Her FSH result was called normal. It wasn't.
Why early menopause gets missed, and what a single blood test can and can't tell you.
Dr Alex Maughan, FRACGP MRCGP MBChB · 16 July 2026 · 4 min read
GUIDELINECLINICAL CASE
A 41-year-old woman came to see me worried about perimenopause. Over the past year she'd noticed small changes to her cycle, low mood and urinary symptoms. She'd been told her hormone levels were normal.
When I looked back through her results, I found a raised FSH from six months earlier. It had been documented as normal. It wasn't. It was a missed early menopause.
Why the result slipped through
FSH goes up and down across the menstrual cycle, so the lab usually won't flag a single high result as abnormal. In a woman with changing periods and urinary symptoms, the number has to be read alongside her story. That takes time, knowledge of early menopause, and a system that allows for both.
Missed cases like this aren't one doctor's failure. They come from a stretched system and too little training on early menopause.
Why it matters
Early menopause affects around 5% of women between 40 and 45. Beyond the symptoms, it brings a higher long-term risk of heart disease and osteoporosis. Guidelines recommend offering hormone therapy, if there's no reason not to, until at least the natural age of menopause.
This patient had been living with symptoms for months. She deserved earlier treatment, and so do the many women like her.
- If you're in your late 30s or 40s and your periods, mood, sleep or bladder have changed, perimenopause is worth asking about.
- A "normal" result doesn't always rule it out. Ask what your result means for you, at your age, with your symptoms.
- Keep copies of your results so a new doctor can look back.
Walk in prepared.
Five lifestyle tips for menopause, one evidence-backed tip for better sleep, and a printable worksheet to bring to your appointment.
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