Do Menopause Tests Work?

You may have heard of or seen menopause test kits in your local drugstore that guarantee to help you know if you are in (peri) menopause. Or you may have even seen glowing reviews on Amazon and social media platforms, but is the hype all smoke and mirrors or are there real diagnostic benefits of these tests? Read on to find out.

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What is a menopause test?

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There are a few variations of OTC menopause tests available that roughly fall into two buckets:

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The first type is the most basic and standard (peri-)menopause test kit that is available in drugstores and online, and is simply a test that measures the levels of follicle-stimulating hormones (FSH) in your urine. It looks like a standard at-home pregnancy test, and works in much the same way - you pee on the stick and wait for it to show results in 15min. The result being either your FSH levels are above or below a certain level - usually 25 mIU/mL [milli-international units per milliliter]. 

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For the second type of test, the more advanced version, you will receive a collection kit at home in which you collect saliva or blood and send this off to a laboratory to be tested. The test results will normally provide detailed information on whether certain hormones such as FSH, Luteinizing hormone (LH), Estrogen, Progesterone, Testosterone, and Estradiol, fall within established normal ranges. In Singapore these type of at home collection and test kits are currently not legally allowed, and hence all at home menopause test kits use urine to measure FSH levels.

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‍How does a “Menopause Test” work

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The follicle-stimulating hormone (FSH) is a female hormone produced in the pituitary gland in the brain and plays an important role in regulating ovulation and supporting ovarian follicles (egg) development. This essentially means that your FSH levels will fluctuate throughout your hormonal cycle as your ovaries produce and release eggs (see image 1). Interestingly, as you age your FSH levels increase. Now, this may seem contradictory and you are probably wondering why FSH  levels are not declining now that your ovaries are on a hiatus. 

During menopause, the number of follicles in your ovaries decreases, and because the follicles are also responsible for producing estrogen, their decline also means lower estrogen levels. When this happens, your brain receives feedback to produce more FSH in order to stimulate the follicles. However, because there aren’t (enough) follicles to make use of the produced FSH, the levels of FSH in the bloodstream increases and rise above the normal range.

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How accurate are the test results? 

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The accuracy of course depends on the particular test you are taking but in general these tests will accurately detect your FSH levels about 9 in 10 times. Having said that, there are a few factors that can skew the results of the test - meaning that it is no longer an accurate representation of the state of your hormones:

• The timing of the urine collected: was it the first urine in the morning?
• Amount of water consumed before the test - changes in total body water can affect hormonal balance. 
• If you are on or recently used birth control pills, this is because the estrogens in birth control pills will suppress FSH levels. 
• If you are receiving estrogen supplements or hormone replacement therapy
• On which day of your cycle you took the test

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But regardless of the accuracy of the test, the real question we need to ask is:

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is an increased FSH level on its own a good indicator of peri-menopause, and/or nearing menopause? 

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What do the test results mean?

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A positive test result (meaning high levels of FSH are detected) may indicate that you are in a stage of menopause, but high FSH levels can also be seen just before your ovaries release an egg. Conversely, a negative result does not definitively mean that you are not in peri- menopause, especially if you exhibit symptoms of menopause such as hot flashes, night sweats or irregular periods. The results are anything but foolproof, and you should always talk to your doctor about any concerns you might have.

When is a menopause test useful? 

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In our humble opinion, an at home testing kit purely measuring the existence of FSH levels is not helpful in determining if you are in peri-menopause. FSH alone is not a good indicator if you are going through peri-menopause, and it has no diagnostic value. Instead, take note of your symptoms (if any) and speak to a trained medical professional to get a diagnosis.  

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If you think you are going through peri-menopause and you would like to get a diagnosis for peace of mind. Or you are experiencing troubling symptoms that you would like to get treatment for - speak to a trained physician. Because of the strong fluctuation of hormones in the peri-menopause phase, your doctor will base a diagnosis on self reported symptoms. When it comes to menopause, a diagnosis is very simple - if you haven’t had a period in 12 months you are considered to have gone through menopause and are no menopausal.  

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Why are these tests being sold?

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So why are these tests being sold you ask? Good question, and the answer is not great. There are probably several reasons but the main one seems to be corporate greed. Companies want to make money, and this has proven to be a relatively good market. Now the reason why women are actually buying these tests is actually more interesting. Here are some of the top reasons on our list.

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Certainty We all want a form of certainty in life and women in mid life are not any different. If you are in your mid forties it is likely that you are entering peri-menopause and having a diagnosis brings piece of mind for many. And if a test claims to do that for $10 and 15min it is tempting! 

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False advertising and good marketing - another reason is false advertising or good marketing, depending on how you look at it. Surely a medical test claiming that it tests you for (peri) menopause does so? Even though this is what is written (in huge font size!) on most of the boxes, the small print usually says something along the lines of ‘FSH may sometimes be a helpful marker of menopause’. Very vague language, and certainly not clear on the fact that an elevated level of FSH is not enough to make a definitive diagnosis.

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‍Poorly regulated market Just like the supplement market, these at-home test kits seem to fall in a grey area that is not or poorly regulated in most countries; leaving the door wide open for manufacturers with above mentioned questionable marketing techniques that prey on women fearing menopause.