Perimenopause Test: How to Know If You’re in Perimenopause

Navigating perimenopause can feel like solving a puzzle with missing pieces. Hot flashes, irregular periods, mood changes – are these just normal aging or signs of a major hormonal shift? For women in their 40s wondering what's happening in their bodies, perimenopause tests might offer clarity. But which tests are worth taking, and when are symptoms alone enough for answers? In this article, you'll find a straightforward guide to perimenopause testing options, what hormone levels can tell you about this natural transition, and when it's time to consult with a healthcare professional.

What’s Perimenopause?

Perimenopause is the transitional stage before menopause, the point when periods stop permanently. It’s a gradual shift, not an overnight change. During this phase, the ovaries slowly begin to produce less estrogen and stop releasing eggs.

This stage typically begins in the mid-40s, approximately four years before the final period, although timing can vary. Hormone levels, especially estrogen, fluctuate a lot, sometimes spiking high or dropping low, which leads to many of the typical symptoms.

Common symptoms of perimenopause vary widely, but hot flashes are the most well-known, affecting up to 80% of women. These sudden waves of heat often involve sweating, chills, and palpitations, and can disrupt sleep at night (“night sweats”).

Other common signs include sleep disturbances (even without hot flashes), mood changes like depression and anxiety (especially in those with a history of mood disorders), and cognitive issues such as forgetfulness or “brain fog.”

Women may also notice joint pain, breast tenderness, menstrual migraines, and changes related to lower estrogen, such as vaginal dryness, discomfort, and urinary symptoms, collectively known as Genitourinary Syndrome of Menopause (GSM).

Perimenopause can be challenging to identify since symptoms vary so much from person to person. The Mira Menopause Transitions Kit and the Mira App’s free Menopause Mode make this process easier by offering real-time hormone tracking and personalized insights.

By measuring key hormones and their metabolites like FSH, LH, E3G, and PdG with ultra-sensitive technology, the kit helps you define your stage – late reproductive years, early transition, late transition, postmenopause, – and track patterns like irregular cycles or ovulation. You can also log symptoms, see how they relate to your perimenopause hormone levels, and even monitor how treatments like HRT work. After two months of testing, you'll receive a personalized report with recommendations and key points to discuss with your doctor.

What Is a Perimenopause Test?

A perimenopause test checks the levels of certain hormones in the body that play a key role in regulating the menstrual cycle and the transition to menopause. During perimenopause, these hormone levels begin to shift in specific patterns. When measured, these changes can help doctors recognise whether someone is entering this transitional phase.

Perimenopause tests come in various forms, which we will discuss shortly.

Why Testing for Perimenopause Is Important

There are several reasons why testing for menopause is important:

• For peace of mind
  
  If you’re not sure whether what you’re experiencing is related to perimenopause or something else, testing can help connect the dots by showing what your hormones are doing behind the scenes.
  

• For those on birth control
  
  Birth control can mask natural cycle changes, making it harder to tell if you're in perimenopause. Hormone tracking offers an extra layer of insight when cycle-based clues are missing.
  

• For appointments
  
  Bringing hormone data to your appointments helps paint a clearer picture. It can back up your feelings, guide treatment decisions, and make conversations with your provider more productive.

Types of Perimenopause Tests

Perimenopause can be assessed through at-home hormone tracking (which can come in blood-test, saliva, or urine kits), and blood tests at the doctor’s office. Some doctors also use thyroid checks or bone scans to rule out other conditions or monitor related risks.

At-Home Perimenopause Tests

There are several types of at-home test kits available to help identify hormonal changes during perimenopause. These kits typically use blood, saliva, or urine samples to measure hormone levels from the comfort of your home.

At-home Blood Testing

At-home blood tests for perimenopause usually involve collecting a small sample through a finger prick. These tests measure follicle-stimulating hormone (FSH), which can help indicate whether you may be entering perimenopause.

Saliva Testing

Saliva-based tests usually measure the levels of three types of estrogen: estrone, estradiol, and estriol. Among these, estradiol is particularly relevant for assessing menopausal status. 

