Experts warn menopause hormone tests often unnecessary

Experts warn menopause hormone tests often unnecessary | Image Credit: © Vitalii Vodolazskyi - © Vitalii Vodolazskyi - stock.adobe.com.

Experts have warned that menopause care is being adversely impacted by unnecessary services that do not improve care, publishing their findings in The BMJ on August 20, 2025.¹

The authors highlighted a rise in the use of commercial services among menopausal women, especially for routine hormone panel testing to evaluate hormone levels. According to investigators, these tests cost hundreds of dollars despite being of limited clinical use, as there is no clear therapeutic window for hormonal therapy in menopause.

“The principle of evidence-based practice is that a test should only be done if the result will directly guide patient care,” wrote investigators.² “For perimenopause and menopause, hormone testing offers no reliable way to determine who will benefit from treatment.”

Provider readiness vs public demand

Primary care specialties have been left unprepared to deliver menopausal hormone therapy (MHT) care expected by societal attitudes and beliefs, which have outpaced provider education. Services addressing the growing need for relief of menopause symptoms have seen an uptake in use, as indicated by a recent Canadian report.

The report found that MHT use increased by 21% among women aged 45 to 65 years between 2020 and 2023. Additionally, other studies reported significant rises in MHT use of up to 50% in Wales, Sweden, and England.

Investigators discussed rising concerns over digital health technologies accessible to consumers targeting menopause management, with the global “femtech” market value rising from $500 million to $28 billion in the previous decade. This may increase the risk of a potential commercial bias of information.

Cost and accuracy issues

These trends include a rise in routine hormone panel testing, which often includes serum, salivary, or urine assays for multiple hormones, driving up the cost. Some tests may also fail to provide accurate measures of hormone levels.

Alongside these limitations, investigators highlighted constraints to the utility of hormone testing. Oestradiol and follicle-stimulating hormone levels frequently fluctuate during the perimenopausal period, often highly variable from one day to the next.

Therefore, patients may be underdiagnosed and undertreated for vasomotor symptoms such as hot flashes and sleep disturbances if “normal” hormone levels are observed. Most experts suggest patients only undergo a medical test if their care is directly guided by the results, but these hormone tests are unreliable for determining which patients will benefit most from treatment.

Despite these issues, a significant prevalence of hormone panel use has been observed among menopausal women. Additionally, investigators have reported cases of patients using the panels as a reason for taking compounded hormone regimens or supplements without clinical support.

Advocating for symptom-driven menopause care

Alongside lacking safety and efficacy testing, standardization and regulatory oversight have not been given to compounded bioidentical hormone therapy. This has led to concerns about potential risks for endometrial hyperplasia or carcinoma, especially in women receiving inadequate progestogen.

Investigators highlighted the importance of a symptom-driven and patient-centered approach to menopause care, recommending that symptoms be assessed based on clinical history instead of hormone levels. MHT is most effective against vasomotor and genitourinary symptoms in women aged under 60 years or within 10 years of menopause onset with a favorable safety profile.

“Until we can establish individualized target hormone levels by accounting for pharmacokinetics, receptor-specific pharmacodynamics, and differentiating between endogenous and exogenous hormones, there is no role for commercial hormonal panel testing to guide therapy,” wrote investigators.

References

1. Menopause misinformation is harming care, warn experts. BMJ Group. August 20, 2025. Accessed August 26, 2025. https://www.eurekalert.org/news-releases/1095157.
2. Christakis MK, Roebotham T, Sterry S, Koshkina O. Menopause misinformation is harming care. BMJ. 2025;390. doi:10.1136/bmj.r1695