Perimenopause and menopause blood test

The perimenopause and menopause blood test is a nine-marker panel for women whose cycles, sleep, mood or energy have started to change. It costs $199 with your own doctor's signed request, or $279 with a KnowLuna doctor who requests the panel and explains your results in a 20-minute video consult. Collect at an accredited Australian centre, or choose a home kit or a nurse visit at checkout (options below).

Here is the honest framing first, because it matters more than the numbers. Perimenopause and menopause are clinical calls, made from your age, your symptoms and your cycle history, not from a single blood result. Hormones swing widely during the transition, so one sample is a snapshot of one day. Where blood tests earn their place is in the situations below, and in ruling other things in or out.

When a blood test helps, and when symptoms are the answer

• You are under 45. Guidelines are clear that hormone testing is worth doing when symptoms start early, because early menopause is managed differently and deserves a proper look.
• You have had a hysterectomy with your ovaries left in place. Without a cycle to read, symptoms alone are harder to interpret, so the hormone markers add something.
• You are on hormonal contraception. On the combined pill, patch or ring the hormone markers cannot be interpreted, so the value is in the thyroid, iron and prolactin screen.
• Your symptoms are atypical or could easily be something else: exhaustion, brain fog, palpitations, hair shedding, low mood.
• You want other causes checked before you accept "it is probably your hormones" as the whole story.
• You are over 45 with classic symptoms and changing periods. In this case a hormone level often adds little, and your doctor may say so. The thyroid and iron markers in this panel can still be worth having.

What it measures

• FSH (follicle-stimulating hormone): the pituitary signal that asks the ovaries to recruit an egg. It tends to rise as the ovaries respond less readily, and it is the marker most people mean when they say "the menopause test".
• LH (luteinising hormone): read with FSH for context on how the cycle is being driven.
• Oestradiol: the main oestrogen of the reproductive years. It does not fall in a straight line through perimenopause; it can spike high and drop low, sometimes in the same month.
• Testosterone: women make testosterone too, and it declines slowly with age rather than at menopause. It is measured as a baseline and to pick up an unusually high or low result, read together with SHBG. A level cannot explain low libido or low energy.
• SHBG (sex hormone binding globulin): the protein that carries sex hormones in the blood. It changes how much testosterone is actually available, so a testosterone result without SHBG is hard to read.
• Prolactin: a raised level is a checkable cause of irregular or absent periods that has nothing to do with the transition.
• TSH (thyroid-stimulating hormone): thyroid changes are common in the forties and fifties and produce many of the same symptoms.
• Iron studies (including ferritin): heavy or unpredictable bleeding drains iron stores, and low iron is one of the most common reasons for exhaustion in this age group.
• Full blood count: shows whether low iron has progressed to anaemia, and gives a broad view of your blood cells.

Who it's for

Anyone noticing changes in their forties or fifties, or earlier, who wants to understand what is happening and rule other things in or out. It is for adults aged 18 and over, with regular, irregular or absent cycles. It also suits women who have been told "your bloods are normal" without ever seeing which markers were checked.

What you'll learn, and what you won't

You will get a plain-English read on each marker against your laboratory's range, in the context of your age and where you are in the cycle if you still have one. You will also learn whether thyroid function or iron stores are contributing to how you feel, which is the part women most often say they wish they had known sooner.

What it will not do is hand you a verdict. A blood test is one input to a doctor's assessment, not a diagnosis on its own. A normal FSH does not rule perimenopause out, and a high FSH on one day does not confirm menopause. Your symptoms and history carry the most weight, and the panel supports that conversation rather than replacing it.

Things that mimic perimenopause

Tiredness, brain fog, low mood, palpitations, poor sleep, hair shedding and weight change all appear on every perimenopause symptom list, and all of them have other common causes. That is exactly why this panel is broader than a hormone-only test.

• Thyroid. An under-active or over-active thyroid produces almost the whole perimenopause symptom list. TSH is the first-line check, and a full thyroid panel follows if it is off.
• Iron. Heavy periods are common in perimenopause, and low ferritin causes fatigue, breathlessness and hair shedding long before haemoglobin falls. Read more on low iron and heavy periods.
• Prolactin. A raised prolactin can stop periods altogether and is easily missed if nobody looks for it.

Reference ranges and what they mean

The table below gives typical adult figures where they are widely published in Australia. Hormone results in perimenopause are best read as a pattern across your symptoms and history, not as a pass or fail.

