“Perimenopause and menopause should be diagnosed
without laboratory tests in otherwise healthy women aged
over 45 years, on the basis of vasomotor symptoms…”.¹

Umbrella
What may the Menopause Diagnosis Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

Predict

What is the best way to predict menopause?

In What Is Menopause? Diagnosing Perimenopause and Menopause the (Australian) Jean Hailes for Women’s Health (JH) explain:

“The best way to predict menopause is to keep track of your symptoms. If your periods are irregular and your symptoms are getting worse, it’s likely you are approaching menopause”.²

Blood Tests

Can blood tests diagnose menopause?

In What Is Menopause? Diagnosing Perimenopause and Menopause: Blood Tests the JH explain:

Follicle Stimulating Hormone Test

What is the blood test to measure follicle stimulating hormone (FSH)?

In the NICE Guideline Menopause Diagnosis and Management – Information for the Public: Diagnosing Menopause the (British) National Institute for Health and Care Excellence (NICE) explain:

“The blood test measures a hormone called FSH (follicle stimulating hormone). FSH is found in higher levels in menopause”.⁴

Follicle Stimulating Hormone Test Reliability

How reliable is a single FSH test to diagnosed perimenopause or menopause?

In What Is Menopause? How Is Menopause Diagnosed? the Australasian Menopause Society (AMS) note:

“Measurement of FSH to diagnose perimenopause or menopause is not usually indicated. A single hormone test, such as a measurement of elevated follicle-stimulating hormone (FSH) is not a reliable indicator of the perimenopause, as women’s hormone levels may fluctuate from day to day”.⁵

Follicle Stimulating Hormone Test Validity

What can compromise the validity of FSH tests?

In the NICE Guideline Menopause Diagnosis and Management – Information for the Public: Diagnosing Menopause the NICE note:

“You should not be offered this test if you are taking a contraceptive containing oestrogen and progestogen or high dose progestogen because the contraceptive changes your natural FSH levels”.⁶

In Diagnosing Menopause: Symptom Assessment and Diagnosis At Perimenopause and Menopause the AMS also note:

“It is especially unhelpful to do hormone blood tests while women are on MHT/OCP – symptoms, not blood levels, guide therapy”.⁷

What is MHT?

MHT can be an abbreviation for Menopausal Hormone Therapy (HRT), otherwise known as Hormone Replacement Therapy (HRT) or Hormone Therapy (HT).

What is OCP?

OCP can be an abbreviation for Oral Contraceptive Pill, otherwise known as “The Pill” or birth control pills.

Over-the-Counter FSH Test

What may over-the-counter FSH tests check?

In Menopause:  Menopause Diagnosis & Treatment – Treatment the (United States) Mayo Clinic elaborate on:

“Over-the-counter home tests to check FSH levels in your urine are available. The tests could tell you whether you have elevated FSH levels and might be in perimenopause or menopause. But, since FSH levels rise and fall during the course of your menstrual cycle, home FSH tests can’t really tell you whether or not you’re definitely in a stage of menopause”.⁸

Diagnosis

How are perimenopause and menopause diagnosed?

In What Is Menopause? Diagnosing Perimenopause and Menopause the JH explain:

“You can ask your doctor to check if you are perimenopausal or have reached menopause. If you are at the expected age, have experienced some symptoms and have irregular periods, it’s likely you are perimenopausal. If you haven’t had a period for 12 months, you have probably reached menopause”.⁹

On page one in Diagnostic Tests for Menopause the European Menopause and Andropause Society note:

“Perimenopause and menopause should be diagnosed without laboratory tests in otherwise healthy women aged over 45 years, on the basis of vasomotor symptoms, irregular periods and amenorrhea”.¹⁰

In Diagnosing Menopause: Key Points the AMS explain:

• “Perimenopause is usually diagnosed clinically on the basis of new onset vasomotor or other symptoms and a change in the pattern of menstrual bleeding. Menopause is diagnosed 12 months after the final menstrual period”.¹¹

What are vasomotor symptoms?

DotS the definition of vasomotor symptoms may vary. The NAM’s definition is:

“Vasomotor symptoms. Also known as hot flashes and night sweats, common symptoms during perimenopause and early postmenopause”.¹²

In Diagnosing Menopause: Symptom Assessment and Diagnosis At Perimenopause and Menopause the AMS elaborate on:

“Many women come to the consultation expecting a blood test to diagnose menopause, and it is important to explain to them why we use the symptom score rather than a blood test in establishing a diagnosis. It is important to explain to women that the blood tests of FSH/oestradiol can fluctuate on a daily basis and therefore are not useful or necessary”.¹³

Symptom Score

What is the Symptom Score used by the AMS?

In Diagnosing Menopause: Symptom Score Sheet the AMS include a Symptom Score (Modified Greene Scale) and explain:

Early Menopause and POI

When may FSH assessment be indicated?

On page four in the European Menopause and Andropause Society Consensus Statement Menopause, Wellbeing and Health: A Care Pathway From the European Menopause and Andropause Society: 3. Investigations and Assessment of Ovarian Reserve 3.1 Endocrine Investigations 3.1.1 Follicle-Stimulating Hormone, published 12 May 2022, Lambrinoudaki et al. note:

“Measurement of serum concentrations of follicle-stimulating hormone (FSH) is not required for formal confirmation of menopausal stage for women over the age of 45. FSH assessment is indicated in women aged 40–45 years who report a change in their menstrual cycle and menopausal symptoms. Women aged <40 years in whom menopause is suspected should be assessed to explore possible POI”.¹⁵

What is POI?

POI in this context, is an abbreviation for Premature Ovarian Insufficiency.

In What Is Menopause? How Is Menopause Diagnosed? the AMS note:

“Measurement of FSH to diagnose perimenopause or menopause is not usually indicated. A single hormone test, such as a measurement of elevated follicle-stimulating hormone (FSH) is not a reliable indicator of the perimenopause, as women’s hormone levels may fluctuate from day to day. However, investigations may be required in certain cases including: (i) if the woman has had a hysterectomy; (ii) concern that symptoms may be due to illness (e.g., thyroid disorder rather than 8natural ageing); or (iii) if woman is under 45 years of age”.¹⁶

In the NICE Guideline Menopause Diagnosis and Management – Information for the Public: Diagnosing Menopause the NICE explain:

Who is a GP?

DotS and/or DotC (Depending on the Country) a GP may be a qualified and registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Health Care Provider

What if I would like to find out if I am perimenopausal or not?

If you would like to find out if you are perimenopausal or not, it may be in your best interest to choose to talk to your health care provider about this. Together you can clarify your symptoms, discuss your options and if required, agree on who may be the most appropriate health care provider to help you.

In the NICE Guideline Menopause Diagnosis and Management – Information for the Public: Diagnosing Menopause the NICE elaborate on:

In What Is Menopause? When To See Your Doctor the JH also note:

Health Topics A-Z

Where may I find Health Topics A-Z related to Menopause Diagnosis?

In Health Topics A-Z you may find:

Links

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Sources

Where may I find the Sources quoted?

You may find the Sources at: