How is menopause diagnosed?

So, you’re wondering “How is menopause diagnosed?”

It’s a great question! Menopause isn’t just about changes in your monthly cycle; it’s about your body, your hormones, and a big shift in your life. Can you figure out if you’re in menopause just by your symptoms? Or should you visit a doctor?

Let’s dive in and break down what you need to know about this natural change every woman goes through.

Can you make your own diagnosis based on menopause symptoms?

Often, it’s not too hard to recognise the onset of menopausal symptoms.

You’re likely familiar with the most common symptoms: hot flashes and night sweats (sometimes known as vasomotor symptoms), brain fog and problems sleeping. There are many other symptoms, though, and you may not at first link these to menopause. These are things like headaches, mood swings, anxiety, depression, dry eyes, dry mouth, mouth ulcers, ringing ears, muscle and joint aches and pains, dry skin, odd skin sensations and vaginal dryness, itching and soreness.

The particular combination and severity of symptoms will be unique to you, and that can make it hard to recognise that these are perimenopausal symptoms. It can also be hard to recognise it for what it is if these symptoms start before you expect them, as in premature menopause (before age 40) and early menopause (between 40 and 45).

If you’re experiencing some of these symptoms, consider keeping a daily journal. Tracking frequency and severity can help you make your point during doctor visits and is great for assessing the effects of treatment. Our comprehensive manual of menopause, The Menopause Handbook, contains specially designed logs for you to record your symptoms and other key healthcare information.

Symptoms are the basis for menopause diagnosis

Perimenopause diagnosis is almost always based on your symptoms and perhaps the findings of a physical examination. Being of an appropriate age and having typical symptoms are usually all that’s needed to confirm that you have entered the menopause transition. 

Typically, the first signs of perimenopause are irregular periods. Indeed, deciding which stage of menopause you are in is based on the regularity of your periods. You can read more about the stages of menopause here. By this definition, once your menstrual cycle length varies by seven days or more between periods, you have started perimenopause. All the other symptoms are just a grim icing on the cake.

We generally talk about menopause as being the period of several years towards the end of your reproductive life in which you might suffer from a variety of symptoms. In technical terms, however, menopause isn’t a period of time but a single event, your final period. Since your periods will have been increasingly irregular for some time, you can’t be sure that was your final period (and thus your menopause) until you’ve gone at least 12 months without a period.

To sum up,

• If your periods have become irregular to the point that your cycle lengths vary by seven days or more, you have started perimenopause.
• If you haven’t had a period for at least 12 months, that last period was your menopause.

If diagnosing perimenopause and menopause is so easy, is there any need to see a doctor?

Do you need to see a doctor to diagnose menopause?

While it may not be essential to see a doctor to confirm that you’ve started the menopause transition, there are many reasons why it’s a great idea to do so.

Firstly, it’s not always so easy to make a menopause diagnosis. For example, if you have irregular periods or signs and symptoms earlier than expected, it may not be menopause. There may be an alternative reason, such as an overactive thyroid. When menopause does come early, it’s particularly important to confirm the diagnosis. That’s because there are strong arguments to consider hormone therapy to help prevent the long-term consequences of low estrogen, like osteoporosis and cardiovascular disease.

Secondly, the symptoms of menopause can be challenging. You don’t need to battle on heroically, as there are many treatment options. Of course, there’s hormone replacement therapy with estrogen and often progesterone, but there are many alternative treatments, too. Your doctor will be experienced in the management of menopause and so able to help you find the most effective treatment.

Thirdly, menopause is a critical transition in life. Your body’s needs and health risks change around this time. It’s the perfect opportunity for a health check-up, ensuring you are set up for a long and healthy future post menopause. We’ll get into the specifics in a future article.

Now we’ve established that it’s a good idea to see your doctor, how will they confirm a menopause diagnosis?

How will your doctor or health care provider diagnose menopause?

As we’ve said, the diagnosis of perimenopause is based mainly on symptoms. That’s how your doctor will usually confirm menopause, too.

Your doctor may ask you to complete a symptom score sheet. This helps you to think about symptoms that you may not have associated with menopause. It can also act as a baseline to monitor the effects of treatment. 

Your doctor may want to do a physical examination. They will be looking to exclude another cause for your symptoms, such as fibroids or pregnancy, and for signs that support a diagnosis of menopause, such as changes to the vaginal walls, labia, and pubic hair.

Sometimes, diagnosing menopause can be trickier

In some situations, diagnosing perimenopause or menopause is less straightforward and perhaps more critical. For example:

• If you are taking oral hormonal contraceptives or hormonal treatment for heavy periods. These can maintain regular periods after they might naturally have become irregular or stopped.
• If you have had a hysterectomy, you can’t assess the regularity or absence of your periods.
• If you have the symptoms of menopause at an earlier-than-expected age.
• Certain drugs used to treat breast cancer cannot be used until you are postmenopausal, and other cancer treatments may have already disrupted or ended your periods.

