Early Menopause Blood Tests: Under 45 and POI

Most women reach menopause between 45 and 55. The NHS describes early menopause as periods stopping before the age of 45, and premature menopause as this happening before 40, which doctors call premature ovarian insufficiency (POI). It can run in families, follow treatments such as chemotherapy, radiotherapy or surgery to remove the ovaries, or happen with no clear cause.

Unlike menopause after 45, blood tests play a real part in diagnosing early menopause and POI, and getting the diagnosis matters: the NHS says early menopause raises the chance of osteoporosis and cardiovascular disease, which is why hormone replacement is usually advised. This guide explains which blood tests help at each age, which to book, their limits and when to see a GP.

Test it in Chiswick: our Hormone Health Check blood test costs £69, with your result explained in person by a practitioner. No GP referral needed. Book this test or call 020 4515 0000. Prefer to test at home? A home finger-prick kit is also available, ask us when you enquire.

Quick answer

If you are over 45 with typical symptoms, NICE says perimenopause and menopause are diagnosed without blood tests. Between 40 and 45, an FSH blood test can be considered if your symptoms include a change in your periods. Under 40, premature ovarian insufficiency is diagnosed from symptoms plus a raised FSH on 2 blood samples taken 4 to 6 weeks apart, never a single test. FSH is not reliable on combined hormonal contraception. A pregnancy test, thyroid function and prolactin help rule out other causes, and AMH is not recommended for diagnosis.

Blood tests that can help

NICE menopause guidance (NG23, updated in November 2024) sets out when tests are useful:

• Over 45: perimenopause and menopause are diagnosed from symptoms, without laboratory tests, in otherwise healthy women.
• 40 to 45: consider an FSH test if you have menopausal symptoms, including a change in your menstrual cycle.
• Under 40: consider an FSH test if menopause is suspected; POI is diagnosed on symptoms plus raised FSH on 2 samples 4 to 6 weeks apart.

FSH (follicle stimulating hormone)

FSH is made by the pituitary gland and rises as the ovaries respond less. In perimenopause it can swing up and down from month to month, which is why one result is never enough. The Daisy Network, the UK charity for women with POI, advises testing between days 2 and 4 of bleeding if you still have periods, or at any time if they have stopped. Our FSH test costs £49, and our guide to FSH levels explains the ranges.

Oestradiol

Oestradiol is the main form of oestrogen, and the Daisy Network lists it among the tests used when POI is being investigated. Read on its own it is not diagnostic, and NICE advises against using it to diagnose menopause in women over 45. Our Oestradiol test costs £49; see oestradiol levels explained.

Pregnancy test

Pregnancy is a common reason for missed periods, and the Daisy Network says a pregnancy test is standard practice when periods have been missed for a few months. A home urine test is usually enough, or we offer a Beta hCG blood test (£79).

Thyroid and prolactin

The NHS lists an overactive or underactive thyroid among the causes of stopped periods, and the Daisy Network lists prolactin and thyroid antibody tests among the investigations for POI. A Thyroid test (£59) covers TSH, free T4, free T3 and thyroid antibodies, and a Prolactin test costs £49. Our guides to thyroid function results and prolactin levels explain the results.

AMH (anti-Mullerian hormone)

AMH reflects how many eggs remain, but NICE advises against using it to diagnose menopause over 45 and against routinely using it to diagnose POI. The Daisy Network adds that AMH cannot predict POI. It is more useful for fertility planning; see AMH levels explained.

Specialist tests

If POI is confirmed, a specialist may arrange a chromosome test (karyotype), an FMR1 gene test linked to fragile X, and antibody tests. We do not offer these; they are arranged through your GP or specialist.

Which test should I book?

• A focused start: Hormone Health Check, £69. FSH, LH, oestradiol, progesterone, prolactin, testosterone, SHBG and free androgen index.
• A broader picture: Hormone and Thyroid Panel, £99. Everything in the Hormone Health Check plus TSH, free T4, free T3 and thyroid antibodies, so thyroid causes are checked at the same time.
• The fullest view: The Complete Woman, £299. All of these hormones and thyroid tests plus a full blood count, iron, B12, folate, vitamin D, calcium, parathyroid hormone, a detailed cholesterol profile, HbA1c, kidney and liver function. This gives a useful baseline for bone and heart health.

If your first FSH result is raised and you are under 40, you will need a second FSH test 4 to 6 weeks later (£49), as NICE says POI should not be diagnosed on a single blood test. None of these panels includes AMH.

What blood tests cannot tell you

A normal FSH does not rule out perimenopause, because levels fluctuate. Gloucestershire Hospitals pathology notes that FSH is of no value in women taking combined oestrogen and progestogen contraception or high-dose progestogen, and NICE says menopause can be hard to diagnose in anyone on hormonal treatments. Blood tests also cannot tell you exactly when your periods will stop, or how long symptoms will last.

A diagnosis of POI is made by a doctor, taking into account your history and family history, and NICE advises referral to a specialist if there is any doubt. The Daisy Network notes that around 5% of women with POI can still conceive naturally, so talk to your GP about contraception if you do not want to become pregnant. Blood tests cannot measure bone density either; your GP can advise whether you need a bone scan.

When to see a GP urgently

See a GP if you are under 45 and your periods have become irregular, you have missed 3 periods in a row, or you have menopausal symptoms such as hot flushes or night sweats. See a GP promptly if:

• you bleed between periods or after sex
• you have any bleeding after your periods have stopped for more than a year, even a small amount

Call 999 or go to A&E if you might be pregnant and have sudden, severe tummy pain or feel very dizzy or faint, as these can be signs of a ruptured ectopic pregnancy.

Frequently asked questions

Can a blood test tell if I am going through early menopause?

It can help. Under 45, a raised FSH alongside symptoms supports the diagnosis, and under 40 NICE asks for 2 raised FSH results 4 to 6 weeks apart. A normal result does not rule it out, because FSH fluctuates.

What FSH level means premature ovarian insufficiency?

NICE does not set a single cut-off. The Daisy Network describes an FSH above 25 IU/L, with absent or infrequent periods for at least 4 months, as in keeping with POI. Your result should be read with the range on your report.

Can I have an FSH test on the pill?

FSH is not reliable if you take combined hormonal contraception or high-dose progestogen. Talk to your GP or practitioner before stopping any contraception for a test.

Is AMH a menopause test?

No. NICE advises against using AMH to diagnose menopause over 45 or routinely to diagnose POI. It is mainly used in fertility assessment.

Do I need a blood test if I am 47 with symptoms?

Usually not. NICE says menopause and perimenopause are diagnosed from symptoms over 45. Our guide to when menopause starts explains the usual timeline.

Early menopause blood tests in Chiswick

Omnia Lifestyle is at 8 to 9 Bedford Corner, The Avenue, Chiswick, London W4 1LZ, a short walk from Turnham Green station (District line; Piccadilly line trains stop there early morning and late evening only) and served by buses 94, E3 and 272. Limited parking is available on request when you book. Every clinic test price includes your sample taken at the clinic, analysis at the Randox accredited laboratory, a practitioner review of your result with you, and a GP feedback report on request. You do not need a GP referral, and most results are back within a few working days.

Useful links: book the Hormone Health Check or an FSH test, see The Complete Woman, browse our women's health blood tests, or compare every blood test and price. Our guides to FSH levels and oestradiol levels explain these results. If you would like support alongside your GP care, see our menopause symptoms care at Omnia.

This article is general information, not medical advice. Discuss your results with your GP or practitioner.