NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

National Collaborating Centre for Women's and Children's Health (UK). Menopause: Full Guideline. London: National Institute for Health and Care Excellence (UK); 2015 Nov 12. (NICE Guideline, No. 23.)

Cover of Menopause

Menopause: Full Guideline.

Show details

5Diagnosis of perimenopause and menopause

5.1. Introduction

The most commonly used clinical definition of the phases of the menopause considers:

  • Premenopause is menstrual cycling that is relatively normal for the women (bearing in mind that there is some gradual change in experience of menstruation across a woman’s lifecycle, such as alteration in cycle length, changes in period pain or premenstrual symptoms).
  • Perimenopause, also called the menopausal transition, is the interval in which many woman have irregular menstrual cycles before the menopause.
  • A woman is defined as postmenopausal from 1 year after her last period. Within the UK population, the mean age of women who have a natural menopause is 51 years, although there is wide variation between women and 1% of women reach menopause before the age of 40.
  • Menopause refers specifically to the last menstrual period but is rarely used as a diagnosis in itself because it is impossible to know at the time if a menstrual period is the last one; therefore ‘postmenopause’ tends to be used more than ‘menopause’.

Terms such as climacteric, time of life or menopausal (as a general term) are probably less helpful as they are too broad to have clinical usefulness. Menopause, if used in this chapter, refers to the last menstrual period.

Current practice in the UK is to diagnose menopause clinically on the basis of menstrual history and age. However, a number of other methods have been suggested as possible adjuncts or alternatives to a clinical diagnosis.

These definitions derive from the early World Health Organization definitions (WHO 1994), which were elaborated for international use by the International Menopause Society (Utian 1999). Subsequently, USA study teams (Gracia 2005, Harlow 2012) developed a more detailed staging of menopause, referred to as The Stages of Reproductive Aging Workshop (STRAW).

STRAW classification includes additional criteria for defining specific stages of reproductive life. The revised staging system aims to provide a more comprehensive basis for classification and assessment, from the late reproductive stage through the menopausal transition and into postmenopause – this classification was the focus of another review question (see Chapter 6).

5.2. Review question

What is the diagnostic accuracy of the following indicators (clinical and biological manifestations) in the diagnosis of perimenopause and menopause: age, menopausal symptoms (especially vasomotor), endocrine changes (specifically follicle-stimulating hormone, anti-Müllerian hormone, oestrogen or inhibin B) and total antral follicle count?

The aim of this question was to determine the diagnostic accuracy of age, menopausal symptoms, biochemical measurements (follicle-stimulating hormone [FSH], anti-Müllerian [AMH], antral follicle count [AFC], inhibin B, inhibin A, oestrogen) and ultrasound features (ovarian volume) to diagnose perimenopause and postmenopause. These indexes were considered either individually or in combination.

The diagnostic accuracy of these variables to diagnose the menopause is highly dependent upon the background population of women in whom the test has been applied. Therefore the evidence for the different tests investigated is presented against the background population of women.

For full details see the review protocol in Appendix D.

5.3. Description of included studies

Twenty-one studies (Bener 2014, Blümel 2012, Brown 2002, Burger 1998, Chompootweep 1993, Chuni 2011, Cooper 1995, Dennerstein 1993, El Shafie 2011, Giacobbe 2004, Gold 2000, Henrich 2006, Ho 1999, Johnson 2004, Kapur 2009, Maartens 2001, Punyahotra 1997, Shin 2008, Sierra 2005, Stellato 1998, Williams 2008) were identified as meeting the protocol and were included in this review. Six of the studies were in North America, 3 were in South America, 6 were in Asia, 2 were in the Middle East, 3 were in Australasia and 1 was in Europe.

All included studies except 2 (Cooper 1995, Johnson 2004) defined menopause as being when amenorrhoea lasted for 12 or more months. Cooper (1995) used the definition of menopause as when FSH levels were elevated more than 15 IU/litre whereas Johnson (2004) used a consensus-based method using cycle irregularity and levels of serum FSH, luteinizing hormone (LH), oestradiol, oestrone and progesterone.

The definition of premenopause was consistent across the included studies whereas perimenopausal women were classified under different criteria (mainly related to differences in frequency of menstrual cycles).

5.3.1. Studies looking at the diagnostic accuracy of age and menopausal symptoms

Seventeen studies (Bener 2014, Blümel 2012, Brown 2002, Chompootweep 1993, Chuni 2011, Cooper 1995, Dennerstein 1993, El Shafie 2011, Giacobbe 2004, Gold 2000, Ho 1999, Johnson 2004, Kapur 2009, Maartens 2001, Punyahotra 1997, Sierra 2005, Williams 2008) using a questionnaire study design or a case series were included in this section. All studies included premenopausal, perimenopausal and postmenopausal women aged 38 to 65 years. Some of the studies included women with a wider age profile (Shafie 2011) whereas others used a strict age criterion (Maartens 2001). The sample size of the studies also varied considerably from 129 (Kapur 2009) to over 8000 (Blumel 2012, Brown 2002).

A standardised questionnaire (such as the Menopause Rating Scale) was used to assess the prevalence of specific menopausal symptoms and their role in the diagnosis of menopause.

5.3.2. Studies looking at the diagnostic accuracy of biochemical measures

Four studies were included in this section.

Burger (1998) investigated the levels of inhibin A and B in premenopausal, perimenopausal and postmenopausal women aged 48 to 59 years. This study was conducted in Australia and included a subset of 110 women from a larger study (The Melbourne Women’s Mid-Life Health Project, 2004).

Two studies (Stellato 1998, Henrich 2006) looked at the role of FSH in the diagnosis of menopause. Henrich (2006) assessed the usefulness of FSH in determining menopausal status in women participating in the National Health and Nutrition Examination Survey (NHANES). Both studies were conducted in the USA and included premenopausal, perimenopausal and postmenopausal women.

Shin (2008) assessed the usefulness of a variety of hormonal markers (oestradiol, FSH, AMH and inhibin) to determine menopausal status for 144 postmenopausal women aged 50 to 59 years and premenopausal women aged 20 to 49 years.

5.3.3. Studies looking at the diagnostic accuracy of ultrasound features

Giacobbe (2004) assessed the usefulness of age and ovarian ultrasonography, which measured antral follicle count and ovarian volume to diagnose menopausal status. The study included women aged 40 to 55 years in Brazil. Only 2 groups of women were included: postmenopausal women and women who were not yet menopausal (described as premenopausal but including any women who had not had 12 months amenorrhoea, so could be both premenopausal and perimenopausal women).

5.3.4. Studies looking at the diagnostic accuracy of combination tools

One study (Johnson 2004) tested the usefulness of 3 different algorithms for the diagnosis of perimenopause and menopause in 507 women aged 21 to 55 years who were under investigation for suspected myocardial ischaemia. Two of these algorithms were previously developed: a menstrual algorithm (based on menstrual history alone) and a historical algorithm (based on menstrual history, surgical history and age). The third algorithm (hormonal algorithm) was developed as part of this study and was based on menstrual history, surgical history, age and hormone levels (FSH and oestradiol). Premenopausal, perimenopausal and postmenopausal women participated in this study.

5.4. Evidence profiles

Evidence from these studies is summarised in the clinical GRADE evidence profiles (see Appendix I). The study selection flowchart can be found in Appendix F, the study evidence tables in Appendix H, the forest plots in Appendix J and the list of excluded studies in Appendix G.

The accuracy of the different diagnostic tests is dependent on the population of women in whom the test is conducted. For example, the specificity of a given test to distinguish postmenopausal women from a population of perimenopausal and postmenopausal women will be different to the specificity of the test when conducted in a population which also includes premenopausal women. This also changes the positive and negative likelihood ratios. Therefore, separate GRADE tables are presented to reflect the evidence for distinguishing perimenopausal and postmenopausal women from different background populations.

The type of menopausal symptoms was reported differently across the studies and studies also varied in duration. For example, vasomotor symptoms (VMS) were reported as hot flushes, cold sweats, night sweats, palpitations or a combination of these symptoms. Meta-analysis was not conducted and results are reported separately by symptom due to differences in reporting.

Likelihood ratios are reported as the primary measure of diagnostic accuracy. The positive likelihood ratio reports the number of times more likely postmenopausal women are to have that symptom than other women (either premenopausal women, perimenopausal women or both). The higher the value, the more likely it is that a woman with a positive test is menopausal. By convention, a value between 5 and 10 (inclusive) is regarded as moderately useful and a value of greater than 10 and over is very useful. Tests where the likelihood ratios lie close to 1 have little practical significance.

