Home Menopause Tests-Yay or Nay?

Spoiler Alert! Don't Waste Your Money.

Pregnancy tests, ovulation tests…and now the latest in tests you can do in your bathroom laboratory- menopause tests. That’s right, Clear Blue, the people who sell ovulation predictor kits and home pregnancy tests have come out with an over-the-counter kit to help women who are “confused and wondering if what you’re feeling is the start of the menopause journey, or perhaps something else.” All you need to do is buy the kit, pee on a stick and you will know if you are pre-menopause, perimenopause, or post-menopause.

Sounds great. And very useful if you are deciding if you should invest in bulk tampons or buy the small “just in case” box.

The idea of a test to see where you are hormonally is appealing. Nobody wants to wait until they have not had a period for 12 months to know if their ovaries are permanently out of business. And, a home test is way more convenient than making a trip to a doctor’s office to get blood drawn. Not to mention, helpful for women who have already been to a doctor who wasn’t knowledgeable or willing to do hormonal testing. As the Clear Blue website says,..” confused and wondering.”

What the test measures

The test measures FSH also known as follicle-stimulating hormone. Follicle- stimulating hormone is produced by the pituitary gland, in the brain. FSH stimulates the production of estrogen by the ovaries and during the reproductive years stimulates the growth of ovarian follicles, the small cysts that hold the eggs and produce estrogen.

Overall, FSH levels are the opposite of estrogen levels. When estrogen is high, FSH takes a vacation and is low.

When your ovaries are out of business and estrogen levels tank, FSH rises in a hopeless attempt to get your ovaries to make some estrogen.

During perimenopause, FSH levels fluctuate. They are all over the place. Once a woman is post menopause, and estrogen production has permanently stopped, FSH levels remain high until she dies. So, it is scientifically legitimate to measure FSH as an indication of estrogen output.

Are Home Menopause Tests Accurate?

The Clear Blue folks claim thier tests are 99% accurate. Is that true? It is true! Home tests are 99% accurate in detecting the presence of FSH in urine. But accurate is not the same as useful.

The reason a few random FSH levels are not useful is because during perimenopause, FSH levels fluctuate widely.

And, since the levels are unpredictably up and down, you may do a test, get a low FSH level, and think, OK, it’s not perimenopause. I just can’t sleep and feel like crap because my mother-in-law is making me crazy and I’m about to lose my job. But, chances are you are in the middle of perimenopause and just happened to do the test on a day when your FSH was low.

It's not just urine tests that are misleading. This also happens when women go to their doctor for a blood test, which is why we don’t do these tests routinely. A well-meaning doctor, who is not a menopause expert, may agree to do a blood level for FSH and estrogen, and then report that your hormone levels are normal and you are not in perimenopause. The problem is, your FSH and estrogen may have been normal at 2:00 on Tuesday when they did the test, but 3 weeks later, your FSH is high and your estrogen is undetectable. That’s perimenopause. The only thing that is predictable, is that it is unpredictable.

And again, the number doesn’t tell you where you are on your so-called “journey.”

On the Clear Blue site, there is a lovely diagram of how FSH rises as estrogen falls.

Except their graphic is completely inaccurate. FSH does not gradually rise, it bounces around more than the stock market.

The Clear Blue people acknowledge that these levels can fluctuate and get around this problem by giving you 5 test kits to use over 10 days. Except 10 days out of 1 month isn’t long enough to get the big picture. The nature of perimenopause is that you may have normal estrogen levels for weeks, and then tank for a few months. This is why it is not a good idea to get on an airplane wearing white and having no tampons until you have been without a period for at least a year. In addition, the Clear Blue FSH is not positive until it reaches 25. So, if your FSH is 20, you will be told you are not in perimenopause. And that is not necessarily the case.

If you are 48 years old, having irregular periods, mood swings that come and go, and on-and-off hot flashes, you do not need a test to determine if you are in perimenopause. You are in perimenopause.

Let’s take 3 possible scenarios: A woman who is pre-menopause, a woman in perimenopause, and a post-menopause woman.

Trish was 39 years old and wondering if she was close to menopause. She was curious because she wanted to know if she was still fertile, and also because her mom entered menopause on the early side. Her periods were regular and she had no menopause symptoms. She asked her internist to do an FSH level, which came back slightly elevated, around 15. She came to me because she was told, by her internist, that her slightly elevated FSH was an indication that perimenopause was around the corner and that she was no longer fertile. But, that slight elevation in FSH was in no way predictive of when she was going to enter perimenopause. And a repeat FSH 4 months later was 9, which is what you would expect in a young woman who is still making normal amounts of estrogen. Also, if you happen to test mid-cycle, there is generally a spike in FSH that occurs with ovulation. That’s the premise of ovulation predictor kits. Clear Blue for years has sold an ovulation predictor kit that tests urine FSH and already had the technology, they just repackaged it for menopause. So, if your FSH level is high due to ovulation, you may get fooled into thinking you are in perimenopause, and need to think about hormone therapy, when what you really need to think about is contraception.

And speaking of contraception, these menopause kits are worthless if you are on birth control pills because it is the pill supplying estrogen, not your ovaries. Ditto if you are already taking some form of hormone therapy. It does say that, in small print, but most women don’t read that until they have already bought the kit. What it does say clearly right on the front of the box, is “phone not included.” Glad they cleared that up.

Trish asked me when I thought she was going to become perimenopausal and I told her I had no clue since I did not have a crystal ball and her urine and blood tests were not helpful or predictive of her “journey.”

