“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:

  • Menopause Confirmation
  • Menopause Diagnosis
  • Menopause Test
  • Perimenopause Diagnosis
  • Perimenopause Test

Predict

Menopause DiagnosisWhat 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:

“Blood tests to measure hormone levels won’t tell you if you are perimenopausal or when your final period is going to happen, because hormone levels vary widely at this time”.3

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”.4

Follicle Stimulating Hormone Test Validity

What can compromise the validity of FSH tests?

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”.5

What is MHT?

MHT can be an abbreviation for Menopause Hormone Therapy (MHT), 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 – Diagnosis the (United States) Mayo Clinic elaborate on:

“You can get home tests to check FSH levels in your urine without a prescription. The tests show whether you have higher FSH levels. This might mean that you’re in perimenopause or menopause.

But FSH levels rise and fall during your menstrual cycle. So home FSH tests can’t really tell you whether you’re in menopause”.6

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”.7

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”.8

In Diagnosing Menopause: Key Points the AMS explain:


Menopause Diagnosis

  • “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”.9

What are vasomotor symptoms?

DotS the definition of vasomotor symptoms may vary. The Menopause Society’s (formerly The North American Menopause Society) definition is:

Vasomotor symptoms. Also known as hot flashes and night sweats, common symptoms during perimenopause and early postmenopause”.10

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”.11

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:

“The woman judges the severity of her own symptoms and records the score – 1 for mild, 2 for moderate, 3 for severe and 0 if she does not have that particular symptom. A score of 15 or over usually indicates oestrogen deficiency that is intrusive enough to require treatment, but this is only a guide. Women are very variable in their tolerance of discomfort, often tolerating quite severe symptoms before they will even consider taking MHT”.12

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”.13

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”.14

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

“Talk to your doctor if you are worried about:

  • Irregular periods
  • Heavy bleeding
  • Bleeding after menopause
  • Increased premenstrual syndrome (PMS) symptoms
  • Menopausal symptoms, such as hot flushes, that interfere with your daily life”.15

Health Topics A-Z

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Links

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Sources

Where may I find the Sources quoted?

You may find the Sources at:

Sources

  1. Diagnostic Tests for Menopause. 2022:1. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/05/Diagnostic-tests-for-menopause.pdf Accessed: 09 March 2025
  2. What Is Menopause? Diagnosing Perimenopause and Menopause. Last Updated: 03 March 2025 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 09 March 2025
  3. What Is Menopause? Diagnosing Perimenopause and Menopause: Blood Tests. Last Updated: 03 March 2025 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 09 March 2025
  4. What Is Menopause? How Is Menopause Diagnosed? Content Created May 2022. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/185-what-is-menopause Accessed: 09 March 2025
  5. Diagnosing Menopause: Symptom Assessment and Diagnosis At Perimenopause and Menopause. Content Created May 2022. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 09 March 2025
  6. Menopause – Diagnosis & Treatment: Diagnosis. 07 August 2024. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 Accessed: 09 March 2025
  7. What Is Menopause? Diagnosing Perimenopause and Menopause. Last Updated: 03 March 2025 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 09 March 2025
  8. Diagnostic Tests for Menopause. 2022:1. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/05/Diagnostic-tests-for-menopause.pdf Accessed: 09 March 2025
  9. Diagnosing Menopause: Key Points. Content Created May 2022. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 09 March 2025
  10. Menopause Definitions: V – Vasomotor Symptoms. Menopause Society https://menopause.org/patient-education/menopause-glossary#V Accessed: 09 March 2025
  11. Diagnosing Menopause: Symptom Assessment and Diagnosis At Perimenopause and Menopause. Content Created May 2022. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 09 March 2025
  12. Diagnosing Menopause: Symptom Score Sheet. Content Created May 2022. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 09 March 2025
  13. Lambrinoudaki I., Armeni E., Goulis D., Bretz S, Ceausu I, Durmusoglu F, Erkkola R. Fistonic I, Gambacciani M., Geukes M., Hamoda H., Hartley C., Lindén Hirschberg A., Meczekalski B., Mendoza N., Mueck A., Smetnik A., Stute P., van Trotsenburg M., Rees M. 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 2022:4. https://www.maturitas.org/article/S0378-5122(22)00090-1/fulltext Accessed: 09 March 2025
  14. What Is Menopause? How Is Menopause Diagnosed? Content Created May 2022. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 09 March 2025
  15. What Is Menopause? When To See Your Doctor. Content Created May 2022. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 09 March 2025
Topic Last Updated: 09 March 2025 – Topic Last Reviewed: 09 March 2025