The negative likelihood ratio indicates whether the absence of a sign, age band or endocrine level is a good way of distinguishing a woman who is not menopausal among women who are menopausal. The lower the value, the more likely it is that a woman with a negative test is not menopausal. In this case, the lower the value reported in the GRADE table, the better the test may be to diagnose menopause by ruling out cases that are not menopausal. By convention, a value of less than 0.1 is regarded as very useful and a value of 0.1 to 0.2 (inclusive) is moderately useful. Again, a negative likelihood ratio close to 1 demonstrates that a negative test is equally likely in both menopausal and non-menopausal women.

A summary of the findings is also presented in the following graphs (see Figures 3 to 8) for easier interpretation separately for single and combination tests (green demonstrates a useful test, red not useful and yellow moderately useful).

Figure 3. Single tests for diagnosis of menopause (background population: perimenopause) – results on positive likelihood ratio.

Figure 3

Single tests for diagnosis of menopause (background population: perimenopause) – results on positive likelihood ratio. Note: The red region (ratio of <5) indicates test is not useful. The yellow region (ratio of 5–10) indicates (more...)

Figure 4. Single tests for diagnosis of menopause (background population: perimenopause) – results on negative likelihood ratio.

Figure 4

Single tests for diagnosis of menopause (background population: perimenopause) – results on negative likelihood ratio. Note: The red region (ratio of >0.2) indicates test is not useful. The yellow region (ratio of 0.1–0.2) indicates (more...)

Figure 5. Single tests for diagnosis of menopause (background population: premenopause) – results on positive likelihood ratio.

Figure 5

Single tests for diagnosis of menopause (background population: premenopause) – results on positive likelihood ratio. Note: The red region (ratio of <5) indicates test is not useful. The yellow region (ratio of 5–10) indicates (more...)

Figure 6. Single tests for diagnosis of menopause (background population: premenopause) – results on negative likelihood ratio.

Figure 6

Single tests for diagnosis of menopause (background population: premenopause) – results on negative likelihood ratio. Note: The red region (ratio of greater than 0.2) indicates test is not useful. The yellow region (ratio of 0.1–0.2) indicates (more...)

Figure 7. Single tests for diagnosis of menopause (background population: premenopause plus perimenopause women) - results on positive likelihood ratio.

Figure 7

Single tests for diagnosis of menopause (background population: premenopause plus perimenopause women) - results on positive likelihood ratio. Note: The red region (ratio of <5) indicates test is not useful. The yellow region (ratio of 5–10) (more...)

Figure 8. Single tests for diagnosis of menopause (background population: premenopause plus perimenopause women) – results on negative likelihood ratio.

Figure 8

Single tests for diagnosis of menopause (background population: premenopause plus perimenopause women) – results on negative likelihood ratio. Note: The red region (ratio of >0.2) indicates test is not useful. The yellow region (ratio (more...)

5.5. Evidence statements

Background population perimenopausal women

Low quality evidence from 1 study found that women aged 55 years or older were more likely to be menopausal. However, being aged less than 55 years did not reduce the chances of being menopausal. Distinguishing menopause from perimenopause based on the age criterion alone is not useful if the age cutoff used is 45 years or less or 50 years or less (moderate to low quality evidence).

Moderate to very low quality evidence from several studies which reported VMS (presenting as hot flushes or nights sweats) at different time points (the last 2 weeks, 4 weeks or 12 months) or without a specified time point concluded that the presence of VMS was not a useful tool to distinguish menopause from perimenopause.

One study reported that having a detectable level of inhibin A reduced the chance of being postmenopausal, while having an undetectable level of inhibin A did not increase the chance of being menopausal (moderate quality evidence). Moderate quality evidence for other studies found that no other endocrine tests (FSH or inhibin B) was useful to distinguish menopause from perimenopause.

Background population premenopausal women

Moderate quality evidence from one study reported that if a woman was aged 45 years or more this criterion had no impact on the chances of being peri or menopausal but being aged less than 45 reduced the chances of being menopausal. On the contrary, if a woman was aged 50 to 55 years or more she was more likely to be peri or menopausal and being aged less than 50 reduced the chances of being menopausal (moderate quality evidence). Finally, one study reported that if a woman was aged 60 or more then she was more likely to be menopausal and being aged less than 60 did not reduce the chances of being menopausal.

