Perimenopause and Menopause - Diagnosis

Scope

In otherwise healthy women aged over 45 with menopausal symptoms there is no need for laboratory tests to diagnose menopause or perimenopause. In younger women measure Follicle-stimulating hormone (FSH) but not Luteinizing hormone (LH).

Menopausal women under the age of 50, still need contraception for 2 years after their last period, women aged over 50 require continued contraception for one year only.

Assessment

Signs and Symptoms

Menopausal symptoms include hot flushes and night sweats, musculoskeletal, urogenital, mood and sexual difficulties.

Menopause in women over 45 with a uterus and not using hormonal contraception is defined as not having had a period for one year.

Investigations

It can be difficult to diagnose menopause in women who are taking hormonal treatments.

  • Do not use a serum follicle-stimulating hormone (FSH) test to diagnose menopause in women using combined oestrogen and progestogen contraception or high-dose progestogen.
  • Women over the age of 50 years on progesterone only contraception, who are amenorrhoeic can have their FSH levels checked. If the level is ≥30 IU/L the FSH should be repeated after 6 weeks. If the second FSH level is ≥30 IU/L contraception can be stopped after 1 year.
  • In women using a Mirena, or similar IUS, their hormonal contraception will not affect the FSH blood result

In otherwise healthy women aged over 45 with menopausal symptoms there is no need for laboratory tests to diagnose:

  • perimenopause based on vasomotor symptoms and irregular periods
  • menopause in women who have not had a period for one year and are not using hormonal contraception.
  • menopause in women without a uterus, on the basis of symptoms (vasomotor, musculoskeletal, urogenital, mood and sexual difficulties)

Do not use the following laboratory and imaging tests to diagnose perimenopause or menopause in women aged over 45 years:

  • anti-Müllerian hormone
  • inhibin A
  • inhibin B
  • LH
  • Oestradiol
  • antral follicle count
  • ovarian volume

In women aged 40-45 with menopausal symptoms including a change in their menstrual cycle, use a FSH test to diagnose menopause (however contraception still required until menses have ceased for one year)

In women aged under 40 diagnose premature ovarian insufficiency based on:

  • menopausal symptoms, including no or infrequent periods (taking into account whether the woman has a uterus) and elevated FSH levels on 2 blood samples taken 6 weeks apart.

Do not routinely use anti-Müllerian hormone testing to diagnose premature ovarian insufficiency.

Management

Link to section 6.4.1 of Formulary guidance

Menopausal women under the age of 50, still need contraception for 2 years after their last period, women aged over 50 require continued contraception for one year only.

Referral

Referral Criteria

If there is doubt about the diagnosis of premature ovarian insufficiency, referral is advised.

Referral Instructions

e-Referral Service Selection
Specialty: Gynaecology
Clinic Type: Menopause
Service: DRSS-Eastern-Gynaecology-Devon CCG- 15N

Referral Forms

DRSS referral form

Supporting Information

Patient Information

Menopause and Hormone Replacement Therapy (HRT)

Evidence

Menopause: diagnosis and management NICE guidelines [NG23] Published date: November 2015

Faculty of Sexual and Reproductive Healthcare. Contraception for Women aged over 40 years. July 2010

Pathway Group

Developed by NEW Devon's Pathology Optimisation Clinical Group.

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: December 2016

 

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