Are Lab Tests Accurate in Testing for Perimenopause?

by Magnolia on August 11, 2014

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In Western medicine lab work is king. Blood work can tell you if you’re pregnant or if you’re not. You can determine if you’re diabetic or have kidney disease.

If you have an infection, a high white blood cell count will tell all.

And if law enforcement authorities want to determine if you are legally drunk, blood-alcohol levels can also send you to jail.

So, surely if you’re beginning to exhibit classic symptoms of perimenopause such as erratic menstrual cycles, hot flashes & night sweats, mood swings and insomnia, lab tests will confirm it all – right?

Well,  not exactly.

In fact, a lab test alone is probably the least dependable barometer of the onset of perimenopause. Yet, physicians continue to use them to dismiss women who believe they are in perimenopause,  because the results say their blood work is “normal.”

So, what’s a girl to do?

What Do Lab Tests Look For in Perimenopause?

When your physician administers a blood test to determine if you are in perimenopause, he or she is looking for a hormone that is secreted by your pituitary gland called FSH.

FSH or follicle stimulating hormone, is a hormone that is secreted by your body in response to low estrogen levels. When a woman is in perimenopause, it is assumed she will have low estrogen and progesterone levels, and hence, there will a higher presence of FSH in her blood.

While FSH levels are certainly an indicator of whether you are in perimenopause or not, it should not be presumed that you are or are not, based primarily on high or low FSH levels.

Why Are Lab Tests Alone Not Reliable in Detecting Perimenopause?

Think of lab tests and blood work like a camera. They provide a snapshot of your physiological health at a given point and time. Depending on when the lab tests are taken, you could have several different results.

For example, let’s say you’ve been cycling normally and you begin to enter a rough patch of life and are under a lot of stress.

You’re not eating right, sleeping right and perhaps even drinking a little too much alcohol to help you relax.  As a result, you may not cycle normally. You could even skip a couple of periods.

If you had blood work tested during that time your FSH levels would be high as your body tried to stimulate ovulation. The high FSH levels could indicate perimenopause.

Then, let’s say that period of stress passes and you begin to relax, eat and sleep better, and your cycles return to normal again. However, your estrogen and progesterone could still be out of balance.

You may even experience hot flashes and night sweats. In this scenario, you could be exhibiting classic symptoms of perimenopause and have normal FSH levels because you are cycling normally.

So while lab tests can be an excellent tool to help your physician determine if you are entering perimenopause, because of the variations that can occur at different times, they should not be used exclusively.

How Do I know If I’m in Perimenopause?

If you are in your mid to late 40s, perhaps even your late 30s and you begin to exhibit what you think are perimenopause symptoms, definitely see your doctor for the appropriate lab tests.

However, be mindful that you will need to have more lab tests taken over a period of time, also known as a “panel of lab tests” in order to get a more accurate picture of your hormone levels.

If your physician will not provide that for you seek the opinion of a second or third physician if necessary. Remember, you are the best barometer for how you feel.

If your instincts tell you that you might be in perimenopause, trust yourself.

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{ 9 comments… read them below or add one }

Cassie August 11, 2014 at 11:44 pm

I really appreciate how you advocate for women. Thank you, Magnolia. I was told today by an endocrinologist that I could not possibly be in perimenopause because my cycles are somewhat regular and I am only 41. He told me that cycles ALWAYS become irregular before perimenopause occurs. In my gut, I think he’s wrong. I have so many symptoms, especially anxiety, that have just started over the last few months, at the same time that my cycle has shortened from 30 to 24 days. I’m frustrated that I was dismissed so readily, but I still believe my symptoms are related to changing hormones. Time will tell. In the meantime, thank you for making me feel like I’m not alone in this.


Magnolia August 12, 2014 at 7:46 am


Trust your gut. You’re not too young. I was 41 when I started going through perimenopause. Perimenopause, like every other health issue, is NOT a one-size-fits-all experience. And God bless the endocrinologist, but irregular cycles, in conjuction with your other sysmptoms, IS perimenopause. That is what perimenopause is……..the “transition” before menopause.

Oy. Doctors irritate me. :)

I’m sorry you were dismissed too. But, it is a common experience for many, many women. Especially when it is men who are the physicians. I hate to say that, because I know it’s sexist as hell. But, it’s also true.



Cassie August 12, 2014 at 10:46 am

I will continue to trust my gut. Thank you for your supportive words!
Have a great day!