Moderate to low quality evidence from 2 studies reported that hot flushes and night sweating (over an unspecified time period) increased the chances of being peri or menopausal but having none of these symptoms did not reduce the chances of being menopausal. However, low quality evidence from another 2 studies reported that hot flushes and night sweating at different time points (the last month, or over an unspecified time period) was not useful to distinguish peri or menopause from premenopausal women.

A meta-analysis of 2 studies reported that current hot flushes or night sweats did not increase the chances of being menopausal but having no current hot flushes reduced the chances of being menopausal. The evidence for this finding was of very low quality. The presence of other VMS was not useful to distinguish menopause from premenopause.

Low quality evidence from 1 study showed that rapid heart beating (palpitations) (over an unspecified time period) might increase the chance of being menopausal.

Moderate to very low quality evidence from different studies looking at the diagnostic accuracy of biochemical measures to diagnose menopause found that:

  • an FSH level of more than 22.3 IU/litre increased the chances of being menopausal while a level less than 22.3 IU/litre reduced the chances of being menopausal (low quality evidence)
  • an AMH level of less than 3.57 pmol/ litre increased the chances of being menopausal while a level more than 0.5 nanogram/ml reduced the chances of being menopausal (low quality evidence)
  • an oestradiol level of less than 126.6 pmol/litre increased the chances of being menopausal while a level more than 126.6 pmol/litre reduced the chances of being menopausal (very low quality evidence)
  • a detectable level of inhibin A reduced the chance of being menopausal while having an undetectable level of inhibin A did not increase the chance of being menopausal (moderate quality evidence)
  • an inhibin B level of less than 0.4 nanogram/litre increased the chances of being menopausal while a level more than 0.4 nanogram/litre reduced the chances of being menopausal. The evidence for this finding was of low quality.

Background population all women

Moderate quality evidence reported that if a woman was aged 45 years or more then this had no impact on the chances of being postmenopausal but being aged less than 45 reduced the chances of being menopausal. A meta-analysis of 2 studies reported that if a woman was aged 50 years or more then she was more likely to be postmenopausal but being aged less than 50 did not reduce the chances of being menopausal (very low quality evidence). The same conclusion came from another study which looked at the cut-off points of 55 and 60 years (both were of moderate quality evidence).

A pooled analysis of 2 studies found that current hot flushes or night sweats did not increase the chances of being menopausal but the absence of hot flushes or night sweats reduced the chances of being menopausal. The evidence for this finding was of low quality. The presence of other VMS was not useful in distinguishing postmenopausal women from all other women (moderate to very low quality evidence).

Moderate quality evidence from 1 study found that having a detectable level of inhibin A reduced the chance of being menopausal while having an undetectable level of inhibin A did not increase the chance of being menopausal, whereas inhibin B was found to be not useful to diagnosis menopause.

No ovarian ultrasound features (antral follicle count 2 follicles or less, or ovarian volume less than 4 cm3) were found useful to distinguish menopausal women from all other women (low quality evidence).

Combinations of variables or algorithms

Low to very low quality evidence from 1 study found that all algorithms, either menstrual (classifying women according to the time since their last period – either within 3 months, within 3 to 12 months, or longer than 12 months ago), hormonal (classifying women according to their menstrual history, surgical history, age, FSH and oestradiol levels) or historical (classifying women according to their menstrual history, surgical history and age), allowed for the correct classification of perimenopausal or postmenopausal women.

The following conclusions from single studies were made regarding the usefulness of tools to distinguish perimenopausal women from postmenopausal women:

  • Being aged less than 55 or 60 years may reduce the chances of being perimenopausal but being over 55 did not increase the chance of being perimenopausal (very low quality evidence). No other age groups (less than 45 years or less than 50 years) were useful to distinguish perimenopausal from postmenopausal women.
  • The presence of VMS alone was not useful to distinguish perimenopausal from postmenopausal women (moderate to very low quality evidence).
  • No endocrine tests (inhibin A or inhibin B) were found useful to distinguish perimenopausal from postmenopausal women (moderate quality evidence).

