Telehealth company InstantScripts has just launched a Menopause and Perimenopause Blood Test, the latest in its stable of $20 pathology tests for conditions ranging from erectile dysfunction to IBS.

While promoted as a way to gain “insights into your hormones” and “arm yourself with the knowledge to explain and manage your symptoms,” (in conjunction with medical consultations), the test is largely pointless—and could lead to issues like unplanned pregnancies, experts say.

Test is not diagnostic

The test measures oestradiol, FSH, LH, TSH and FBC, InstantScripts’ website says.

However, “FSH, LH and oestradiol are not needed to diagnose menopause,” says Australasian Menopause Society (AMS) President and New Zealand-based obstetrician and gynaecologist Dr Sylvia Rosevear.

In fact, the AMS advises against measuring them in symptomatic women of normal menopause age (over 45 years) because results are unlikely to change management.

“The menopause is managed by assessing symptoms,” Dr Rosevear says.

Moreover, “perimenopause can be characterised by wide fluctuations in oestrogen levels, so oestrogen levels are not diagnostic,” she adds.

“The perimenopause is a time of upheaval for some women and that’s exactly what happens with the ovarian hormones,” agrees gynaecologist Dr Elizabeth Farrell, AM, Medical Director of Jean Hailes for Women’s Health.

“It can be hormonal chaos in that time, so one blood test is just going to tell you what her hormone levels are on the day that she has the test done,” Dr Farrell says.

“If a woman has got irregular periods, or she has symptoms that are coming and going, and she’s of the right age, then she’s in the perimenopause. So doing the test is useless, because the next day she could be ovulating.”

Risk of unplanned pregnancies

According to InstantScripts’ website, ordering the blood test is “as easy as 1, 2, 3!”

Following a digital consultation, a pathology request is e-mailed to the patient to take to the collection clinic. The results are emailed directly to the patient, and can be viewed on InstantScripts’ app.

Dr Farrell worries that this could cause confusion if the levels show a high FSH and low oestradiol consistent with menopause, which potentially could lead to an unplanned pregnancy.

“It doesn’t actually tell you whether you are still ovulating,” she says. “And we have the potential to ovulate up until three months prior to the final menstrual period.”

“And if you’re not using contraception there is still a small risk of getting pregnant up until then.”

The blood test may also drive misinformation about menopause, if women come in thinking they need one and wonder why they haven’t been told about it – and then turn to social media influencers who may not have any knowledge of menopause to learn more, Dr Farrell adds.

Who will follow up?

InstantScripts say their doctors “can provide comprehensive follow up care,” but where does the patient’s usual GP fit in?

In a March Healthed survey, 44% of almost 1500 GP respondents reported they had patients who’d accessed scripts via online clinics.

Of 428 GPs who provided free text responses, more than half said they had patients who’d encountered adverse experiences using these clinics, an analysis showed.

Many expressed concerns that could equally apply to online blood tests, such as the lack of physical examination and follow-up care, which can leave patients without adequate support—and their regular GPs in the dark.

“The continuity of care is broken, which defeats the purpose of having a GP system,” one GP said.

Dr Rosevear also says it’s crucial that any blood tests to investigate clinical symptoms are done by a doctor “who can then take responsibility and interpret the results.”

When might a blood test be appropriate?

Dr Farrell emphasises that menopause is a clinical diagnosis, and a blood test would only be warranted to investigate other possible causes of symptoms.

“The only people we would use blood tests in are young women who are presenting with possible early or premature menopause, someone who has symptoms that are not quite classical, or in a woman who has had a hysterectomy, because you haven’t got a period as a clinical marker or to exclude other causes, such as an overactive thyroid,” she explains.

Are any aspects of the test helpful?

FSH testing can be useful for deciding when to stop contraception, Dr Rosevear says.

“Amenorrhea is common in perimenopausal women using progesterone-only contraception, making it difficult to determine the date of her final menstrual period.”

“In this situation, for women aged 50 or older, a single FSH measurement ≥30 IU/L will indicate that contraception will be required for a further 12 months and can then be ceased. If the FSH is ≤30IU/L, contraception should be continued for the next 12 months and FSH repeated to check if ≥30 at that time.”

“For women less than 45 years of age, and certainly those less than 40, FSH testing can be done to diagnose premature ovarian insufficiency.”

For women under 40, FSH levels need to fall in the menopausal range (>25 IU/L) for a POI diagnosis, with updated guidelines noting only one test is needed, although it should be repeated after four to six weeks if the diagnosis is uncertain.

Testing TSH can pick up thyroid dysfunction, which can occur in perimenopause, Dr Farrell adds.

“That’s a positive thing. But it should be part of routine, regular blood tests that women are having anyway, as part of their normal lifestyle health checks.”