And then we get to the perimenopause woman, who is the most likely person to fit the “confused and wondering “ category and stock up on these kits.

Joan was 46 years old when she started missing periods. She would get a period 3 or 4 months in a row, and then skip one or two. So, she got a test. Her FSH was low and her internist told her she was NOT perimenopausal but probably missed her periods because of stress. Which was reasonable given that Joan had just left her husband and moved back home with her 72-year-old mother. But, 6 months later, she started flashing and her periods disappeared for good. So, yes she was stressed, but she also was in perimenopause. If like Joan, you are in your 40’s or 50’s, having irregular periods, hot flashes and vaginal dryness, I have news for you. Once I have eliminated other reasons for irregular periods (such as a thyroid condition) YOU ARE IN PERIMENOPAUSE and an FSH test will not tell you anything you do not already know.

Speaking of not telling you something you do not already know; my favorite category is testing post-menopause. Rochelle was 54 years old, hadn’t had a period in 2 years, and was having hot flashes, vaginal dryness, weight gain, and insomnia.I wish Rochelle had talked to me before she spent money on a menopause test. For some reason she thought the results would indicate how much longer she was going to have hot flashes. She shows up in my office and was visibly upset that I wasn’t interested in seeing her Clear Blue results. I told her I didn’t need to see those results, or for that matter, do any further testing to know that her estrogen tank was on empty. She told me she kind of knew that was the case but thought the results would be helpful to me since they say on their website: “Get a personalized menopause report to share with your doctor!” That’s the best part. They think doctors will find this information to be useful.

At the last menopause conference, the Clear Blue folks had a booth. They were trying to convince menopause experts why they should encourage their patients to get these kits. and why we would find them useful.

Against the advice of my friends, who know how I can get, I headed over to their booth to have a chat. It didn’t go well. I basically told them I didn’t need my patients to spend $50 on a kit to log menopause symptoms on the required AP and I wasn’t in the least bit interested in a week’s worth of home urine FSH levels.

If the tests are worthless, how do I know where someone is on her ‘journey?”This sounds low-tech- but 90% of the time, I will know if a woman is pre-menopause, perimenopause, or post-menopause just by talking to her and getting the details on her menstrual cycle, symptoms, and age.

There are some special circumstances. Take the woman who enters menopause prematurely. If I have a 32-year-old who is missing periods without explanation and has menopause symptoms, I may opt to get some serial hormone blood levels to see what’s going on, and also look at other markers that are an indication of ovarian insufficiency or menopause. But I am certainly not going to rely on a home urine test. And if someone is in her 30s and concerned about pre-mature menopause, she really needs to see an expert. I had one 32-year-old patient who missed a few periods. When her home pregnancy test was negative, she did a home menopause test. It came back indicating a high FSH level and she got really depressed. She was trying to figure out how to break it to her fiancée that she was going into menopause and pregnancy was out of the question, and then she got her period. It turned out she was ovulating at the time she had the test, but she didn’t read the fine print and did not know that was possible. Premature menopause should never be a do-it-yourself diagnosis given that the issues surrounding early menopause are complex and can have a huge psychological impact in addition to the medical issues.

Another special circumstance is the woman who doesn’t get periods, either because she has had a hysterectomy, a uterine ablation procedure, or a progestogen IUD. In most cases, it doesn’t matter if you are peri or post menopause. You just treat any symptoms you may be having.

In any case, the Clear Blue people can’t help with this one. The test is not intended for women who have had a hysterectomy because the main part of their algorithm is an analysis of frequency of periods. So, it is completely worthless for about one-third of the women in America.

Look, I get it. Women are looking for information and their doctors aren’t helping them. And I am not against the idea of home tests. A home pregnancy test, an ovulation predictor kit are all very useful. I am totally on board. This one, not so much.

At the bottom of their website, they state: * Only a healthcare professional can confirm your menopause stage.

So if what you are trying to do is avoid going to a doctor to see if you are perimenopause or post-menopause, according to the Clear Blue people, you need to see a doctor anyway. And trust me, despite their trying to convince me otherwise, I will not be in the least interested in the results of your home FSH kit.

Before I finished this rant, I thought, OK, maybe I am missing something here. Maybe women appreciate this information. So, I went on Amazon to check out the comments of women who had bought the kits. Putting aside the reviews that complained about technical problems and tests that didn’t work, and the women who were upset that they had to log their symptoms on an AP to get a result, the majority of the reviews were along the lines of, it didn’t tell me anything I didn’t already know.

Take this one from Michael D

You pee on the stick every other day, wait five minutes each time, record your results of the test, and list all your other symptoms. When the week was over and I finally got my results, they said I am most likely in the early stages of perimenopause and I might be experiencing …all the symptoms I entered into their daily data questionnaire. I could have talked to a mirror for the same feedback! Then it said, for best results see a doctor. Haha! Thanks a lot!

Here's another one from Lauren (and no, it wasn’t me)

“I got two negatives then three positives. The results said “Your FSH test results and other factors indicate you are most likely in premenopause. However, your age does not support this indication.” I’m 43, experiencing irregular periods, and my doctor says I’m in perimenopause. So I’ve learned nothing.”

And finally,

“One out of the five test sticks didn’t give a reading. The other 4 sticks tested negative. My report at the end of all tests said I am in perimenopause based solely on my own reported symptoms, and recommended I test again in few months. Basically, this test didn’t tell me anything I didn’t already know. Won’t be testing again. If you’re really invested in knowing I’d suggest going to your doctor. This is on par with mood rings and horoscopes in my opinion”

And there you have it. I couldn’t have said it better.