Marker	Typical adult range	What it usually means
FSH, reproductive years (day 2 to 5)	About 3 to 10 IU/L	The ovaries are responding to a normal level of signal.
FSH, perimenopause	Variable. Often higher than the reproductive range on some days and entirely normal on others	This variability is the reason a single FSH cannot confirm or exclude perimenopause.
FSH, postmenopause	Persistently raised, commonly above about 30 IU/L, alongside a low oestradiol	Consistent with ovaries that are no longer ovulating. Read with 12 months without a period.
Oestradiol	Fluctuates widely through the cycle and through perimenopause, and is erratic and often high in early perimenopause before falling late in the transition; typically low and stable after menopause	A single value means little on its own. Your doctor reads it beside FSH and your cycle history.
Testosterone and SHBG	Reported against female adult ranges that differ noticeably between assays. Immunoassays are inaccurate at female concentrations, so mass spectrometry is the recommended method	Interpreted together, since SHBG changes how much testosterone is available to your tissues.
Prolactin	Under about 500 mIU/L in women who are not pregnant or breastfeeding	A mildly raised result is often repeated, because stress and time of day can nudge it.
TSH	About 0.4 to 4.0 mIU/L	Within range makes a thyroid explanation for your symptoms much less likely.
Ferritin	A lower limit of about 30 ug/L is commonly used for women	Below that, iron stores are low even if haemoglobin is still normal.
Haemoglobin	About 115 to 165 g/L for adult women	Below range indicates anaemia, which your doctor investigates rather than assumes.

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.

When to do this test

No fasting is needed. If your cycles are irregular or have stopped, collect on any day and tell us the date of your last period. If your cycles are still regular, day 2 to 5 (day 1 is the first day of full bleeding) gives the cleanest read on FSH, LH and oestradiol. Morning collection suits the thyroid and testosterone markers, and it is worth avoiding collection while you are unwell, because ferritin rises with infection and can look falsely reassuring.

If you use hormonal contraception, say so when you order. The combined pill, the patch and the ring, and the injection, suppress FSH, LH and oestradiol, so those three results largely reflect the contraception. The implant and a hormonal IUD interfere less. Thyroid, iron and prolactin stay informative on any method. Testosterone and SHBG are altered by the combined pill, patch and ring (SHBG rises, testosterone falls), so they are best read off them. Our guide to contraception and hormone tests explains what each method changes.

After the result

Your results arrive in your account as a plain-English report, each marker shown against your laboratory's range. If you chose the doctor option, a KnowLuna women's health doctor takes you through the pattern in a 20-minute video consult: what is consistent with the transition, what points elsewhere, and what is worth repeating in six or twelve months. Anything abnormal is always followed up by a doctor.

If managing your symptoms is what you want to talk about next, that is a conversation for a doctor who knows your history and can weigh your options with you. KnowLuna's role here is the testing and the explanation, so you walk into that conversation informed rather than guessing.

How it works

• Order online. Either upload the request your own doctor has signed, or a KnowLuna women's health doctor reviews your short questionnaire and requests the panel for you.
• Collect at an accredited centre near you, or choose a home kit or a nurse visit (options below). No special timing is needed if your cycles are irregular, and we will guide you if they are not.
• Results are usually ready within a few business days, explained in your account, with a doctor to talk them through and plan repeat testing if you want it.

Choose how you collect

Every option is the same accredited test and the same report. Pick what suits you at checkout; the fee, if any, is added to either pathway price.

Common questions

Sources and further reading

• Australasian Menopause Society: Diagnosing menopause (information sheet)
• Australasian Menopause Society: Perimenopause or menopausal transition (information sheet)
• Jean Hailes for Women's Health: menopause
• Pathology Tests Explained (RCPA): follicle stimulating hormone (FSH)
• Pathology Tests Explained (RCPA): oestradiol
• Healthdirect: perimenopause

General information only, not medical advice. A test result is one input to a doctor's assessment, not a diagnosis on its own, and every abnormal result is followed up by a KnowLuna doctor. If your symptoms are severe or sudden, see a doctor promptly. Read our medical disclaimer.

Related

• All perimenopause and menopause tests
• Thyroid blood test (full panel)
• Iron studies and full blood count
• What a perimenopause blood test can and cannot show
• Early signs of perimenopause
• Am I in perimenopause? A 3-minute symptom quiz