If you have had a hysterectomy and are over 45, menopause can generally be diagnosed from your symptoms. If you have a hysterectomy before 45, your ovaries may stop working before normal menopausal age. In that case, you may benefit from starting menopausal hormone replacement therapy (mHRT) to protect your bones and reduce the risk of heart disease.

If your ovaries are removed at the same time as your hysterectomy, your doctor may recommend you start mHRT straight away. This will depend on the reason for the hysterectomy. For example, if your hysterectomy was because of ovarian cancer, you may be advised not to take mHRT.

While symptoms may be the mainstay of diagnosis, you may be wondering if blood tests can provide definitive answers.

Is there a blood test to diagnose menopause?

You might expect that you could have a quick blood test that would tell you where you were in the menopause transition. Of course, it’s not that simple!

Imagine hormones like the tides of the sea, sometimes high and sometimes low. Even though graphs in books or online might make it seem like estrogen levels fall predictably, real-life hormone levels may fluctuate a lot, like unpredictable waves, ebbing and flowing. As levels swing wildly, sometimes your estrogen level may even be higher than normal. This means that a single hormone level sheds little, if any, light on where you are in the menopause transition.

Follicle-stimulating hormone (FSH) is a hormone that signals the ovaries to mature eggs ready for ovulation. Its levels can give clues about where you are in the menopause transition. Once again, a single result is not very helpful. If your FSH is elevated on two separate occasions four to six weeks apart, that does give supporting evidence that you are in the menopause transition.

Given this complexity, how essential and reliable are hormone tests in diagnosing menopause?

Is it important to have a hormone test or other blood test?

As we have said, blood tests are unnecessary for most women since menopause is mostly diagnosed on the basis of appropriate age and symptoms. However, there are a few situations where blood tests can be helpful. Although recommendations vary by country, FSH and estradiol measurements may be used if:

• You are aged 40 or younger and have symptoms suggesting menopause.
• You are between 40 and 45 and have symptoms of menopause and changes to your menstrual cycle.
• You have had a hysterectomy and are under 45; your doctor may test your blood once a year.
• Confirmation of menopause is required to start treatment with certain anti-cancer drugs, particularly for breast cancer.

It’s not always convenient to attend for a blood test. With the recent surge of over-the-counter solutions, can home tests offer reliable answers?

Over-the-counter and home tests: Are they worth it?

Over-the-counter urine and saliva hormone tests are available from shops and online. Don’t waste your money.

As we have said, FSH and estrogen levels vary widely through perimenopause, so even accurate tests from your doctor are unhelpful. Not only that, hormone levels in saliva and urine don’t accurately reflect blood levels, so they’re even less helpful. The Royal College of Obstetricians and Gynaecologists and the British Menopause Society are typical of expert groups who recommend against using over-the-counter tests.

Are there any newer tests for menopause?

Two other hormones deserve mention, even though their use is limited. Inhibin-B and anti-Müllerian hormone are both produced by the ovary. Their blood levels fall slowly throughout reproductive life and become undetectable four to five years before the final menstrual period. Since their levels don’t fluctuate in the same way as estradiol and FSH, they can be used to predict when menopause will occur. However, they are only slightly more accurate than using menstrual cycle regularity as a predictor. They are rarely used in routine practice.

In conclusion: Deciphering the diagnosis of menopause

Getting a clear diagnosis of menopause can be a vital step in dealing with all the varied symptoms women experience in mid-life. Often, it’s good to know that there’s an explanation for those mood swings, memory lapses and forgetfulness!

The diagnosis of menopause is usually pretty straightforward. For most women, menopause is diagnosed through menstrual irregularities and symptoms such as hot flashes and night sweats, occuring at an average age for menopause.

When menopause comes early, as in premature ovarian insufficiency (POI), when the clinical manifestations aren’t typical, or when the irregularities of menstruation can’t be used as a guide (after hysterectomy or when hormonal contraceptives are used), blood tests, particularly the FSH test, can help women with diagnosis and management.

Menopause is a pivotal turning point with many implications for women’s health, and particularly for long-term health, such as a heightened risk of cardiovascular disease. Seeing your doctor as you go through menopause is useful not just to confirm the diagnosis, but also to ensure you are well placed for a long and healthy future.

Could this be menopause? Wonder no more! For comprehensive information about diagnosis and all aspects of menopause, be sure to check out The Menopause Handbook.

Did this guide help clarify the process of diagnosing menopause for you? Share your experiences or questions in the comments below. Remember, everyone’s journey through menopause is unique.