Perimenopause Blood Tests: What the NICE & NHS Guidance Says

 

Perimenopause is the transitional phase before menopause when hormone levels and menstrual cycles begin to change. Many women in their 40s and early 50s experience symptoms such as fatigue, hot flushes, mood changes, disrupted sleep and irregular periods. Understanding these changes can be challenging, hence why many women turn to blood tests for answers, especially that these are available on a private basis now. 

However, it is important that any testing is grounded in clinical evidence and recognised guidance. Here we summarise what NICE (National Institute for Health and Care Excellence) and the NHS recommend about testing in perimenopause.

Clinical Guidance on Perimenopause & Testing

According to the NICE guideline on menopause (NG23), perimenopause and menopause in women aged 45 or over should usually be identified based on symptoms, not laboratory tests. The guideline specifically states that changes such as vasomotor symptoms (e.g., hot flushes) and a change in menstrual cycle are often enough to make a diagnosis without blood testing. (NICE)

NHS resources also explain that blood tests are not normally required to diagnose perimenopause for most women, and that a clinical assessment is often sufficient. (nhs.uk)

When Blood Tests Can Be Helpful

While routine testing is not recommended for women over 45, there are situations where blood tests can still provide useful information:

1. Younger women (under 45) with symptoms
In women under 45, especially those with unclear or severe symptoms, certain blood tests can help rule out other conditions or support a clinical picture. Tests like FSH (follicle-stimulating hormone) may be considered in this context. (Practice Nurse)

2. To rule out other causes of symptoms
Symptoms like fatigue or mood changes can come from conditions such as thyroid dysfunction, iron deficiency or vitamin D deficiency. Targeted blood tests for these conditions may help clarify the underlying causes.

3. In cases of unclear diagnosis
For women with complex health histories, on hormonal contraception, or who have had a hysterectomy, certain tests may be useful in addition to a thorough clinical assessment.

*What Blood Tests Do, and Do Not, Tell You

It is important to set expectations:

Blood tests can help rule out other conditions that may cause similar symptoms.
In younger women, they may offer useful clinical information when symptoms are ambiguous.

Blood tests do NOT provide a definitive diagnosis of perimenopause for most women aged 45 and over, because hormone levels fluctuate widely during this transition and are not reliable markers on their own. (NICE)

A Balanced & Evidence-Based Approach

At London Health Company, we follow clinical guidance and support women with evidence-based testing designed to complement, not replace, clinical assessment. Our perimenopause panel focuses on tests that:

  • Help rule out other medical causes of symptoms

  • Support informed discussions with clinicians

  • Provide a clearer picture of your overall health

We do not promote blood tests as a standalone diagnostic tool for perimenopause in women aged 45 or over.

Next Steps if You’re Experiencing Symptoms

If you’re experiencing symptoms that affect your daily life, we recommend:

  1. Keeping a symptom diary; tracking changes over time can help clarify patterns.

  2. Discussing your symptoms with a healthcare professional: especially if they’re impacting your quality of life.

  3. Considering targeted tests as part of a broader health assessment.

The NHS provides helpful resources on menopause support here:
👉 NHS Menopause Help & Support  https://www.nhs.uk/conditions/menopause/help-and-support/ (nhs.uk)

References

Frequently Asked Questions (FAQs)

How is the test performed? 

You will receive a complete blood collection kit by post. The kit contains all you need to collect blood from your finger. The components of the kit are: 

1. Instruction Sheet: Provides detailed steps on how to collect the blood sample correctly. 

2. Box: Contains all the components and is used to hold the tube while collecting blood. 

3. Lab Request Form: Needs to be filled out and included with the sample. 

4. Labels: For labeling the sample tube. 

5. Tube Pouch: A protective pouch for the sample tube. 

6. UN3733 Prepaid Mailing Bag: For sending the sample back to the lab. 

7. Lancets: Used to prick your finger for blood collection. 

8. Wipes: For cleaning your finger before and after collection. 

9. Plasters: To cover your finger after blood collection. 

10. Blood Collection Tube: for collecting the blood sample. 

These components are essential to ensure that the blood sample is collected, stored and sent correctly for accurate testing. 

Do I need to set up an account?

No, you don’t need to set up an account, but you do need to activate the sample ID before sending your blood sample to the lab.

Should I fast before collecting my blood sample? 

Please check individual test pages for details.

I couldn’t collect enough blood, what should I do? 

If you read the instruction sheet carefully and follow the steps as directed, then you should not have a problem in collecting the right amount of blood. However, if you followed all the steps and couldn’t get enough blood, i.e., to the upper line, please contact us and we will arrange to send you a fresh tube and 4 lancets (for an extra fee) and not for free). Please make sure you keep any unused elements (instruction sheet, box, lab request form, labels, tube pouch, and UN3733 prepaid mailing bag) from the kit as you will need them when you receive the new tube and lancets.

