Menopause Diagnosis

Natural menopause is usually diagnosed when a woman has not had a menstrual period for 12 consecutive months. Some clinicians will diagnose after six months without menses. Your healthcare provider will ask about your symptoms, family and medical history, and perform a physical exam. You may have blood tests, a pelvic exam, and a Pap smear.

Most women in their late 40s and early 50s will have menopausal symptoms. Your doctor will consider testing for other possible causes of these symptoms. In most cases, hormone tests are not needed.

Your healthcare provider may give you a follicle-stimulating hormone (FSH) test, which measures the level of follicle-stimulating hormone in your blood. This is done to confirm that you are in menopause. Women most likely to have this test are those who have had a hysterectomy with preservation of ovaries. Without the cessation of menses as a guide, the FSH level may be used to diagnose menopause.

FSH is produced by your pituitary gland and stimulates your ovaries to produce estrogen. As your estrogen levels decline, your pituitary gland produces more FSH, which enters your blood in an attempt to stimulate more estrogen. When blood levels of FSH consistently rise to certain levels (usually >40), it is likely that you have reached menopause. More than one FSH test may be needed to confirm menopause. You should not be taking birth control pills when you have an FSH test because they contain hormones that will affect the test results.

The process of menopause is broken down into three phases.

Perimenopause

• May begin 3-5 years before your last menstrual period
• Lasts about one to two years after your last menstrual period
• Signs and symptoms may appear during this phase

Menopause

• Complete cessation of menstrual periods
• You have had no menstrual periods for one year, undergo surgical menopause, or have a blood test confirmation of menopause
• Childbearing is no longer naturally possible

Postmenopause

• Begins one to two years after your last menstrual period
• You no longer menstruate.
• Risk of certain health problems increases, such as
  • osteoporosis
  • cardiovascular disease
  • vaginal dryness

The American College of Obstetricians and Gynecologists website. Available at: http://www.nia.nih.gov/ . Accessed November 2009.

Fritz, M. A. and Speroff, L. Clinical Gynecologic Endocrinology and Infertility . 8th ed. Lippincott, Williams & Wilkins; 2011: 673-858.

National Institute on Aging website. Available at: http://www.nia.nih.gov/ . Accessed February 14, 2006.

National Women's Health Information Center website. Available at: http://www.womenshealth.gov/ . Accessed February 14, 2006.

North American Menopause Society website. Available at: http://www.menopause.org/ . Accessed February 14, 2006.