“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”.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:

Best Way

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?

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”.⁷

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

What are vasomotor symptoms?

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

“Vasomotor symptoms. Also known as hot flashes and night sweats, common symptoms during perimenopause and early postmenopause”.⁹

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

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

What is FSH?

FSH can be an abbreviation for Follicle Stimulating Hormone.

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:

Blood 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”.¹³

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 perimenopause, as women’s hormone levels may fluctuate from day to day”.¹⁴

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 because 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 important, 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”.¹⁵

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”.¹⁶

What is HRT?

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

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”.¹⁷

Saliva Tests

Can saliva tests diagnose perimenopause?

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

“Salivary hormone level tests are expensive, are not accurate, and should not be used to evaluate or treat menopause symptoms”.¹⁸

Blood Tests Because…

Why may blood tests 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”.¹⁹

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 natural ageing); or (iii) if woman is under 45 years of age”.²⁰

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: 11 June 2022 – Topic Last Reviewed: 14 May 2022