The following conclusions from single studies were made regarding the usefulness of tools to distinguish perimenopausal women from premenopausal women:

  • A woman aged 45 years or more may not have an increased chance of being perimenopausal, but being aged less than 45 reduced the chances of being perimenopausal (moderate quality evidence). The same study also showed that a women aged 55 years or more had an increased chance of being perimenopausal but being aged less than 55 did not reduce the chance of being perimenopausal. No other age groups (42 years or older, 46 years or older, 50 years or older, 60 years or older) were found to be useful to distinguish perimenopausal women from premenopausal women (moderate to very low quality evidence).
  • One or more hot flushes or night sweats per day during the past 6 months may increase the chances of being perimenopausal while the absence of hot flushes or night sweats did not reduce the chances of being perimenopausal (very low quality). The presence of other VMS alone was not found to be useful to distinguish perimenopausal women from premenopausal women (moderate to very low quality evidence).
  • An FSH level of more than 13 IU/litre increased the chances of being perimenopausal but a level below 13 IU/litre did not reduce the chances of being perimenopausal. The evidence for this finding was of low quality. No other endocrine tests (FSH level of 24 IU/litre, inhibin A or inhibin B, AMH, oestradiol) were found to be useful to distinguish perimenopausal women from premenopausal women (moderate to low quality evidence).
  • The presence of at least 1 of a list of symptoms (started HRT when periods became irregular, 1 or more hot flushes/night sweats per day for the past 6 months or last menstrual cycle longer than 60 days) increased the chances of a woman being perimenopausal. However, not reporting any of these symptoms did not reduce the chances of being perimenopausal. The evidence for this finding was of moderate quality.
  • No other combination tests were found to be useful to distinguish perimenopausal women from premenopausal women (moderate quality evidence).

Moderate to very low quality evidence did not find either the presence of VMS symptoms or endocrine tests useful tools to distinguish perimenopausal women from all other women whereas other evidence of moderate quality showed that both a menstrual algorithm (classifying women according to the time since their last period – either within 3 months, within 3 to 12 months, or longer than 12 months ago) and a hormonal algorithm (classifying women according to their menstrual history, surgical history, age, FSH and oestradiol levels) allowed for the correct classification of perimenopausal women.

5.6. Health economics profile

No health economic search was undertaken for this question. The Guideline Development Group’s prior view was that these tests are often performed unnecessarily and that the topic was included in the scope as a potential area for disinvestment.

5.7. Evidence to recommendations

5.7.1. Relative value placed on the outcomes considered

The Guideline Development Group considered all the properties of diagnostic accuracy measurements for decision-making in this topic: sensitivity, specificity, positive and negative likelihood ratio, and area under the curve (AUC). The group considered the relative importance of having a high false positive and high false negative result from the diagnosis of menopause and the consequences in women’s further clinical management.

Likelihood ratios were considered the most critical measures of diagnostic accuracy of different tests for menopause and for the group’s decision-making. The positive likelihood ratio reports the number of times more likely postmenopausal women are to have that symptom than non-menopausal women (either premenopausal women, perimenopausal women or both, depending on the study). The higher the value, the more likely it is that a woman with a positive test is postmenopausal.

Given that women at different stages of menopause (perimenopause or postmenopause) may experience different symptoms and require different types of further management, it was considered important by the group to examine the role of each test to diagnose different stages of menopause in reference to the background population.

5.7.2. Consideration of clinical benefits and harms

Different tests were considered to diagnose perimenopausal or postmenopausal women from different background populations (premenopause, all women). In summary, no indication (age, VMS, biochemical measures, endocrine changes, ultrasound features measuring ovarian volume) when they were examined in isolation were found to accurately discriminate between those women who have positive and negative diagnosis. This was the case when different background populations were taken into consideration. Some indicators, such as age above 55 or 60 years, were found to have useful positive likelihood ratio but not very useful negative likelihood ratio.

On the other hand, algorithms either as combinations of menstrual (classifying women according to the time since their last period – either within 3 months, within 3 to 12 months, or longer than 12 months ago), hormonal (classifying women according to their menstrual history, surgical history, age, FSH and oestradiol levels) and historical (classifying women according to their menstrual history, surgical history and age) allowed for the correct classification of menopausal women from both premenopausal and perimenopausal women.