I sent my sample, and the blood wasn’t enough, and I didn’t contact London Health Company. What’s going to happen now? 

Don’t send any sample if the blood isn’t enough unless you contactedus and we told you to do so. If you sent the sample and the blood wasn’t enough, the lab will reject your sample and it won’t be processed.

After I closed the yellow tube cap, and inverted it 5-10 times gently, I noticed the waxy substance in the tube didn’t dissolve or move, is this OK? 

Yes, this is fine. When inverting the tube, the blood will mix with the waxy substance, but you won’t be able to see any difference. The waxy substance will not move or dissolve.

The yellow-top tube has waxy substance, but the purple top tube looks empty. Is it a faulty tube? 

The purple top tube is perfectly fine and should look empty.

Where do I find my sample ID?

Your sample ID is unique and should be on the small lab request slip and is highlighted. Your sample ID should always start with three letters and has no spaces.

What happens if I forgot to activate my sample ID before sending the sample to the lab? 

This will cause significant delays in reporting the sample if it arrives at the lab and is not yet activated.

What if I forgot to include the lab request slip/form with my sample? 

That shouldn’t be a big problem. You can still receive your report on time, but you need to make sure that the sample ID is activated before the sample arrives at the lab. If the lab request slip/form isn’t included and the sample ID isn’t activated, the lab will discard the sample and no refund will be issued.

I bought my test kit online, does that mean that you have my details, and I don’t need to activate my sample ID? 

You still need to activate your sample ID. By activating your sample ID, your blood sample is linked to you. Without activating your sample ID, your blood sample won’t be traced back to you.

Do I need to drop off my blood sample at the post office? 

Yes, please do so. Make sure that it’s dropped off before the last collection time; otherwise, it will stay in the post office overnight and the lab won’t get it the next day.

Why do I need to avoid posting my blood sample on Friday and weekends? 

We aim to receive your blood sample within 24 hours of blood collection. If the sample is posted on a Friday, it means that it will stay in the post for 3 days.

How long does it take for the lab to receive my sample?

Generally, samples arrive within 24 hours of posting to the lab. We use Royal Mail Tracked 24 service, but sometimes, there might be a slight delay in delivery. If the sample’s integrity was compromised by delays, we send a free replacement kit if you have the tracking number to prove the time of posting. This is if sent on Mon, Tue or Wed.

How will I know if my sample was received by the lab? 

You will receive an email notification confirming that your sample was checked into the lab.

How will I receive my results? 

Once your report is checked and ready, it will be sent to your registered email.

Why have I not received all my results? 

This is usually due to one of two reasons: 

1. Late or non-activation of the sample ID. 

2. Entering the wrong sample ID. 

Why does my report say that my sample was rejected by the lab? 

Sample rejection mainly occurs due to haemolysis, which is when the red blood cells in the blood collection tube start to break down. This impacts the lab ability to generate results for some tests. 

 

Haemolysis can happen at any stage of the process but most commonly occurs during blood collection. It often results from squeezing your finger instead of massaging the side of your hand. This only happens in a small number of cases, and we will provide a second kit free of charge. 

 

Another reason for sample rejection is when a person has been unable to collect the necessary amount of blood required to perform the testing and sends it to the lab without contacting us beforehand. 

Can I return my item for a refund?

We do offer refunds, and you do not need to send the kit back to us.

As this product is a medical device, we cannot accept returned kits. Any returned items would need to be discarded and cannot be reused or resold to other customers.

However, if you no longer need your kit or have changed your mind, we can offer a partial refund under the following conditions:

  • Please open the box and provide us with the Sample ID.
  • Once we receive the Sample ID, we will void the kit.
  • You will then receive a refund minus the kit cost of £5.

This allows us to process your refund without the need for the kit to be returned.

How do I request a return?

If you no longer need the kit, please contact our support team directly. You will need to open the box and provide the Sample ID so we can void the kit and process your refund. Please do not request a return through the website, as there is no need to send the kit back to us. Once we have the Sample ID and the kit has been voided, we can proceed with your refund.

How long does a refund take?

Refunds are processed within 10 working days.

This timeframe is required so we can locate and void any associated Sample IDs before issuing the refund.

Once this process is complete, your refund will be issued to your original payment method.

Can I change my address after I checked out?

Please note that we cannot change your address if it was entered incorrectly, as orders are dispatched automatically. Once labels are printed, it is difficult for our staff to locate and retract them.

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