At-Home Hormone Testing for Menopause While on Birth Control
No, a patient cannot reliably use an at-home hormone test to check FSH or estrogen levels related to menopause while on hormonal birth control, because these methods suppress and alter hormone levels, making the results uninterpretable for determining menopausal status. 1
Why Hormone Testing Fails on Birth Control
Hormonal Contraceptives Suppress FSH
Combined oral contraceptives (COCs) significantly suppress FSH levels (mean FSH 12.5 IU/ml, SD 18.7) compared to non-users (mean FSH 26.7 IU/ml, SD 28.7), making FSH measurements uninformative for menopausal status. 2
Progestin-only methods also suppress FSH, with norethisterone enanthate users showing mean FSH of 11.0 IU/ml (SD 10.9) versus 26.7 IU/ml in non-users. 2
Even depot-medroxyprogesterone acetate (DMPA), which suppresses FSH less than other methods, still shows mean FSH of 23.1 IU/ml (SD 27.8), making individual measurements unreliable. 2
Estrogen Levels Are Artificially Maintained
Birth control pills maintain estradiol levels artificially, preventing the natural decline that signals menopause. 3
In reproductive-age women on oral contraceptives, estradiol levels increase after stopping the pill for one week, but this rebound does not occur in truly menopausal women. 3
Hormone levels fluctuate dramatically during perimenopause even without contraceptives, with abrupt swings between postmenopausal and normal reproductive ranges, making single measurements diagnostically useless. 4
The Guideline-Based Approach
Official Recommendations
No reliable laboratory tests are available to confirm definitive loss of fertility in women, and FSH assessment to determine when a woman is no longer fertile is not accurate. 1
The American College of Obstetricians and Gynecologists and the North American Menopause Society recommend that women continue contraceptive use until menopause or age 50-55 years, regardless of hormone test results. 1
How to Actually Assess Menopausal Status
The only reliable method requires stopping hormonal contraception first:
Stop all hormonal methods for at least 2 weeks (preferably 4-6 weeks for depot methods) before testing FSH. 5
Obtain two FSH measurements ≥20-30 IU/L taken at least 2 weeks apart while off hormonal contraception. 5
Check that estradiol levels remain in the basal range (do not increase above baseline) at 1-2 weeks off contraception. 3
Even with this approach, a single elevated FSH cannot reliably confirm menopause, as 7% of regularly cycling women over age 45 have postmenopausal FSH levels that subsequently return to normal. 4
Clinical Decision Algorithm
For Women Age 40-49 on Birth Control
If age <50 years: Continue contraception regardless of symptoms, as spontaneous pregnancies occur even with irregular cycles. 1
If age ≥50 years with amenorrhea for 1 year: Consider stopping contraception and testing FSH after 2-4 weeks off hormones. 5
If age ≥50 years without amenorrhea: Continue contraception until age 55 years or until amenorrhea persists for 2 years after age 50. 1, 5
For Women Age 50-55 on Birth Control
Menopause confirmation requires cessation of menses for 1 year after age 50 (or 2 years before age 50), not hormone testing. 5
Sterility cannot be assumed until at least age 60, as spontaneous pregnancies have been reported up to age 59. 5
The median age of definitive loss of natural fertility is 41 years (range up to 51 years), but the median age of menopause is 51 years (range 40-60 years). 1
Critical Pitfalls to Avoid
Common Mistakes
Do not rely on vasomotor symptoms alone while on hormonal contraception, as methods like DMPA, NET-EN, and COCs may suppress hot flashes independent of menopausal status. 2
Do not test FSH while the patient is actively taking birth control pills, as the results will be artificially suppressed and misleading. 3, 2
Do not assume a single elevated FSH confirms menopause, even off contraception, as levels can fluctuate wildly during perimenopause. 4
The Safest Approach
Continue contraception until clinical menopause is confirmed by amenorrhea duration (1 year after age 50), rather than attempting hormone testing while on birth control. 1, 5 This avoids the risks of unintended pregnancy at advanced reproductive age, which carries higher risks for maternal complications (hemorrhage, venous thromboembolism, death) and fetal complications (spontaneous abortion, stillbirth, congenital anomalies). 1