Currently, menopause affects every woman who lives long enough — approximately 51 million women in the United States alone are postmenopausal. Yet as many as half of women going through menopause experience symptoms severe enough to impact their quality of life, relationships, and professional performance, and many receive inadequate or no treatment. Because symptoms are wide-ranging and can be mistaken for depression, thyroid disorders, or ageing, women often struggle for years before receiving the diagnosis and help they need.
Menopause affects every woman differently. Recognising your symptoms and understanding their hormonal causes is the first step to reclaiming your quality of life.
Answer 18 yes/no questions about symptoms you may be experiencing to assess whether menopause is affecting your health and what you can do about it.
Are you currently experiencing this symptom?
Menopause Self-Assessment — HRT.org
Menopause is defined as the permanent cessation of menstruation following the end of ovarian function, confirmed after 12 consecutive months without a menstrual period. It marks the end of a woman's reproductive years and results from the permanent decline in oestrogen and progesterone production by the ovaries. The average age of natural menopause in the UK and US is 51 years, though it can occur as early as the late 30s (early menopause) or before age 40 (premature ovarian insufficiency, or POI).
Oestrogen is the primary female sex hormone, produced mainly in the ovaries throughout the reproductive years. It regulates the menstrual cycle, bone density, cardiovascular health, vaginal and urinary tract health, skin elasticity, brain function, mood, and sleep. When oestrogen withdraws at menopause, its effects are felt across every major organ system — which explains why menopausal symptoms are so wide-ranging. Progesterone, which works in balance with oestrogen throughout the cycle, also ceases with menopause — removing its calming, sleep-promoting, and anti-inflammatory effects.
- Hot flashes and night sweats
- Sleep disturbance or insomnia
- Mood swings, irritability, and anger
- Anxiety
- Depression or persistent low mood
- Fatigue and lack of energy
- Decreased concentration, alertness, or memory loss (brain fog)
- Vaginal dryness, pain, or itching
- Urinary incontinence or increased urgency
- Decreased sex drive (libido)
- Water retention, bloating, and weight gain
- Breast tenderness or swelling
- Pain — headache, migraine, lower back, muscle or joint ache
- Acne or oily skin
- Increased facial hair
- Thinning hair on the scalp
- Personal risk factors for heart disease
- Personal risk factors for osteoporosis
Yes, you can test your hormone levels at home using a reliable at-home female hormone test kit. A comprehensive female hormone panel measuring FSH, LH, oestradiol, progesterone, testosterone, and thyroid function can be completed using an at-home blood spot kit. FSH and LH levels rise significantly as the ovaries decline, and consistently elevated FSH alongside low oestradiol confirms postmenopausal status. You can also use our quiz above as a validated screening tool to assess whether your symptoms are consistent with menopause.
- Natural menopause — The gradual cessation of ovarian function with age. The average age in the UK and US is 51 years. Preceded by the perimenopausal transition, which can last 2–10 years.
- Early menopause — Menopause occurring between ages 40 and 45. Carries greater long-term health implications for bone density and cardiovascular health. Treatment with HRT is strongly recommended until at least the average age of natural menopause.
- Premature ovarian insufficiency (POI) — Menopause before age 40. Affects approximately 1% of women. Requires urgent hormone replacement therapy.
- Surgical menopause — Immediate menopause following bilateral oophorectomy (removal of both ovaries). Typically more severe than natural menopause due to abrupt hormonal withdrawal. HRT is strongly indicated unless there is a specific contraindication.
- Medical menopause — Induced by chemotherapy, radiation, or GnRH agonist therapy. May be temporary or permanent depending on the treatment.
The following blood tests are available to evaluate menopausal and postmenopausal hormonal status:
- FSH (Follicle-Stimulating Hormone) — elevated in menopause; a level above 40 IU/L on two separate tests confirms postmenopausal status
- LH (Luteinising Hormone) — also elevated in menopause
- Oestradiol (E2) — persistently low in established menopause
- Progesterone — absent in postmenopause
- Testosterone (total and free) — declines further after menopause; important for libido, energy, and mood
- DHEA-S — adrenal androgen that supports oestrogen and testosterone production after menopause
- SHBG (Sex Hormone-Binding Globulin)
- TSH, Free T3, Free T4 — thyroid disorders are common in postmenopausal women and closely mimic menopausal symptoms
- Bone turnover markers (CTX, P1NP) — to assess rate of bone loss in postmenopause
- Lipid panel — oestrogen loss significantly affects cardiovascular risk factors
FSH Test—This test measures Follicle-Stimulating Hormone. FSH rises as the ovaries produce less oestrogen, because the pituitary signals harder to stimulate ovarian response. A consistently elevated FSH above 30–40 IU/L alongside symptoms is the standard biochemical confirmation of menopause.
Oestradiol Test—This test measures the primary form of oestrogen in the blood. Persistently low oestradiol (below 100 pmol/L or 27 pg/mL) alongside elevated FSH confirms postmenopausal status. Oestradiol also guides HRT dosing.
Testosterone Test—Female testosterone declines gradually through the 40s and 50s and is often overlooked in menopausal assessment. Low testosterone contributes significantly to reduced libido, fatigue, low mood, and reduced muscle mass in postmenopausal women.
Thyroid Panel—Thyroid disorders — particularly autoimmune hypothyroidism (Hashimoto's disease) — are disproportionately common in women over 50 and produce symptoms that closely overlap with menopause, including fatigue, weight gain, brain fog, and hair thinning.