Cassie August 19, 2014 at 12:48 am

I hope this idea is ok to post here. I’m curious what anyone knows about perimenopause and sleep apnea. I have been waking up from a sound sleep with anxiety and muscle spasms. My husband finally witnessed an episode and said I was snoring, then stopped breathing right before I woke up. I will have a sleep study soon. I have never had this problem before. Is there a connection between perimenopause and sleep apnea? Some articles I read said it is correlated with low estrogen. What do you smart ladies know? Thanks, Cassie


Kelly August 12, 2014 at 11:12 am

Cassie, I’ve had the same thing happen. My hot flashes started at age 40! I was told that I was too young. My periods also started changing shortly after I turned 40 and I became anxious, moody etc. Again, “you’re too young”. Well, I certainly wasn’t imagining it. It seems to me that if your cycles are getting shorter, that is a classic sign of perimenopause. I saw a nutritionist yesterday to see if they can help me lose weight- I am only eating 1200 calories, she wants me to up 1500 a day. Anyway, I told her I wondered if the issue was peri-menopause because I recently skipped a period for 65 days. I am 46, will be 47 in November and I was told that I was young to be going through that. I don’t think so. I know many women who were in menopause by 45,46,47. My mom was finished around 48 or 49. She doesn’t remember because she didn’t have a lot of issues with this. I think a lot of it is your own individual genes and family history. Many of the women I know who went through this early are of eastern European descent. I have some of that as well, so I fully expect to be finished with this possibly before 50. There is a tendency to assume that 51 is this magic number that menopause hits at and yet there are other women who do not finish until their early and mid 50’s.


Magnolia August 12, 2014 at 11:17 am

Hi Kelly,

Here’s why I am continually mystified at the lack of understanding of perimenopause that the medical community at large seems to have…….think about this:

If the *average* age of menopause is 52, that implies there is a lower number of at least 5 years, and a higher number of at least 5 years. Therefore, a woman, strictly statistically speaking, could be fully menopausal at the age of 47.

If the *average* time for perimenopuase is 5 to 7 years (however, that number is actually rather low….it’s more like 10 to 12 years), then a woman who is fully menopausal at the age of 47, actually *entered* perimenopause at the age of 40-ish.

So, if these “experts” are going to tell us that 52 is an “average” then they need to use their brains and think about what an “average” actually means.



Cassie August 12, 2014 at 3:01 pm

Thank you for sharing, Kelly. Just hearing that you also had the same symptoms gives me a lot of comfort. There is a lot of collective wisdom in our community of women! I will continue to take care of myself and know that my experiences are real, and although tough at times, they will end one day…. Best wishes, Cassie


Gail August 20, 2014 at 7:34 pm

Just discovered this blog – thanks for all the info!

Thirteen days ago, I started my first obviously perimenopausal period, after a 40 day cycle. It’s been a blast (not)! Famous last words: I don’t need to put a couple of towels on the sheet before I go to sleep… ha ha!

Before this period, for the last 10 or so years, my cycles have consistently been 22-26 days, light to moderate, with minimal to no cramping. However, I’ve also spotted consistently between periods for about that long. I had hormone testing, and knew I had low progesterone (and also low testosterone).

Then, last month, days 11, 12, 13, 14, 15, no spotting. Awesome! Then over two weeks late, comes this period unlike any I’ve ever had! So, no, cycles don’t always become irregular before peri-m occurs.

After reading on this blog, I could probably surmise that I’ve actually been peri for years, with a regular cycle, where peri is defined partially as having higher estrogen and lower progesterone. That would put me starting perimenopause around age 38 or so.


Marista M June 18, 2015 at 11:07 am

HI Magnolia! Boy am I glad I found this article. I am 31 and haven’t had a period in 6 months. I have hot flashes and night sweats. The later are horrible! I have had worse anxiety and constant headaches. The fatigue has been awful, I can’t fall asleep or stay asleep. My sex drive has plummeted. Had a blood panel done a couple of weeks ago, and my dr. said that “You are not in menopause.” I was a little annoyed, knowing that hormones can fluctuate wildly. I know I am young for this stage, but my maternal grandmother went through menopause early. And even though she denies it, my mother has been menopausal for the last 10 years too, and she is 47.
I am wondering if there is something that I can take to my dr as evidence that this is possible, that I could actually be menopausal. My doctor is a very sweet woman who is post menopausal herself, but at times she can be a little shortsighted. Though she is always ready to listen to me. Any help would be appreciated.


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