symptoms
Recommended tests
Same-day appointments at our Harley Street clinic, results clinician-reviewed.
Need a marker not in these panels? Build a custom panel and a GMC-registered clinician will design one for you.
Markers your clinician will commonly look at
These are the individual blood markers in the recommended panels above. Click any to read what it measures, its UK reference range, and what high or low values mean.
Testing advice
Post-menopausal women can test any day. Morning slot recommended. Under-45 women being investigated for POI or early menopause should plan for two separate FSH draws 4 to 6 weeks apart per NICE NG23.
Common questions
Should I have a vitamin D and bone health test?
Yes. Vitamin D is in our General Wellness panel. Bone density scanning (DEXA) is not a blood test but is worth discussing with your GP if you are post-menopausal.
I have had a hysterectomy with ovaries intact. Am I in menopause?
Because a hysterectomy removes your periods, you cannot use the standard "12-month timeline" to diagnose menopause. While your ovaries remain intact, they will eventually transition. To confirm menopause in this scenario, UK guidelines (NICE NG23) require two separate FSH blood tests taken 4 to 6 weeks apart to show a sustained menopausal state.
Related symptoms
Sources and further reading
- NICE NG23: Menopause: diagnosis and management
- British Menopause Society (BMS)
- Royal College of Obstetricians and Gynaecologists (RCOG)
This page provides general information only and is not a substitute for medical advice. A GMC-registered clinician will review your results and tailor any recommendations to you personally.