Urine Testing

At-home urine tests provide a more comprehensive view of hormone fluctuations by tracking changes over time. Tools like the Mira Hormone Monitor, Wands and Mira App measure key hormones including FSH, estradiol metabolite E3G, luteinizing hormone (LH), and progesterone metabolite PdG. These non-invasive tests provide insight into hormonal patterns, making it easier to monitor the perimenopause or menopausal transition without repeated clinic visits.

Advantages

These at-home tests are simple, non-invasive, and easy to use from the comfort of your own home. Compared to frequent lab visits, at-home hormone tests are also more affordable and accessible.

Accuracy & limitations

At-home hormone tests, especially those using saliva or urine, aren’t designed to diagnose perimenopause or menopause on their own. They work best when interpreted alongside your symptoms and hormone trends over time. Because hormone levels naturally fluctuate daily, a single reading may not provide the full picture.

• Saliva-based tests, in particular, tend to have inconsistent accuracy and are less commonly used in clinical settings.
  

• Urine hormone levels can also be influenced by external factors like hydration and metabolism, which may affect results.

Accuracy can also vary depending on the brand of the test and how it's used, so results should always be interpreted with caution.

Blood Tests for Perimenopause at the Doctor's Office

Blood tests for perimenopause are typically done by drawing a sample from a vein in your arm, usually in a clinic or doctor’s office. 

These tests measure hormones like follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), and progesterone. Another hormone that can be checked through blood tests is Anti-Müllerian Hormone. We’ll discuss this one later in the article.

When entering perimenopause:

• FSH levels tend to rise as the ovaries become less responsive.

• Estradiol levels often begin to decline, contributing to many of the hallmark symptoms, like hot flashes and irregular periods. 

• LH, which works closely with FSH, also changes during this time and helps regulate the menstrual cycle. 

• Progesterone, measured during the second half of the cycle, can drop when ovulation becomes irregular.

Advantages

The primary benefit of blood testing at a doctor’s office for perimenopause is that the results are interpreted by a healthcare professional, who can align them with their clinical expertise. Since the diagnosis of perimenopause and menopause is largely based on symptoms and medical history, having a doctor review hormone levels adds important context. 

Another advantage of these tests is that they provide more precise hormone measurements at the time of testing. 

Limitations

Hormone levels fluctuate daily during perimenopause, so a single blood draw may not capture the full hormonal picture. 

Additionally, follicle-stimulating hormone (FSH) on its own is an unreliable marker; normal levels do not rule out perimenopause, and elevated levels can occur even outside the menopausal transition. 

Last but not least, blood testing requires a clinical setting and venipuncture, making it more invasive and typically more expensive than at-home urine or saliva-based hormone tracking.

Additional Diagnostic Tests

Additional tests for perimenopause include thyroid function tests and bone density scans. 

• Thyroid function tests, done through a blood sample, help rule out thyroid-related conditions that can mimic perimenopausal symptoms.
  

• Bone density scans, typically performed using DEXA, evaluate bone strength and assess the risk of osteoporosis, which becomes more relevant as estrogen levels decline during this stage.

However, it's important to note that these tests do not confirm perimenopause directly; they are used to assess related health concerns. Additionally, they may require specialist referrals and come with added costs.

Limitations of Perimenopause Testing 

The main limitation of perimenopause testing is that it’s often unnecessary. Healthcare providers emphasise that perimenopause is usually a clinical diagnosis, based primarily on symptoms rather than lab tests.

Additionally, even if testing is desired, symptoms and hormone patterns over time are far more meaningful than a single test result. For instance, a one-time hormone test, such as FSH, can be misleading; just because a result falls within the normal range doesn’t rule out perimenopause. Hormone levels naturally fluctuate during this phase, so relying on a single reading offers only a limited snapshot. 

When to Take a Perimenopause Test

You might consider testing if you're experiencing signs like:

• Irregular periods

• Hot flashes

• Mood changes

• Sleep disturbances
  

That’s especially true if you're in your 40s. 

Hormone levels fluctuate throughout the cycle, so tests like FSH and progesterone are often most informative when timed properly (e.g., FSH early in the cycle, progesterone around day 21). Age also plays a role; testing is generally more relevant for those over 40 with symptoms, but younger women with suggestive signs may also benefit from evaluation.

