The core hormones checked for menopause are follicle-stimulating hormone (FSH) and estradiol, the body’s primary form of estrogen. These two tests together give the clearest snapshot of where you stand in the menopausal transition. But depending on your age, symptoms, and medical history, your provider may also order tests for luteinizing hormone (LH), anti-Müllerian hormone (AMH), progesterone, thyroid function, and prolactin to rule out other conditions or estimate how close menopause is.
That said, for women over 45 with classic symptoms like irregular periods, hot flashes, and sleep disruption, routine hormone testing often isn’t necessary. A diagnosis can be made based on symptoms alone. Testing becomes more useful when you’re younger than 45, when symptoms are ambiguous, or when something else might be going on.
FSH: The Primary Menopause Marker
FSH is the hormone your pituitary gland releases to tell your ovaries to produce eggs. As ovarian function declines, the pituitary compensates by pumping out more and more FSH, essentially shouting louder at ovaries that are responding less. That rising FSH level is the hallmark lab finding of the menopausal transition.
An FSH level above 25 mIU/mL, combined with menstrual cycles spaced 60 days or more apart, is one of the consensus criteria for late perimenopause. After menopause is fully established, FSH levels climb even higher, reaching a plateau around 64 mIU/mL on average, roughly 14 times the level seen in men.
The tricky part is that FSH fluctuates significantly during perimenopause. A single test might catch a high reading one month and a normal one the next, because ovarian function doesn’t decline in a straight line. If you’re still having periods, testing is most accurate when done early in your menstrual cycle, since FSH naturally shifts throughout the month. Your provider may repeat the test weeks later to confirm a pattern rather than relying on one result.
Estradiol: Measuring Estrogen Directly
While FSH measures your brain’s signal to the ovaries, estradiol measures what the ovaries are actually producing. These two tests work as a pair: as FSH rises, estradiol falls. Premenopausal women typically have estradiol levels between 10 and 300 pg/mL, varying with the menstrual cycle. After menopause, estradiol drops below 10 pg/mL.
Estradiol on its own isn’t a reliable menopause test during perimenopause because it swings wildly from month to month. You can have a perfectly normal estradiol reading in the same week you’re having hot flashes. But when combined with an elevated FSH, a consistently low estradiol level helps confirm that the ovaries have significantly slowed down.
AMH: Predicting When Menopause Will Arrive
Anti-Müllerian hormone is different from the other tests on this list. It doesn’t confirm menopause. Instead, it estimates how many eggs your ovaries have left, which helps predict how far away menopause might be. AMH is produced by the small follicles in your ovaries, and it declines steadily over time in a way that’s less erratic than FSH or estradiol.
Research published in The Journal of Clinical Endocrinology and Metabolism found that AMH was a stronger predictor of time to menopause than either FSH or inhibin B. Women in the lowest AMH quartile (below 0.20 ng/mL) reached menopause in a median of about 6 years, while those with higher levels (above 1.50 ng/mL) had a median of nearly 13 years. Once AMH becomes undetectable, the median time to menopause is roughly 6 years.
Age matters alongside the number. A woman aged 45 to 48 with very low AMH might expect menopause in about 6 years, while a woman aged 35 to 39 with the same low AMH level might not reach it for closer to 10 years. AMH testing is most useful if you’re in your late 30s or early 40s and want a rough timeline, perhaps for family planning or to understand early symptoms.
LH: A Supporting Test
Luteinizing hormone rises during the menopausal transition for the same reason FSH does: the pituitary is working harder to stimulate ovaries that aren’t responding as well. LH and FSH generally climb together, though they don’t rise at the same pace. LH tends to plateau earlier than FSH, which keeps climbing into postmenopause.
LH is less commonly used as a standalone menopause marker because it doesn’t add much beyond what FSH already tells your provider. The LH-to-FSH ratio, which is sometimes useful in diagnosing conditions like polycystic ovary syndrome, doesn’t show significant changes across the stages of menopause. LH may be included in a hormone panel for completeness, but it’s rarely the deciding factor.
Progesterone: Confirming Ovulation Has Stopped
Progesterone surges after ovulation each month. When the ovaries stop releasing eggs, progesterone production drops to minimal levels. In postmenopausal women, progesterone typically falls below 1 ng/mL.
This test is more useful for confirming that ovulation has ceased than for diagnosing menopause itself. If you’re in perimenopause and still having occasional periods, a low progesterone level in the second half of your cycle suggests those periods are happening without actual ovulation, which is common in the years leading up to menopause.
Thyroid and Prolactin: Ruling Out Mimics
Hypothyroidism and high prolactin levels can both cause symptoms that look remarkably like menopause: missed periods, hot flashes, and vaginal dryness. A prolactin level above 100 ng/mL can produce all three of those symptoms. And hypothyroidism itself can raise prolactin through a chain reaction involving thyroid-releasing hormone, which stimulates both thyroid hormone and prolactin production.
Because of this overlap, a thyroid-stimulating hormone (TSH) test is frequently ordered alongside FSH and estradiol, especially if you’re under 45 or if your symptoms don’t quite fit the typical menopause pattern. Thyroid dysfunction is common in women during midlife, and catching it changes the treatment entirely. If hypothyroidism is the underlying cause, correcting it with thyroid hormone replacement normalizes prolactin on its own.
When Hormonal Birth Control Complicates Testing
If you’re using combined hormonal contraception (the pill, patch, or ring) or hormone replacement therapy, standard hormone tests won’t give accurate results. These medications suppress your body’s own production of estradiol, FSH, and LH, so a blood test will reflect the medication rather than your actual menopausal status. There’s no reliable way to “test through” combined hormonal contraception.
Progestin-only methods like the hormonal IUD, implant, or mini-pill are less straightforward. They may or may not suppress FSH enough to make testing unreliable. Your provider will likely need to consider the specific method you’re using and possibly have you stop it temporarily before testing, depending on your situation.
Blood Tests vs. Saliva Tests
Blood draws (serum testing) remain the clinical standard for measuring menopause-related hormones. Saliva tests are marketed as a more convenient alternative, but the evidence for their accuracy is limited. A study comparing simultaneous saliva and blood samples from postmenopausal women found that saliva estradiol correlated well with blood levels only in women already using estrogen therapy. In women not on estrogen therapy, the correlation was not statistically significant. The low concentration of estradiol in saliva makes it difficult to measure precisely, and the methodology requires larger sample volumes to produce valid results.
If you’re considering an at-home saliva test kit, keep in mind that the results may not match what a blood test would show, particularly if you’re not on hormone therapy. For clinical decision-making, a blood test through your provider gives the most reliable numbers.
Which Tests You Actually Need
The testing your provider orders depends heavily on your age and circumstances. For women over 45 with irregular or absent periods and typical symptoms, many guidelines recommend against routine hormone testing entirely. The diagnosis is clinical, meaning your symptoms and menstrual history are enough.
Testing becomes more valuable in specific scenarios. If you’re under 45 and periods have stopped or become irregular, FSH and estradiol help determine whether you’re experiencing early menopause. If your symptoms overlap with thyroid disease, adding TSH and prolactin helps sort that out. If you want to estimate your reproductive timeline, AMH combined with your age gives a rough forecast. And if you’re on hormonal contraception and want to know whether you’ve reached menopause, the timing and method of testing requires careful planning with your provider.
Hormone levels during perimenopause are inherently unstable, so a single set of normal results doesn’t rule anything out. A repeat test several weeks later, or simply tracking your symptoms over time, often provides more clarity than any one blood draw.