This deserves more caution than it usually gets.
Clinicians in the field give very different washout times before hormones become interpretable, ranging from about two weeks to twelve weeks, and none of those specific timeframes has actually been studied. There is also a real, guideline-stated downside: stopping combined hormonal contraception for more than about a month and then restarting can raise your clot risk again, similar to when you first started it, and guidelines specifically advise against repeated stopping and restarting for this reason. Before agreeing to stop and test, it is worth asking what happens to your plan if the result comes back showing you are not yet menopausal.
Clinicians in the field agree that stopping is the only way to get an interpretable hormone reading, but they disagree sharply, by a factor of roughly six, on how long the washout period needs to be, and none of them has trial evidence behind their specific number.
What the research shows, and which source each finding rests on
No study has established how long hormone suppression from combined hormonal contraception persists after stopping in perimenopausal women, or how long it takes before FSH becomes interpretable again.
Clot risk increases whenever a woman first starts combined hormonal contraception; if she stops for any reason, including to measure FSH, and later restarts after a break of more than one month, she may incur that elevated first-start clot risk again, which is why guidelines specifically advise against repeated stopping and restarting, particularly for women over 40.
Where the real disagreement is
Each position is shown with its own sources. A position listed here is not necessarily the accepted view.
a shorter washout of about two to four weeks is enough
one clinician in the source material
This clinician tells patients to be off the pill for at least two, and typically two to four, weeks before drawing hormone levels for an accurate result.
a much longer washout of eight to twelve weeks is needed
a different clinician in the source material
This clinician advises stopping the pill and waiting at least eight to twelve weeks before drawing FSH and estrogen, to get a clearer sense of where a woman is in the transition.
What would settle it: A study that measures FSH serially after stopping combined hormonal contraception in perimenopausal women, compared against a reliable off-treatment reference standard, would resolve which washout period is actually needed. This has not been done.
What is really going on here
- A test that cannot change your management plan, and whose administration carries its own risk, is not a neutral test; ask what the plan is if the result is inconclusive or shows you are not yet menopausal.
- The guideline's caution against repeated stopping and restarting directly contradicts the common field practice of coming off for a month or two just to test and then going back on.
Questions for your doctor
- If we stop my contraception to test, what is the plan if the result shows I am not yet menopausal?
- How long would I need to be off before you would trust the result?
- What is my personal clot-risk profile if I stop and later need to restart?
- Is there a way to plan my care that does not depend on getting a definitive lab answer first?
Questions with no answer yet
How long does hormone suppression from combined hormonal contraception actually persist after stopping in perimenopausal women, and when does FSH become interpretable again?
Not directly studied yetNo research does not mean it does not work, and it does not mean it works. It means nobody has tested it yet.
What is known: Clinicians in the field give washout recommendations ranging from about two weeks to twelve weeks, a six-fold difference, and none of these specific timeframes has actually been studied.
What would test it: A study that measures FSH serially after stopping combined hormonal contraception in perimenopausal women, compared against a reliable off-treatment reference standard; this has not been done.
Does the elevated clot risk from restarting the pill after a break of more than a month apply equally regardless of how long the break was, or does a very short break carry meaningfully lower risk than a longer one?
Not directly studied yetNo research does not mean it does not work, and it does not mean it works. It means nobody has tested it yet.
What is known: The guideline states that stopping for more than about a month and restarting can raise clot risk again similarly to first starting, and specifically advises against repeated stopping and restarting for women over 40; the source material does not report a study establishing whether risk scales gradually with break length or behaves more like a threshold effect at one month.
What would test it: A study measuring clot risk on restart as a function of break duration, to see whether the one-month figure reflects a true threshold or a rounded approximation.
Sources
- 1.FSRH. Contraception for Women Aged Over 40 Years. Guideline, August 2017 (amended September 2019, further amended July 2023).Systematic review or guideline
- 2.Mary Claire Haver, MD. Your Top Menopause Questions Answered (video transcript).Review, opinion or mechanism
- 3.Heather Hirsch, MD. The Different Stages of Perimenopause and Menopause (video transcript).Review, opinion or mechanism
The letter grades the type of study behind a claim, not the answer itself.
This page is general information based on published research and public sources. It is not medical advice and not a personal assessment, and it does not replace a conversation with your doctor. Peritale is a wellness product, not a medical device, and is not intended to diagnose, treat, cure or prevent any disease. For any medical question, speak with a licensed clinician.
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Start Free MappingRelated questions
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- Back to topic: Contraception in perimenopause