For those unsure about when or what to test, the Mira Hormone Health Clinic for Fertility offers expert support tailored to your fertility journey.

Whether through a one-time consultation or ongoing support, you’ll receive personalized insights, hormone analysis, and practical recommendations to support hormonal balance and overall reproductive health.

How to Interpret Perimenopause Test Results

What different hormone levels indicate:

• FSH (Follicle-Stimulating Hormone): In perimenopause, FSH tends to stay elevated across the cycle, not just around ovulation.
  

• LH (Luteinizing Hormone): The LH surge may still occur, but it can be less sharp or less predictable than in younger reproductive-age women.
  

• Estrogen (estradiol): estradiol levels are generally higher and more erratic in early perimenopause. Later on, estradiol levels become lower than those in non-perimenopausal women.
  
  Why are estrogen levels higher in early perimenopause, you may ask? Well, that’s because ovaries become less consistent but remain active. The feedback loop between the brain and ovaries starts to falter, leading to “estrogen dominance”, a state where estrogen levels spike unpredictably due to irregular or absent ovulation. With less progesterone to balance estrogen, hormone levels may appear elevated.
  

• PdG (Pregnanediol Glucuronide): This progesterone metabolite is usually lower in perimenopause, reflecting weaker or inconsistent ovulation.

As we’ve been mentioning, a single hormone result may not confirm perimenopause.

Repeated patterns, like consistently high FSH, elevated estradiol (E2), and low progesterone, are stronger indicators of the transition.

In contrast, some markers provide more stable insights. Anti-Müllerian Hormone (AMH) and antral follicle count (AFC) don’t vary much across the cycle and are considered more reliable indicators of declining ovarian reserve. Lower AMH or AFC levels suggest that a woman is approaching menopause, making them clearer markers of perimenopause.

If symptoms are significant or results are unclear, it's important to follow up with a healthcare provider for further evaluation or repeated testing.

Treatment and Management Options After Testing

Once perimenopause is identified, managing symptoms and supporting long-term health becomes key. Lifestyle changes, such as healthy eating, regular exercise, and stress management, can help alleviate symptoms like mood swings, sleep disturbances, and fatigue.

There are also medications available for perimenopause management. For example, Hormone Replacement Therapy (HRT), also known as Menopausal Replacement Therapy, is a common and effective perimenopause treatment. It replaces declining estrogen, and if needed, progesterone, to relieve symptoms like hot flashes, brain fog, and vaginal dryness. HRT comes in various forms: patches, gels, tablets, or implants, and may also include testosterone if low libido persists. Though there are some risks, they’re usually small and often outweighed by the benefits.

Some choose to explore natural remedies or perimenopause supplements, such as black cohosh, evening primrose oil, or red clover. While these may be helpful, they’re best used under medical guidance, as they can interact with other medications.

A tailored plan, medical or natural, should be guided by your symptoms and a doctor’s input.

Conclusion

While most healthcare providers emphasize that perimenopause is primarily diagnosed through symptoms rather than lab results, hormone testing for women can provide valuable peace of mind for those experiencing changes typical of this transition. 

Whether you choose at-home options like urine or blood tests, or clinical blood work, remember that a single test result rarely tells the complete story. Perimenopause testing works best when tracking patterns over time and interpreting results alongside your symptoms. 

For those experiencing hot flashes, irregular periods, mood changes, or sleep disturbances, especially in your 40s, testing can confirm whether perimenopause is indeed the cause and help guide appropriate treatment decisions.

Whatever approach you choose, partnering with a healthcare provider to develop a personalized management plan remains the most effective strategy for navigating this natural life transition.

Frequently Asked Questions

What are the signs that you need hormone replacement therapy?

If perimenopause symptoms are bothering you and ruining your everyday routine, then that’s usually enough of a sign that you may need hormone replacement therapy.

Can you be perimenopausal and not have symptoms?

Yes. Perimenopause can feel different for everyone. Some may have several signs of perimenopause, while others may have none.

What are the warning signs of perimenopause in women?

Warning perimenopausal symptoms, like very heavy bleeding, bleeding between periods, or symptoms that start unusually early, may signal the need to see a doctor to rule out other conditions. Not all changes are typical, so it’s best to check if something feels off.