Diagnosis

Making a diagnosis of perimenopause or menopause is generally based on symptoms alone, but blood tests are sometimes necessary in certain cases.¹ The diagnosis in women aged over 45 years old is a clinical one, based on age and symptoms once other causes have been excluded, such as thyroid disease and anaemia.¹

In women aged under 45, there is a need to confirm the diagnosis. A follicle-stimulating hormone (FSH) test should be performed. FSH is a hormone made by the pituitary gland which stimulates the ovarian follicles to develop. As the ovarian follicular activity reduces during the menopause, the level of FSH rises. This rise is a marker of the menopause. Blood tests are only indicated in women where POI or an early menopause are suspected; they are not routinely used to diagnose perimenopause or menopause in healthy women aged 45 years or over.¹

If FSH levels are indicated, two blood tests should be taken to confirm them. These should be taken four to six weeks apart. FSH levels consistently above 30mlU/ml or higher would indicate menopause.¹

In perimenopause, a woman’s FSH may be normal, but this does not mean that perimenopause can be excluded. An individualised discussion can help to guide whether HRT might be indicated to help manage symptoms.