What tests confirm a woman has attained menopause (perimenopause cessation)?

From the Guidelines

A woman is considered to have attained menopause if she has gone 12 consecutive months without a menstrual period in the absence of other causes, and blood tests such as follicle-stimulating hormone (FSH) levels can help confirm menopause status. According to the study 1, menopause is generally the permanent cessation of menses, and includes a profound and permanent decrease in ovarian estrogen synthesis. The study suggests that reasonable criteria for determining menopause include prior bilateral oophorectomy, age ≥60 years, or age <60 years and amenorrhea for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, and FSH and estradiol in the postmenopausal range.

Key Points to Consider

• The clinical presentation is usually sufficient for diagnosis in women over 45 with typical menopausal symptoms, and hormone level tests are generally unnecessary in this population.
• For women under 45 with menopausal symptoms, or those who've had a hysterectomy but still have ovaries, blood tests such as FSH, estradiol, and anti-Müllerian hormone (AMH) levels can be useful in confirming menopause status.
• Hormone levels can fluctuate during perimenopause, so a single test may not be definitive, and multiple tests over time may be necessary for an accurate diagnosis.
• Other hormones like luteinizing hormone (LH) and inhibin B may be tested but are less commonly used.

Important Considerations

• The study 1 emphasizes the importance of considering the clinical context and medical history when evaluating menopause status, rather than relying solely on laboratory tests.
• The criteria for determining menopause outlined in the study 1 provide a useful framework for clinicians to evaluate menopause status in their patients.

From the Research

Diagnosis of Menopause

To confirm if a woman has attained menopause, several tests and criteria can be considered:

• A clinical diagnosis is made retrospectively, based on a 12-month period of consecutive amenorrhoea in a compatible age group (after 45 years of age) 2
• No hormonal dosage or imaging is indicated to make a diagnosis of menopause in a classic situation 2
• In women using hormonal contraception, hormonal assays or pelvic ultrasound are neither recommended to make a diagnosis of menopause nor to decide to stop contraception 2

Laboratory Criteria for Menopause

Some laboratory criteria that can be used to evaluate menopause in women include:

• Follicle-stimulating hormone (FSH) levels: a level of FSH ≥ 40 can be a diagnostic orientation towards menopausal status, especially in women with a history of hysterectomy 2
• Estradiol levels: low estradiol (<20pg/ml) can be used in combination with FSH levels to diagnose menopause 2, 3
• FSH:LH ratio: a ratio > 1 can be a more appropriate marker of menopause in women using oral contraceptives 3

Special Considerations

In certain situations, the diagnosis of menopause can be more complex:

• Women with a history of hysterectomy: a repeat FSH ≥ 40 combined with low estradiol (<20pg/ml) at least 3 months after the procedure could be a diagnostic orientation towards menopausal status 2
• Women who have received gonadotoxic treatment: the classic clinical criteria of 12 months of amenorrhea cannot be used to make a diagnosis of menopause with certainty 2