“A diagnosis of menopause is made on the basis of new onset vasomotor symptoms and a change in the pattern of menstrual bleeding”.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 or Confirm

Menopause DiagnosisIs 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 menstrual period (FMP) is going to happen?

Menopause DiagnosisIn 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?

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

“A definite diagnosis of perimenopause is not possible using hormone levels because oestradiol and FSH levels can fluctuate markedly throughout the cycle, from day to day”.4

Menopause Blood Tests

Can blood tests diagnose menopause?

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

“Hormone levels are not useful for the diagnosis of the menopause either, as menopause is usually said to have happened if a woman describes 12 months of having no periods, with or without typical menopausal symptoms, and if she is at the typical age of menopause (between 45-55 years)”.5

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:

Menopause Diagnosis
  • “A diagnosis of menopause is made on the basis of new onset vasomotor symptoms and a change in the pattern of menstrual bleeding”.7

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:

“There is no test to diagnose perimenopause. It is best identified by considering:

  • Changes in the nature of your periods, such as:
    • How frequent they are now and if that has changed?
    • How long they last and if that has changed?
    • How light or heavy they are and if that has changed?”9

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:

“The woman judges the severity of her own symptoms and records the score – 1 for mild, 2 for moderate, 3 for severe and of course 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 guideline. Women are very variable in their tolerance of discomfort, often tolerating quite severe symptoms before they will even consider taking MHT”.11

FSH Tests

Menopause DiagnosisWhat can FSH tests diagnose perimenpause?

In What Is Menopause? How Is Menopause Diagnosed? the AMS 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”.12

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”.13

What can compromise the validity of FSH tests?

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

“Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid”.14

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?Menopause Diagnosis

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 How Do I Know I’m In Menopause? the NAMS also note:

“During perimenopause, hormone tests are generally not helpful because hormone levels change throughout the menstrual cycle. Sometimes testing is done to check specific hormone levels, especially to evaluate fertility problems or when periods stop at an early age. This can help women make decisions about beginning or adjusting treatment. For some women, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease”.20

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 published in November 2015, the (British) National Institute for Health and Care Excellence (NICE) elaborate on:

“If menopausal symptoms are affecting your day to day life you should see your GP. Your GP should be able to tell if you are in perimenopause or menopause based on your age, symptoms and how often you have periods, so you are unlikely to need tests. If you are taking any hormonal treatments (for example, to treat heavy periods) it can be more difficult to know when you have reached menopause”.21

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.

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Links

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Sources

Where may I find the Sources quoted?

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Sources

  1. Diagnosing Menopause: Key Points. April 2016. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 02 March 2020
  2. How Do I Know I’m In Menopause? The Bottom Line. North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-i’m-in-menopause- Accessed: 02 March 2020
  3. About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? Blood Tests. Last Updated: 14 January 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 02 March 2020
  4. About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? Blood Test. Last Updated 14 January 2020 | Last Reviewed 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 02 March 2020
  5. About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? Blood Test. Last Updated 14 January 2020 | Last Reviewed 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 02 March 2020
  6. About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? The Best Test So Far. Last Updated 14 January 2020 | Last Reviewed 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 02 March 2020
  7. Diagnosing Menopause: Key Points. April 2016. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 02 March 2020
  8. Hot Flushes and Night Sweats – Background Information: What Are Hot Flushes and Night Sweats? October 2011:1. International Menopause Society https://www.imsociety.org/downloads/world_menopause_day_2011/wmd_media_backgrounder.pdf Accessed: 02 March 2020
  9. About Menopause: The Stages of Menopause – Perimenopause: Diagnosis of Perimenopause. Last Updated 14 January 2020 | Last Reviewed 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 02 March 2020
  10. Diagnosing Menopause: Symptom Assessment and Diagnosis. April 2016. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 02 March 2020
  11. Diagnosing Menopause: Symptom Score Sheet. April 2016. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 02 March 2020
  12. What Is Menopause? How Is Menopause Diagnosed? Content Updated February 2016. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/185-what-is-menopause Accessed: 02 March 2020
  13. How Do I Know I’m In Menopause? What About Follicle-Stimulating Hormone Testing? North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-i’m-in-menopause- Accessed: 02 March 2020
  14. How Do I Know I’m In Menopause? What About Follicle-Stimulating Hormone Testing? North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-i’m-in-menopause- Accessed: 02 March 2020
  15. Diagnosing Menopause: Key Points. April 2016. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 02 March 2020
  16. What Is Menopause? How Is Menopause Diagnosed? Content Updated February 2016. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/185-what-is-menopause Accessed: 02 March 2020
  17. How Do I Know I’m In Menopause? What About Saliva Testing? North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-i’m-in-menopause- Accessed: 02 March 2020
  18. About Menopause: Diagnosis of Menopause – Is There A Test To Diagnose Perimenopause or Menopause? Blood Tests. Last Updated: 14 January  2020 | Last Reviewed 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/about-menopause/ Accessed: 02 March 2020
  19. What Is Menopause? How Is Menopause Diagnosed? Content Updated February 2016. Australasian Menopause Society https://www.menopause.org.au/hp/gp-hp-resources/300-diagnosing-menopause Accessed: 02 March 2020
  20. How Do I Know I’m In Menopause? North American Menopause Society https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/how-do-i-know-i’m-in-menopause- Accessed: 02 March 2020
  21. Menopause: Diagnosis and Management – Information for the Public: Diagnosing Menopause. NICE Guidelines [NG23]. Published Date: November 2015. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Diagnosing-menopause Accessed: 02 March 2020
Topic Last Updated: 02 March 2020 – Topic Last Reviewed: 02 March 2020
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