Hormonal health
The information you bring to your doctor's appointment matters more than you think.
How to track your cycle effectively
The most useful thing you can do before a medical appointment is track your cycle systematically. Your doctor cannot diagnose a pattern from memory — concrete data shapes the conversation and guides which tests are ordered. Aim to record:
• First day of each period (to calculate cycle length)
• Number of days of bleeding
• Flow volume (light / medium / heavy / very heavy — how many products used per day)
• Any spotting or bleeding between periods
• Associated symptoms: pain, bloating, breast tenderness, mood changes
• Any life changes that coincide: medication changes, stress, weight shifts
Tracking apps (such as Clue, Flo, or Apple Health) make this straightforward. Even a basic calendar with these data points tracked for 2–3 cycles gives your clinician far more to work with than a verbal account.
What tests your doctor may order
Condition | How it presents | Diagnostic tool |
|---|---|---|
TSH | Thyroid function — rules out hypo/hyperthyroidism | Almost always first-line |
FSH + LH | Ovarian function — elevated FSH suggests perimenopause | Women 40+ with cycle changes |
Oestradiol (E2) | Circulating oestrogen level — highly variable in perimenopause | Alongside FSH, with caveats |
AMH | Ovarian reserve — best predictor of time to menopause | When timing prediction is relevant |
Prolactin | Rules out hyperprolactinaemia (excess prolactin suppresses ovulation) | Unexplained irregular cycles |
Full blood count | Checks for anaemia from heavy or prolonged bleeding | Heavy/prolonged periods |
Coagulation screen | Rules out von Willebrand disease and other clotting disorders | Heavy bleeding since adolescence |
Transvaginal ultrasound | Visualises uterus, ovarian follicles, fibroids, polyps, cysts | First-line structural investigation |
Endometrial biopsy | Rules out hyperplasia or cancer | Postmenopausal bleeding; risk factors present |
IMPORTANT CAVEAT ON HORMONE TESTS
Because hormone levels fluctuate dramatically during perimenopause — sometimes from day to day — a single blood test can be normal even when perimenopause has begun, and abnormal even when everything is fine. A 'normal' FSH in one cycle does not rule out early perimenopause. Tests are most useful when taken serially (repeated over time) and interpreted alongside symptom history, not as standalone verdicts.
Read more: Menopause diagnosis & testing — ACOG (American College of Obstetricians and Gynecologists) ↗
