How Menopause Is Diagnosed

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Diagnosing menopause, the end of your reproductive years, can be challenging: Most women won't know for sure that they've reached this milestone—the point at which the ovaries no longer produce estrogen and progesterone—until at least a year after they get there. Until that point, a woman still is at risk of pregnancy.

Self Checks/At-Home Testing

Strictly speaking, a woman has reached menopause when she has gone an entire year without having a period. Here's where it gets tricky: Unless you have a surgical procedure that will cause your periods to stop immediately, such as a hysterectomy (which, incidentally is often referred to as "surgical menopause"), there's no way to know ahead of time when you'll reach menopause. In fact, you'll only know for sure if you note each time you menstruate on a calendar or in some other way, and then notice when a year or more goes by that you haven't had a period.

There are home lab kits to measure FSH in urine that usually is consistent with lab tests that measure FSH in the blood. During perimenopause and menopause, the FSH levels rise. Elevated levels detected with an FSH home test won't be a guarantee that you've reached menopause. This is because FSH levels can vary during menopause, and while it may be high on the day you measure it, it is not a guarantee that you have stopped menstruating completely.​​ Even if you've gone several months without menstruating, until an entire year goes by there's always a chance you'll have another period. In that case, you'll have to start the countdown all over again.

The terminology around menopause is one of the things that makes understanding the timing so confusing. Often you'll hear someone say she's "in menopause," or she's "going through menopause," or she's "menopausal." But this rarely means she's actually reached menopause. Most likely, she's experiencing perimenopause—the period of time leading up to menopause. Perimenopause symptoms include hot flashes, night sweats, irregular periods, changes in menstrual flow (heavier or lighter, for example), and so forth.

Labs and Tests

Menopause is diagnosed based on your age, clinical history, and a year having passed since your last menstrual period (unless your menopause was surgically induced).

In cases in which it's not clear if a woman has reached menopause, there are lab tests that can confirm the diagnosis. These measure amounts of certain reproductive hormones in the body that fluctuate during the menstrual cycle. These are the specific hormones and what they do:

  • Follicle-stimulating hormone (FSH). This hormone is released by the pituitary gland. After menopause, the levels of FSH in the blood rise dramatically, making it a good indicator of having reached menopause.
  • Estradiol. This is one of three types of estrogen and is the type most often evaluated when testing for menopause.
  • Thyroid stimulating hormone (TSH). Sometimes a thyroid problem can cause symptoms that mimic menopause. Especially in the case of someone who seems to have reached premature menopause, meaning she's under age 40 when symptoms begin to appear, it may be important to test levels of TSH to rule out a condition other than menopause.

Imaging

It is rare that imaging studies are used in the diagnosis of menopause. Ultrasound can show details of follicle counts and ovarian volume to help determine whether menopause has occurred.

You should continue with your regular imaging health screens when you reach perimenopause and menopause. These include mammograms to screen for breast cancer. It also is often a time when you will have your first colonoscopy to screen for colon cancer.

Differential Diagnoses

Some illnesses have symptoms similar to those often attributed to menopause. Be sure to discuss any symptoms with your doctor so nothing is overlooked. Perimenopausal symptoms, including sweating, mood changes, and menstrual irregularities can be seen in hyperthyroidism. You might also stop menstruating due to pregnancy, thyroid disease, or hyperprolactinemia (which may be caused by a pituitary tumor).

As well, if you have an ongoing condition such as migraine, depression, or anxiety, you may have a worsening of symptoms as you enter menopause. You may need adjustments to your medications.

If you begin hormone replacement therapy, be sure to talk to your doctor if your symptoms are not getting better or are getting worse.

A Word From Verywell

Menopause is often an "am I or aren't I?" proposition. You may have been period-free from months and then have spotting or a light period, resetting the countdown until you are sure you are postmenopausal. While menopause means you don't have to use birth control to prevent pregnancy, remember that you still need to practice safe sex to prevent sexually transmitted diseases.

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Article Sources

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