Menopause Diagnosis

“Blood tests won’t tell you when your final period is going to happen and won’t help you manage your perimenopause, or what follows”.¹

Umbrella
What may the Menopause Diagnosis Umbrella include?

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

Predict or Confirm

Is there a simple test to predict or confirm menopause or perimenopause?

In How Do I Know I’m In Menopause? The Bottom Line the North American Menopause Society (NAMS) elaborate on:

“To date, there is no simple test to predict or confirm menopause or perimenopause, but research continues. So, check your menstrual calendar and seek your health providers’ opinions”.²

Final Menstrual Period Blood Tests

Can blood tests tell you when your final period is going to happen?

In About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? the (Australian) Jean Hailes for Women’s Health (JH) explain:

“Blood tests won’t tell you when your final period is going to happen and won’t help you manage your perimenopause, or what follows. During the perimenopause, hormone levels vary widely and can be low one day and within the normal range the next”.³

Perimenopause Blood Tests

Can blood tests diagnose perimenopause?

In About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? Blood Tests the JH elaborate on:

Menopause Blood Tests

Can blood tests diagnose menopause?

In About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? Blood Tests the JH elaborate on:

Symptoms

Currently what is the best way to predict menopause?

In About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? The Best Test So Far the JH also explain:

“Currently, the best way to predict menopause is to use the symptoms you have as a guide to whether you are close to menopause. If your periods are irregular or have stopped for some time, or if you are experiencing symptoms such as hot flushes and they are gradually getting worse, these signs are likely to be better indicators than blood or saliva tests that you are getting closer to menopause”.⁶

Diagnosis

How is menopause diagnosed?

In Diagnosing Menopause: Key Points the Australasian Menopause Society (AMS) explain:

What are vasomotor symptoms?

DotS the definition of vasomotor symptoms may vary. The International Menopause Society note:

“Hot flushes and night sweats are also referred to as Vasomotor Symptoms (VMS)”.⁸

In About Menopause: The Stages of Menopause – Perimenopause: Diagnosis of Perimenopause JH explain:

In Diagnosing Menopause: Symptom Assessment and Diagnosis 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”.¹⁰

Symptom Score

What is the Symptom Score used by the AMS?

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

Blood/FSH Test

What may a blood test measure?

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. 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”.¹²

How reliable is a single FSH test as an indicator of perimenopause?

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

“A single hormone test, such as a measurement of elevated follicle-stimulating hormone (FSH) is not a reliable indicator of the peri-menopause, as during this time women’s hormone levels fluctuate from day to day”.¹³

In How Do I Know I’m In Menopause? What About Follicle-Stimulating Hormone Testing? the NAMS elaborate on:

“…a single FSH level can be misleading in perimenopause since estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels can vary greatly during perimenopause. One elevated FSH level is not enough to confirm menopause. More importantly, a low FSH level in a woman who is having hot flashes and changing periods does not eliminate the likelihood that she is still in perimenopause”.¹⁴

What can compromise the validity of FSH tests?

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

“It is especially unhelpful to do hormone blood tests while women are on HRT/OCP…”.¹⁵

What is HRT?

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

What is OCP?

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

Saliva Tests

Can saliva tests diagnose perimenopause?

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

“While some practitioners recommend saliva tests to determine hormone levels, there is no evidence that the result will be accurate or useful. The Australasian Menopause Society does not endorse the use of these tests. Measurement of AMH (anti-Müllerian hormone) can help to predict age of menopause but it is not a test routinely used except in the specialist setting”.¹⁶

In How Do I Know I’m In Menopause? What About Saliva Testing? the NAMS also note:

“Some clinicians recommend testing a woman’s saliva for estrogen or other hormone levels. But salivary hormone levels are expensive, are not accurate, and should not be used to evaluate or treat menopausal symptoms”.¹⁷

Blood Tests Because…

So if “blood tests won’t tell you when your final period is going to happen” or are unnecessary to diagnose perimenopause or menopause, why may they be ordered?

In About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? Blood Tests the JH elaborate on:

“In some unusual situations, such as in women younger than 45 whose periods are irregular or have stopped, a doctor will measure hormone levels. Outside of such situations, hormone levels are not very helpful and won’t change the advice a doctor will give you about treating menopausal symptoms”.¹⁸

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

“It is not necessary to have hormonal tests to “prove” a woman is menopausal. However a doctor may order tests if there is concern that physical changes are a sign of illness, such as a thyroid disorder, rather than natural ageing, or if spontaneous menopause occurs at an early age”.¹⁹

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:

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Topic Last Updated: 10 July 2020 – Topic Last Reviewed: 10 July 2020