The group discussed the role of hot flushes in the diagnosis of menopause as these are considered to be one of the principal symptoms that result in visits to a healthcare professional by women around the age of menopause in the UK. The group was surprised that hot flushes did not produce high diagnostic accuracy for menopause as a single measurement. They considered that this may be because this symptom also occurs in a significant number of premenopausal women, so hot flushes are considered together with other indications, such as absent or infrequent menses, to accurately distinguish menopause from premenopause.

The reviewed evidence did not give the group confidence to decide that the diagnosis of menopause should involve the use of biochemical, hormonal tests or an ultrasound test for assessing the function of the uterus as the results did not provide robust evidence for their routine use in diagnosis of menopause. The group concluded that it should be considered adequate to combine age (over 45 years) with amenorrhea for at least 12 months for diagnosis of postmenopause and with oligomenorrohea for the diagnosis of perimenopause. This is currently the routine clinical method of diagnosis of menopause.

The group also highlighted that FSH measurements in the perimenopause cannot be considered precise because FSH levels fluctuate considerably over short periods of time during the years leading up to the menopause (for example varying in the same woman over a period of a few days) and therefore measurements considered in isolation can be unreliable for any diagnosis.

The diagnostic accuracy of FSH as a tool for menopause may also be confounded for those taking hormonal treatment (for example for heavy periods) and the group decided to inform prescribers that FSH levels should not be considered for measurement for this group of women. Many women will experience irregular bleeding or absent menstruation when using hormonal contraception. Some, for example those on injectable progestogens, may also experience menopausal symptoms since they are hypoestrogenic. The group concluded that there is no value in measuring gonadotrophins (LH, FSH) in these women since they will be altered by the hormonal contraceptive. In addition, women on hormone replacement therapy (HRT) will have decreased gonadotrophin levels.

5.7.3. Consideration of economic benefits and harms

Diagnosis carries an opportunity cost, with the resources used for it unavailable for alternative use within the NHS. Therefore, it is important that diagnosis ultimately leads to improved management and outcomes. However, the Guideline Development Group was not persuaded by the clinical evidence alone that there was a place for the routine use of biochemical or hormonal tests, or ultrasound test for uterus function, in diagnosis of menopause. Therefore, it is reasonable to conclude that such tests do not represent an efficient use of scarce NHS resources.

5.7.4. Quality of evidence

The quality of the majority of evidence contributed to this section was moderate to low as assessed by the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2) checklist. The thresholds of measurements were not selected based on clinical considerations but the results reported as per studies. In addition, results on the same test, for example on gonadotropins, may not be directly comparable between studies as there are different assay methods produced by different manufacturers and differences may exist in the interpretation of results based on the reference ranges between these methods. The review of evidence did not make inference on any of the differences in these methods. The studies varied considerably in terms of population characteristics but this is not unusual for diagnostic studies.

5.7.5. Other considerations

The recommendations were based on both the interpretation of clinical evidence reviewed and on the expert opinion of Guideline Development Group members.

The group has discussed the point that the diagnosis of perimenopause would be the only clinically relevant diagnosis with implications for further management among women presenting with any type of menopausal symptoms.

5.7.6. Key conclusions

The Guideline Development Group concluded that:

  • diagnosis of the perimenopause would be the only useful diagnosis clinicians should consider making
  • age and amenorrhea are sufficient clinical indicators for the routine diagnosis of menopause
  • biochemical measurements, hormonal tests and ultrasound tests were not found useful in routine practice of diagnosis of menopause and perimenopause.

5.8. Recommendations

2.

Diagnose the following without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms:

  • perimenopause based on vasomotor symptoms and irregular periods
  • menopause in women who have not had a period for at least 12 months and are not using hormonal contraception
  • menopause based on symptoms in women without a uterus.
3.

Take into account that it can be difficult to diagnose menopause in women who are taking hormonal treatments, for example for the treatment of heavy periods.

4.

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
  • oestradiol
  • antral follicle count
  • ovarian volume.
5.

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.

6.

Consider using a FSH test to diagnose menopause only:

  • in women aged 40 to 45 years with menopausal symptoms, including a change in their menstrual cycle
  • in women aged under 40 years in whom menopause is suspected (see also section 12).
Copyright © 2015 National Collaborating Centre for Women's and Children's Health.
Bookshelf ID: NBK343466

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (4.6M)

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...