Perimenopause and menopause tests: what a blood test can confirm, and what it costs.
There is no single blood test that confirms perimenopause or menopause. Over 45, doctors make the diagnosis from your symptoms and cycle history. A blood test earns its place under 45, on hormonal contraception, or to check thyroid and iron, which mimic the transition. In Australia that test is often rebated through a GP, or self-pay from $199 with KnowLuna.
Why there is no single "menopause test", and when FSH helps
The hormone people expect on a menopause test is FSH, follicle stimulating hormone. As the ovaries slow down, the brain releases more FSH to stimulate them, so FSH rises and, after menopause, stays high. After menopause it is a reasonably clean marker.
The problem is perimenopause. During the transition the ovaries do not wind down smoothly. One month they barely respond and FSH climbs; the next they produce a burst of oestradiol and FSH drops back into the premenopausal range. A single result is a snapshot of a moving target. This is why Australian guidance from the Australasian Menopause Society and Jean Hailes says that in women over 45 with typical symptoms, hormone testing is not needed to make the diagnosis. Your doctor reaches it from your age, your symptoms and what your periods are doing.
So when does FSH help? Under 45, when the question is whether the ovaries are changing early; when you have no periods to track because of contraception or a hysterectomy; and after menopause, to confirm the picture. In each case it is read alongside everything else, never on its own.
FSH and oestradiol levels in perimenopause and after menopause
These are typical patterns, not cut-offs, and they assume a sample taken on day 2 to 5 of a cycle where cycles still occur. Hormonal contraception changes both readings (more on that below).
| Stage | FSH (IU/L), typical | Oestradiol (pmol/L), typical | What it usually means |
|---|---|---|---|
| Reproductive years, day 2 to 5 | Roughly 3 to 10 | Roughly 100 to 300 | Ovaries responding normally to a normal signal. |
| Early perimenopause | Often still in the normal range, sometimes higher | Normal, sometimes higher than expected | Cycles shortening; a single result often looks unremarkable. |
| Late perimenopause | Frequently above 25, but swings month to month | Variable, trending lower | Skipped cycles; one high FSH supports but does not settle the picture. |
| Postmenopause (12 months without a period) | Usually above about 30, and stays there | Usually below about 100, often much lower | Consistent with menopause when it matches your history. |
Ranges vary by laboratory; your report shows the range your lab uses. Typical ranges on this page are drawn from Pathology Tests Explained (RCPA) and the sources listed below.
Notice that early perimenopause, when most women are searching for answers, is exactly the stage where the numbers are least helpful. FSH and LH are the hormones that end up high, but a high reading only means something next to your age and cycle history. See FSH and LH levels explained for more.
Why a blood test is more useful under 45 or on contraception
Under 45. Menopause between 40 and 45 is called early menopause, and menopause before 40 is premature ovarian insufficiency, so symptoms at these ages are assessed properly rather than assumed. Here the hormone results carry real weight: a high FSH at 38 is a different finding from a high FSH at 50, and other causes of missed periods, such as thyroid disease, raised prolactin and pregnancy, need to be excluded. Doctors often repeat the test four to six weeks later because of the fluctuation described above.
On hormonal contraception. The combined pill, patch and ring, and the injection, suppress FSH, LH and oestradiol, so those readings mostly reflect the contraception rather than your ovaries. The implant and the hormonal IUD interfere much less. TSH and iron studies remain informative. Testosterone and SHBG are also altered by combined hormonal contraception (SHBG rises, testosterone falls), and prolactin can be mildly raised by it, so those markers are best read off it. FSH stays unreliable on the combined pill even in the pill-free break, so if the hormone picture itself matters, your doctor may suggest changing method before testing. The contraception and hormone tests article explains which methods affect which markers.
After a hysterectomy. Without periods to track, blood results give your doctor something concrete to work with.
What else the KnowLuna panel checks, and why
Fatigue, brain fog, low mood, palpitations, poor sleep and weight change are classic perimenopause symptoms. Every one is also a classic symptom of an under-active thyroid or low iron, both common in women in their forties and both easy to measure. That is why the perimenopause and menopause panel is built the way it is.
- FSH, LH and oestradiol: the hormone picture, read with the fluctuation caveat in mind.
- TSH: the first-line thyroid marker. Thyroid problems disturb cycles, mood, weight and energy.
- Iron studies including ferritin, plus a full blood count: heavy periods in the early transition are a common way to run iron stores down.
