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What Is Menopause?
Menopause is the time in a woman’s life when her normal menstrual periods have stopped for at least 12 months and she can no longer become pregnant. Usually, menopause is a gradual transition, beginning with a stage called perimenopause between the ages of 45 and 55. Menopause may also be triggered earlier in a woman’s life due to health conditions or medical procedures that affect the body’s production of or response to important hormones.
Before menopause, a woman’s hormones work together to release an egg from the ovaries and either regulate the monthly menstrual period or support the beginning of a pregnancy. During perimenopause, women begin to experience hormonal fluctuations. These hormonal fluctuations cause irregular menstrual periods and other symptoms of perimenopause including hot flashes, sleep problems, and vaginal changes.
The Role of Menopause Tests
Menopause testing is used to determine if a patient’s symptoms are part of menopause or related to another condition. Symptoms related to menopause include:
- Irregular menstrual periods
- Hot flashes
- Sleep problems
- Vaginal dryness, irritation, or discharge
- Mood swings
- Trouble concentrating
In evaluating the cause of these symptoms, a doctor may ask about a patient’s age, symptoms, and family history. In around 75% of women, symptoms of perimenopause begin during the expected age range and doctors can diagnose menopause without laboratory testing. Menopause is confirmed after a woman has had no menstrual period for 12 months.
However, menopause testing is often ordered when the cause of symptoms is not clear. For example, menopause testing may be used for women who have had a hysterectomy, women who begin to have symptoms of menopause several years before age 50, or when a woman experiences abnormal symptoms suggestive of menopause.
Types of Menopause Tests
As women age, the ovaries become less responsive to follicle-stimulating hormone (FSH) and luteinizing hormone (LH), two hormones important for ovulation and regulating menstrual periods. In response, the ovaries stop producing estrogen and progesterone, causing estrogen levels in the body to decrease and FSH levels to increase.
When testing for menopause is warranted, doctors may order an FSH test to detect elevated levels of FSH in the blood. Measuring FSH can help determine if a woman is perimenopausal or has already gone through menopause.
Because FSH levels naturally fluctuate each month to stimulate ovulation, results of FSH testing should be interpreted with caution and may be misleading. Rather than interpreting a single FSH test result, consistently elevated levels over time are used to confirm menopause.
Additional tests that may be ordered to help a doctor diagnose menopause include:
|TESTS TO EVALUATE MENOPAUSE STATUS|
|Test Name||Test Sample||What It Measures|
|Estrogens||Blood, urine, or saliva sample||Level of estradiol in the blood to diagnose menstrual problems|
|Luteinizing hormone||Blood or urine sample||A hormone that can confirm the start of perimenopause|
|Anti-Müllerian Hormone (AMH)||Blood sample||A hormone that can predict the start of menopause or determine the reason for early menopause|
Other conditions can cause irregular menstruation or can stop it completely. In some cases, doctors will perform testing to determine whether something other than menopause is affecting menstruation:
|TESTS TO RULE OUT OTHER CONDITIONS|
|Test Name||Test Sample||What It Measures|
|Thyroid panel||Blood sample||Thyroid function|
|Prolactin test||Blood sample||Amount of prolactin hormone|
|Pregnancy test (hCG)||Blood or urine sample||Pregnancy status|
Getting Menopause Testing
Menopause testing usually takes place in a doctor’s office, laboratory, or hospital. Most tests for menopause involve a blood sample that is drawn from your arm using a needle.
Anyone with symptoms of perimenopause should talk with their doctor to determine if menopause testing is appropriate in their case.
At-home test kits are available that can analyze hormones that may be relevant to menopause, such as the following:
- At-home FSH testing: At-home FSH tests detect elevated levels of FSH in a urine sample. However, this test cannot definitely diagnose menopause. At-home kits may be less accurate than a laboratory test for FSH.
- At-home estrogen testing: At-home estrogen testing measures the levels of three types of estrogens in a saliva sample: estrone, estradiol, and estriol. Estradiol levels may be used to help determine menopausal status but must be interpreted with the help of a doctor.
- At-home luteinizing hormone test: At-home luteinizing hormone tests measure levels of luteinizing hormone in a urine sample. This home test may be used to detect ovulation, but is not commonly used to detect menopause.
Sources and Resources
These resources provide additional information about menopause and aging:
- American College of Obstetricians and Gynecologists: The Menopause Years
- MedlinePlus Medical Encyclopedia: Menopause
- Merck Manual: Menopause
- National Institute on Aging: What Is Menopause?
- Womenshealth.gov: Menopause
A.D.A.M. Medical Encyclopedia. Menopause. Updated June 30, 2019. Accessed April 13, 2021. https://medlineplus.gov/ency/article/000894.htm
American College of Obstetricians and Gynecologists. The menopause years. Published December 2018. Accessed April 2, 2021. https://www.acog.org/womens-health/faqs/the-menopause-years
Casper RF. Clinical manifestations and diagnosis of menopause. In: Barbieri RL, Crowley WF, eds. UpToDate. Updated March 20, 2020. Accessed April 13, 2021. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-menopause
Knudtson J. Effects of aging on the female reproductive system. Merck Manuals Consumer Version. Updated April 2019. Accessed April 13, 2021. https://www.merckmanuals.com/home/women-s-health-issues/biology-of-the-female-reproductive-system/effects-of-aging-on-the-female-reproductive-system
MedlinePlus: National Library of Medicine. Menopause symptoms. Updated October 21, 2016. Accessed April 13, 2021. https://medlineplus.gov/menopause.html
MedlinePlus: National Library of Medicine. Estrogen levels test. Updated July 31, 2020. Accessed April 13, 2021. https://medlineplus.gov/lab-tests/estrogen-levels-test/
MedlinePlus: National Library of Medicine. Anti-Müllerian Hormone Test. Updated December 15, 2020. Accessed April 13, 2021. https://medlineplus.gov/lab-tests/anti-mullerian-hormone-test/
MedlinePlus: National Library of Medicine. Follicle stimulating hormone (FSH) levels test. Updated December 17, 2020. Accessed April 13, 2021. https://medlineplus.gov/lab-tests/follicle-stimulating-hormone-fsh-levels-test/
MedlinePlus: National Library of Medicine. Luteinizing hormone (LH) test. Updated December 17, 2020. Accessed April 13, 2021. https://medlineplus.gov/lab-tests/luteinizing-hormone-lh-levels-test/
National Institute of Child Health and Human Development. Menopause: Condition information. Updated December 1, 2016. Accessed April 13, 2021. https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/default
National Institute on Aging. What is menopause? Updated June 27, 2017. Accessed April 13, 2021. https://www.nia.nih.gov/health/what-menopause
Pinkerton JV. Menopause. Merck Manuals Professional Edition. Updated December 2019. Accessed April 13, 2021. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menopause/menopause
Pinkerton JV. Menopause. Merck Manuals Consumer Version. Updated December 2019. Accessed April 13, 2021. https://www.merckmanuals.com/home/women-s-health-issues/menopause/menopause
US Department of Health and Human Services. Menopause basics. Updated March 18, 2019. Accessed April 13, 2021. https://www.womenshealth.gov/menopause/menopause-basics
US Food and Drug Administration. Menopause. Updated September 27, 2018. Accessed April 13, 2021. https://www.fda.gov/medical-devices/home-use-tests/menopause
Welt CK. Ovarian development and failure (menopause) in normal women. In: Barbieri RL, Crowley WF, eds. UpToDate. Updated July 13, 2019. Accessed April 13, 2021. https://www.uptodate.com/contents/ovarian-development-and-failure-menopause-in-normal-women