Should I Use a Menopause Test?

I am in my late 40s. My periods have changed in the past few years. I would love to know how much longer I am going to have a period. Should I take the new OTC menopause test? How reliable is it?
—Anonymous

There are a number of products available over the counter to tell you about your hormone levels. Historically, they have involved collecting saliva and sending it off to a commercial lab for analysis. The tests typically cost more than $100, and results take some time to get back to you. They give you little more information than a blood test drawn in your doctor’s office.

In August 2023 a new, inexpensive urine test promising to help you pinpoint your stage of menopause hit the shelves. For many of us, using the urine test will remind us of our days taking pregnancy tests or using ovulation predictor kits (OPKs). This makes sense given that the test is manufactured by Clearblue Easy, a maker of at-home urine pregnancy tests and OPKs. And the menopause kits work similarly. The menopause tests use the same technology to measure a different hormone, follicle-stimulating hormone (FSH).

FSH is made in the pituitary gland and stimulates the ovaries to mature an egg. As women progress through perimenopause, it takes more FSH to get the ovaries to mature an egg, so FSH rises. When there are no eggs left, FSH gets sky-high but the ovaries can’t respond. That is menopause.

The idea behind the menopause test is that rising levels of FSH in your urine mean you are further along the path toward menopause. However, this is complicated, because in all women FSH varies throughout a cycle. Cycles in women in perimenopause are quite variable in length, which makes it harder to know where exactly a woman is in her cycle. The Clearblue Easy test gets around this issue by requiring five tests over 10 days. They also collect data from users about cycle history. You plug all this information into an app, and the app tells you what stage of perimenopause you are in.

If the test is used perfectly, persistently elevated FSH levels in the urine could help determine where you are in the menopausal transition. But reading the instructions, it is clear there are many opportunities for error, including waiting too long to read the test, drinking too much water before taking the test, not using the first morning urine, and providing inaccurate information in the app.

As with any test, my biggest question is: what will you do with the results? The manufacturer encourages women to take the results to their physician to help guide treatment. As a physician who treats the symptoms of menopause, I don’t need this information to prescribe treatment for perimenopause. There are many situations in which the test might falsely diagnose perimenopause, including in women with polycystic ovarian syndrome (the manufacturer recommends against using the test in these women) or even in women who test around ovulation.

My recommendation: Skip the test, but don’t hesitate to have a conversation with your doctor about changes in your menstrual cycle or any symptoms you are having that may be related to menopause.