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Menstrual & Sex Hormones: What to Test (and What Not To) When Diagnosing Perimenopause

Menopause is a clinical diagnosis, defined as one full year without a menstrual period. For most women over the age of 45 experiencing typical menopausal symptoms, routine hormone testing is not usually necessary. Diagnosis is typically based on your age, health history, menstrual patterns, and symptoms.

This can feel frustrating, as many women understandably want concrete lab results. But here’s why testing isn’t always helpful: hormone levels fluctuate constantly throughout the menstrual cycle and even from month to month. A test on one day might look very different from another, making interpretation tricky and sometimes misleading.

Instead, symptom tracking is often more helpful in identifying the root of your concerns, whether it’s perimenopause, PMS, iron deficiency, thyroid issues, insulin resistance, or something else.

WHEN TESTING IS *NOT* ACCURATE
Hormone levels can’t be accurately assessed in women who are taking:
**Oral contraceptives**, or
**Hormone Replacement Therapy (HRT)**
These medications alter hormone levels in the blood, so tests like estrogen or FSH won’t give us meaningful information about your menopausal status or help decide when to stop contraception.

When Hormone Testing Is Helpful

Hormone testing may still be useful in specific situations, especially when the picture isn’t so clear:

Women under 45 with persistent irregular cycles (less than 21 days or more than 35 days)
→ Testing can help determine whether it’s perimenopause, PCOS, or another condition.
Women over 50 using progestogen-only contraception (like the IUD)
→ These contraceptives often cause regular bleeding, making it hard to know if menopause has occurred. In these cases, FSH testing can help clarify menopausal status.
Women under 48 who have stopped menstruating altogether
→ Hormone testing may help identify early menopause or another underlying issue.
Suspected PCOS that hasn’t been formally diagnosed
→ Blood work can help confirm or rule out the diagnosis.
Women without a uterus who are experiencing menopausal symptoms
→ Testing can offer clarity when menstrual cycles are not a reference point.

If You Do Test: Timing Matters

If you're still getting periods and we decide hormone testing is appropriate, Day 2–4 of your cycle (counting from the first day of bleeding) is the best time for testing. At this stage:

Estrogen is low
Progesterone hasn’t yet kicked in
FSH and LH are starting to stimulate the ovaries

This timing gives us the clearest baseline picture.

Don’t Overlook Other Possibilities

Sometimes your symptoms may not be hormone-related at all. Other lab tests may be more useful to investigate:

Thyroid function
Iron levels
Vitamin D status
Insulin resistance
Prolactin levels

In Summary:

Hormone testing isn’t always necessary, but symptom tracking is often more insightful.

If testing is done, do it on Day 2–4 of your cycle.
Other lab tests might better explain your symptoms.
Talk to your naturopathic doctor about the best approach for you.

want to go deeper?

I offer personalized evaluations that go beyond lab results to understand the whole picture. Reach out to schedule a consult, your hormones (and your peace of mind) are worth it.

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