Many women want to know exactly when menopause is happening, and once symptoms begin, they often seek confirmation. While the timing of menopause is influenced by factors like age, maternal age at menopause, and the remaining egg supply (ovarian reserve), a more precise picture can come from blood tests. Ovarian reserve testing, though typically used in fertility assessments, can provide valuable insight into reproductive aging and menopausal status. You can have these tests—even if it’s harder to accurately because of the hormonal effects of your contraception.
Understanding the hormonal changes that accompany different stages of menopause helps guide appropriate testing:
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Perimenopause: Begins with irregular cycles; progesterone declines, while estrogen, testosterone, and FSH often remain within normal ranges.
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Late Perimenopause: Menstrual periods are absent for 3–11 months. Hormone levels become increasingly erratic, making interpretation more difficult.
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Menopause (average age 51.4): Defined by 12 consecutive months without a menstrual period. FSH is elevated, and both estrogen and progesterone are low.
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Surgical Menopause: Results from removal of both ovaries, with or without hysterectomy. FSH is elevated; estrogen, progesterone, and testosterone drop.
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Postmenopause: Hormonal changes stabilize at low estrogen and progesterone, with persistently elevated FSH.
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Unilateral Oophorectomy: The remaining ovary can sometimes compensate, but hormone patterns vary.
Fertility begins declining after age 30, well before menopause begins.
Although it’s still possible to conceive later in life, it becomes more difficult as ovarian function wanes. Only about 1% of women reach menopause by age 40, but more than 95% will do so by age 55. Around age 50, many women—particularly those using oral contraceptives—start wondering whether they’ve already transitioned.
This leads to a long-standing clinical question: how can we determine menopausal status in women taking birth control pills? Since hormonal contraception alters or suppresses the body’s natural cycle, classic indicators like missed periods, elevated FSH, and low estrogen are unreliable while on the pill—even during the placebo week. Some women stop bleeding entirely due to the pill’s effects, unrelated to menopause. Stopping birth control just to “test” for menopause isn’t always safe or practical, particularly if contraception is still needed.
Menopause tests if you are on Oral Contraceptives
To address this, researchers began exploring more specific hormonal markers unaffected by contraceptives. One of the most promising is Anti-Müllerian Hormone (AMH). AMH is secreted by granulosa cells in ovarian follicles and serves as a direct marker of ovarian reserve. Unlike FSH or estrogen, AMH levels are not significantly altered by oral contraceptive use. This makes it a particularly valuable tool for evaluating menopausal status or future fertility in women who are still on hormonal contraception. While AMH isn’t perfect—it can be lower in premature ovarian insufficiency and higher in women with polycystic ovary syndrome (PCOS)—it remains one of the most reliable indicators of remaining follicular activity and can help clarify where a woman is on the menopause spectrum.
Other assessments include Inhibin B and FSH, but these rise later in reproductive aging and aren’t useful early on for predicting fertility potential. Antral follicle count by transvaginal ultrasound and clomiphene citrate challenge testing may offer additional insight. In special populations, such as cancer survivors, fertility may return after chemotherapy, but recovery can be gradual.
In summary, AMH offers a key advantage: it can be measured accurately even in women on oral contraceptives, providing meaningful insight into ovarian aging without interrupting contraception. If you’re unsure whether you’re in menopause—or how close you are—talk to your gynecologist about AMH testing as part of a broader hormonal evaluation.
