How is the perimenopause and menopause diagnosed?

Dr Alison Vickers a Sydney GP with a special interest in care of women during perimenopause and menopause explains

Short answer

Perimenopause and Menopause are diagnosed based on your age and what is happening with your periods and symptoms you may be having, like not sleeping, hot flushes, and night sweats. In some cases, a blood test may be helpful.

Long answer

You would think there would be a simple test for something that affects every woman who goes through midlife. But there is no simple test, and it can actually be pretty complicated to try and work out where a woman is in her journey through menopause.

When is a blood test helpful for making the diagnosis?

Generally, a blood test is not helpful as hormone levels are up and down during perimenopause. When you do the test, you only know what is happening with the hormones on that day and it may be different the following week. Symptoms like hot flushes and night sweats and what is happening with your periods are a much more accurate way of deciding whether you are perimenopausal or menopausal.

However, a blood test is helpful in the following situations

• If you have had a hysterectomy or endometrial ablation
• If you are less than 45 and your periods have stopped or are irregular
• To check for another cause for no periods, particularly if you are less than 40 years old
• If you are over the age of 50  and on progesterone contraception like the Mirena, Slinda or Minipill a blood test can help you decide how much longer you will need contraception

When do I know I am probably menopausal?

It is always good to chat with your doctor to make sure there is no other cause, but generally, we are happy to say you are menopausal if you:

• are over 50 and have had no period for 12 months
• are 45-50 and have had no period for 2 years

When do I know I am probably perimenopausal?

You are probably perimenopausal if:

• you are over the age of 45
• your periods are irregular
• you are starting to get some hot flushes and night sweats
• you have noticed a change in your mental health or sleep

What if I have flushes or other symptoms and an irregular cycle or no periods and I am younger than 40?

1 in 100 women go through menopause before the age of 40. You may be one of these women if you are under 40 if :

• your periods are irregular or have stopped
• you are starting to get some hot flushes and night sweats
• you have noticed a change in your mental health or sleep
• have symptoms such as breast tenderness

This is more likely to happen if it happened to your mother or sister. It is called Premature Ovarian Insufficiency. If you think you may have Premature Ovarian Insufficiency, it is extremely important to have a blood test to have this diagnosed. You should strongly consider hormone therapy, which for this group of women has enormous benefits for:

• Maintaining strong bones
• Preventing heart disease
• Preventing dementia
• Improving mood and wellbeing

What if I have flushes and an irregular cycle or no periods and I am 40-45?

You are probably going into early menopause if you are aged 40-45 and:

• your periods are irregular or have stopped
• you are starting to get some hot flushes and night sweats
• you have noticed a change in your mental health or sleep
• you have symptoms such as breast tenderness

Seeing your doctor is a good idea. A blood test may be beneficial to ensure no other cause for your symptoms. Additionally, you will need to know about the benefits of hormone therapy for your bones and general health.