Bone Turnover Markers—Elevated CTX (C-terminal telopeptide) indicates accelerated bone loss and is a prompt to consider DEXA scanning, calcium and vitamin D optimisation, and HRT or other bone-protective therapy.
FSH Test—High levels of FSH indicate the ovaries are no longer responding to hormonal signals, confirming menopause or ovarian insufficiency. Two readings above 40 IU/L taken at least 4–6 weeks apart confirm postmenopausal status.
Oestradiol Test—Low oestradiol confirms oestrogen deficiency. Levels below 100 pmol/L alongside elevated FSH confirm postmenopause and guide HRT dosing decisions.
Testosterone Test—Low testosterone in postmenopausal women contributes to reduced libido, fatigue, and mood changes. Low-dose testosterone replacement alongside oestrogen has strong and growing evidence.
Thyroid Panel—Hypothyroidism and menopause frequently co-exist and must be assessed together. You can also assess this using our Comprehensive Female Hormone Home Test Kit.
Common Causes of Menopausal Symptoms
- Natural age-related cessation of ovarian oestrogen and progesterone production
- Surgical removal of the ovaries (bilateral oophorectomy)
- Premature ovarian insufficiency (before age 40)
- Chemotherapy or radiation to the pelvic region
- Autoimmune destruction of ovarian tissue
- Genetic conditions affecting ovarian development (Turner syndrome, Fragile X premutation)
- Concurrent thyroid dysfunction amplifying menopausal symptoms
- Chronic stress and elevated cortisol compounding oestrogen withdrawal effects
- Nutritional deficiencies (magnesium, vitamin D, B vitamins, omega-3 fatty acids)
- Smoking — associated with earlier menopause onset by 1–2 years on average
Treatment for menopause may include:
- Bioidentical hormone replacement therapy (BHRT) — oestradiol and micronised progesterone in forms structurally identical to those produced by the body; the most effective evidence-based treatment for menopausal symptoms
- Conventional HRT — conjugated equine oestrogens and/or synthetic progestins; widely prescribed and effective
- Testosterone replacement — low-dose topical testosterone for postmenopausal women with reduced libido, fatigue, and mood changes
- Vaginal oestrogen — topical oestrogen for urogenital symptoms (dryness, pain, urgency); effective and safe even for women who do not wish to use systemic HRT
- SSRIs and SNRIs — for vasomotor symptoms and mood in women who cannot or choose not to use HRT
- Fezolinetant — a novel neurokinin B receptor antagonist for hot flashes; the first non-hormonal treatment specifically approved for this indication
Natural support may also include phytoestrogens (soy isoflavones, red clover), black cohosh, and evening primrose oil. Regular weight-bearing exercise, resistance training, calcium and vitamin D supplementation, reduced alcohol and caffeine intake, and stress management all support bone health and cardiovascular health in the postmenopausal years.
Based on your menopause assessment and symptoms, you may be experiencing menopause or significant postmenopausal hormonal change.
See a healthcare practitioner to discuss your symptoms and possible testing, or order tests on your own and share results with your doctor.
References
1"The 2022 Hormone Therapy Position Statement of The Menopause Society." Menopause. 2022;29(7):767–794.
2"Menopause: diagnosis and management." NICE Guideline NG23. National Institute for Health and Care Excellence, 2015 (updated 2019).
3Baber RJ, et al. "IMS Recommendations on women's midlife health and menopause hormone therapy." Climacteric. 2016;19(2):109–150.
A deficiency of oestrogen, progesterone, and testosterone at menopause can affect virtually all body functions. The severity of symptoms ranges from mild and barely noticeable to severe and significantly debilitating. While menopause is a universal experience for women who reach midlife, the degree to which it impairs quality of life varies enormously — and for those who struggle, effective treatments are available that most women are never offered.
Self-assessment Questionnaire
Because many symptoms of menopause are similar to those of thyroid disorders, depression, adrenal fatigue, and other conditions, they can easily be confused or misinterpreted. Symptoms such as fatigue, mood changes, brain fog, and weight gain often accumulate gradually, making them easy to normalise or attribute to ageing or stress.
We strongly suggest that you contact your healthcare provider if you have any concerns that you may be experiencing menopause or significant hormonal change. The self-assessment above should not be substituted for hormone testing and clinical evaluation by your provider.
A menopause assessment typically combines a clinical symptom evaluation — such as the quiz on this page — with a blood test measuring FSH, LH, oestradiol, and where relevant, testosterone and thyroid hormones. In women still having periods, FSH can fluctuate considerably, so two tests at least 4–6 weeks apart are recommended. In women who have not had a period for 12 consecutive months, the diagnosis of menopause is clinical and does not require blood testing to confirm.
Yes, most home hormone tests for menopause are accurate when used correctly and processed by certified laboratories. FSH and oestradiol measurements from at-home blood spot kits are clinically comparable to in-clinic venous blood draws and are a convenient, affordable, and private way to assess hormonal status.
Online menopause assessments using validated symptom questionnaires and at-home hormone test kits are effective, reliable, and increasingly used in clinical practice. They provide results comparable to in-clinic testing and often include telehealth support to help interpret findings in the context of your symptoms and health history.
Yes, physical signs of menopause include hot flashes, night sweats, vaginal dryness and atrophy, skin thinning, thinning hair, weight redistribution to the abdomen, joint stiffness, urinary changes, and loss of muscle mass. Changes in body odour and increased facial hair due to shifting testosterone-to-oestrogen ratios are also commonly reported.
