Blood tests in perimenopause and menopause
For anyone in perimenopause or past menopause, including people taking menopause hormone therapy (HRT).
9 tests explainedAI-verified against cited sources. Awaiting expert reviewLast reviewed 2026-10-19
For most people over 45, menopause is recognized from symptoms and periods, not from a blood test. Blood tests matter more for what changes around it: cholesterol tends to rise near the final period, and heavy perimenopausal bleeding can lower iron. For estradiol tablets, the FDA label says the dose is guided by how you respond rather than by hormone levels.
The tests that matter most
Most important first. Each one links to its full page, where the note for this group sits near the top.
Follicle-Stimulating Hormone (FSH)
If you are 45 or over with typical symptoms, NICE says perimenopause and menopause can be recognized without blood tests. It suggests an FSH test only for people aged 40 to 45 with symptoms and cycle changes, or under 40 when early menopause is possible.
Source: National Institute for Health and Care Excellence (2026)
- Usual adult range
- 1.5–12.4 mIU/mL
Estradiol (E2)
NICE advises against using estradiol, AMH or inhibin tests to identify menopause at 45 or over. On hormone therapy, the FDA label for estradiol tablets says the dose is guided by how you respond rather than by estradiol or FSH levels.
Sources: National Institute for Health and Care Excellence (2026) and U.S. Food and Drug Administration (2026)
- Usual adult range
- 7.6–42.6 pg/mL
LDL Cholesterol
In SWAN, a large U.S. study of women in midlife, total cholesterol, LDL and apoB rose noticeably in the year before and after the final period, and the authors say lipids are worth checking in perimenopause. Estradiol tablets tend to lower LDL and raise HDL, the FDA label notes.
Sources: Journal of the American College of Cardiology (2009) and U.S. Food and Drug Administration (2026)
- Usual adult range
- up to 99 mg/dL
Triglycerides
The FDA label for estradiol tablets lists higher triglycerides among their effects on lab tests. It notes this matters most for people whose triglycerides are already high.
- Usual adult range
- up to 149 mg/dL
Hemoglobin A1c (HbA1c)
USPSTF recommends diabetes screening from age 35 to 70 for people with overweight or obesity, and says every 3 years may be reasonable after a normal result. NICE says the risk of type 2 diabetes doesn't go up with HRT.
Sources: U.S. Preventive Services Task Force (2021) and National Institute for Health and Care Excellence (2026)
- Usual adult range
- 4.8–5.6 %
TSH (Thyroid Stimulating Hormone)
NICE notes that thyroid symptoms can be mistaken for menopause. For people who take thyroid hormone, the FDA label for estradiol tablets says they may need a higher dose while taking estradiol, and advises monitoring thyroid tests.
Sources: National Institute for Health and Care Excellence (2019) and U.S. Food and Drug Administration (2026)
- Usual adult range
- 0.45–4.5 mIU/L
Hemoglobin
Heavy periods are more likely in the menopause transition than at other times of life, a review of midlife studies notes. NICE suggests a full blood count, which includes hemoglobin, for anyone with heavy periods.
Sources: Obstetrics and Gynecology Clinics of North America (2011) and National Institute for Health and Care Excellence (2026)
- Men, 16+
- 13–17.7 g/dL
- Women, 16+
- 11.1–15.9 g/dL
Ferritin
In 2026, NICE withdrew its old advice against ferritin tests for heavy periods, saying it wasn't justified given the risk of iron deficiency in people with heavy bleeding.
Source: National Institute for Health and Care Excellence (2026)
- Men, 20–59
- 30–400 ng/mL
- Men, 60+
- 31–409 ng/mL
Vitamin D (25-Hydroxy)
The Endocrine Society notes that ages 50 to 74 are a time of bone loss linked to menopause and aging. Even so, it suggests against routine vitamin D testing for generally healthy people in this age group. NICE suggests talking about bone health at menopause reviews.
Sources: Endocrine Society (2024) and National Institute for Health and Care Excellence (2026)
- Usual adult range
- 30–100 ng/mL
Ranges shown are the usual adult ranges labs print. The range on your own report is the one your result is judged against.
Getting results you can compare
- NICE says an FSH test can't be used to identify menopause in people using combined hormonal contraception or a high-dose progestogen. Estrogen itself also lowers FSH, the FDA label for estradiol tablets notes.
Sources: National Institute for Health and Care Excellence (2026) and U.S. Food and Drug Administration (2026)
- When FSH is used for people under 40, NICE bases it on 2 samples taken 4 to 6 weeks apart, never on a single test.
Source: National Institute for Health and Care Excellence (2026)
- Estradiol tablets raise the protein that carries thyroid hormone, so total T4 can read higher while free T4 stays the same, the FDA label notes.
Good to know
- In SWAN, cholesterol changes around the final period were larger than aging alone explains, while blood sugar and insulin changed more gradually, in step with age.
Source: Journal of the American College of Cardiology (2009)
- Estradiol tablets also raise SHBG and other binding proteins, the FDA label notes, so total hormone results can read higher while free levels may fall. That can matter when testosterone or cortisol is checked while taking them.
Questions you could ask
- Do I need any blood tests to understand where I am in menopause?
- Should we check my cholesterol now, and again after my periods stop?
- Could heavy periods have lowered my iron?
- Would a thyroid test help explain any of my symptoms?
- How will we know my hormone therapy dose is right for me?
Sources
- Menopause: identification and management (NG23), National Institute for Health and Care Excellence (2026)
- Heavy menstrual bleeding: assessment and management (NG88), National Institute for Health and Care Excellence (2026)
- Heavy menstrual bleeding: assessment and management (NG88), Update information, National Institute for Health and Care Excellence (2026)
- Thyroid disease: assessment and management (NG145), National Institute for Health and Care Excellence (2019)
- Are Changes in Cardiovascular Disease Risk Factors in Midlife Women due to Chronological Aging or to the Menopausal Transition?, Journal of the American College of Cardiology (2009)
- Estradiol tablets USP prescribing information, U.S. Food and Drug Administration (2026)
- Prediabetes and Type 2 Diabetes: Screening, U.S. Preventive Services Task Force (2021)
- Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline, Endocrine Society (2024)
- Menstruation and the Menopause Transition, Obstetrics and Gynecology Clinics of North America (2011)
AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-19. How we build and check these pages.
Educational information, not medical advice. Blood Test Tracker doesn’t diagnose or treat, and it doesn’t replace your clinician. Talk with your clinician before changing medications, supplements or care.