- Testosterone and SHBG: androgens shift through the transition and influence energy, mood and libido.
- Prolactin: a raised level can stop or disturb periods and is easy to mistake for the transition.
The symptoms checklist shows which individual symptoms a blood test can and cannot help with.
Cost with a GP vs self-pay, and KnowLuna's price
Through your GP. When a GP requests FSH, oestradiol, TSH and iron studies for a recognised clinical reason, the pathology is usually rebated by Medicare, so at the collection centre you may pay nothing. Your cost is the GP appointment (bulk-billed or with a gap fee), usually a second appointment for the result, and time. Medicare rebates hormone tests requested for a clinical reason; testing purely for reassurance or a baseline may not qualify, and your GP can tell you whether a rebate applies.
Self-pay. Consumer-initiated pathology is not rebated. Prices vary between providers, and so does what is included: a single FSH result with a PDF is a very different product from a panel with a doctor who explains it. See hormone test without a GP for the questions to ask any provider.
KnowLuna. The perimenopause and menopause panel is $199 (indicative launch price) with your own doctor's signed request, or $279 when a KnowLuna women's health doctor reviews your questionnaire, requests the panel and explains the results in a 20-minute video consult. Both include the same accredited laboratory testing and plain-English report. The KnowLuna vs your GP page sets out both routes fairly; every test for this stage is on the perimenopause and menopause hub and the pricing page.
What happens after the result: the doctor conversation
Your report arrives in your account with each marker explained in plain English. If you chose the KnowLuna doctor option, the consult is where the numbers become useful: the doctor tells you whether the overall picture fits perimenopause, points out anything that needs attention (a low ferritin, a TSH outside range) and explains what to raise with your regular GP. Abnormal results are always followed up by a doctor, whichever route you took.
The conversation is not a treatment plan. KnowLuna is a testing service, and decisions about managing symptoms belong with a doctor who knows your history. If your doctor has prescribed menopause treatment, the separate menopause treatment monitoring panel checks levels and general health markers. Not sure your pattern fits the transition at all? Start with the three-minute perimenopause quiz, or read perimenopause blood test: what it can and can't tell you.
Common questions
Can you actually test for perimenopause?
Not with a single yes-or-no result. Perimenopause is a clinical diagnosis based on age, symptoms and cycle changes. FSH and oestradiol fluctuate so much during the transition that one reading can look normal one month and postmenopausal the next. A blood test is still useful under 45, on contraception, and for checking thyroid and iron, which produce very similar symptoms.
Will my GP do a blood test for perimenopause?
Many GPs will, particularly if you are under 45, on contraception, or have symptoms that could have another cause. Some will explain that over 45 with typical symptoms a hormone test is not needed for the diagnosis, which is consistent with Australian guidance. Asking specifically for thyroid and iron to be checked alongside hormones is a reasonable request at any age.
What should FSH and LH levels be in menopause?
After menopause FSH is usually above about 30 IU/L and stays there, with LH raised as well and oestradiol low. During perimenopause the readings swing between normal and postmenopausal values, so a single result is only meaningful next to your age and cycle history. Ranges vary by laboratory; your report shows the range your lab uses.
How much does a menopause blood test cost in Australia?
Through a GP the pathology is usually rebated by Medicare when requested for a clinical reason, so your cost is mainly the appointments. Self-pay prices vary by provider and by what is included. KnowLuna's perimenopause and menopause panel is $199 with your own doctor's request or $279 with a KnowLuna doctor's request and results consult, indicative launch prices.
How do I know what stage of perimenopause I'm in?
Mostly from your cycle. Early perimenopause is when cycles change length by a week or more but still arrive; late perimenopause is when you start skipping cycles for 60 days or longer. Menopause is confirmed after 12 months without a period. Blood results support that assessment rather than replace it, and your doctor reads them alongside your history.
Sources and further reading
- Australasian Menopause Society: Diagnosing menopause (information sheet)
- Australasian Menopause Society: What is menopause? (information sheet)
- Jean Hailes for Women's Health: menopause
- Pathology Tests Explained (RCPA): follicle stimulating hormone (FSH)
- Medicare Benefits Schedule: item 66695, hormone quantitation
- Healthdirect: menopause
Prices are indicative launch prices in Australian dollars including GST and may change. General information only, not medical advice. If your symptoms are severe or sudden, see a doctor promptly.
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