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Menopause: Diagnosis of menopause

The diagnosis of menopause and the menopausal transition should be made from a combination of factors with most emphasis being placed on the pattern of periods and presence of menopausal symptoms. Over the age of 45, the absence of periods or infrequent periods along with symptoms such as flushes and sweats can alone be used to diagnose the perimenopause or menopause. Blood or urine tests are unnecessary and are not recommended. [Ref 90]

Measurements of hormone levels are most useful when early or premature menopause is suspected, following hysterectomy with conservation of ovaries when there is no period pattern to observe, when unusual symptoms are present and when fertility appears to be reduced. [Ref 27]

As both the number and quality of egg cells in the ovaries decrease, the response of the ovaries declines, estrogen levels fall and levels of the hormones from the pituitary gland, Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) rise.

Home kits can be used to check for a raised FSH in a urine test, and you can have a blood test to measure the level, however the level depends on the phase of the cycle and can vary by a factor of 10-30 or more during the menstrual cycle. If having a blood level measured, the blood sample should be taken on the 3rd to 5th day of a period. A normal level does not exclude early menopausal transition and a raised level does not exclude continuing ovarian function. One raised level should therefore not be relied upon as a reason to stop using contraception since egg release can still occur late in the menopausal transition.

FSH level can be temporarily raised after stopping the oral contraceptive pill or depot progestogens, during breast feeding and with some medicines such as selective serotonin reuptake inhibitors.

Recently, measurement of Anti Mullerian Hormone (AMH) is being recommended in women who are commencing fertility treatment. AMH is produced from the egg cells in the ovaries and the more egg cells that are remaining, the higher the level will be. This can be helpful in assessing the likelihood of success of fertility treatment, and in helping choose the dose of drug to be used to stimulate the ovaries. It is not routinely used to diagnose menopause, when the level will be very low, but can be helpful if the diagnosis is unclear.

See also:

Recommendations from NICE - Diagnosis of menopause and perimenopause.

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