From the Guidelines
Diagnosing perimenopause involves assessing symptoms such as irregular periods, hot flashes, and night sweats, and considering age, as perimenopause commonly begins in the mid-40s but can start in the 30s. A healthcare provider will primarily evaluate these symptoms, as well as sleep disturbances, mood changes, and vaginal dryness. They will also consider the patient's age and medical history. Laboratory tests are not always necessary but may include measuring follicle-stimulating hormone (FSH) levels, which rise as ovarian function declines, and estradiol levels, though these also vary throughout perimenopause 1. However, FSH testing has limitations because levels can fluctuate significantly during perimenopause.
Diagnostic Criteria
The diagnostic criteria for perimenopause include:
- Irregular periods
- Hot flashes
- Night sweats
- Sleep disturbances
- Mood changes
- Vaginal dryness
- Age, as perimenopause commonly begins in the mid-40s but can start in the 30s
- FSH and estradiol levels in the postmenopausal range, if tested
Limitations of Laboratory Tests
It's essential to note that laboratory tests, such as FSH and estradiol levels, have limitations in diagnosing perimenopause. FSH levels can fluctuate significantly during perimenopause, and estradiol levels also vary throughout this transition 1.
Importance of Symptom Assessment
A thorough symptom assessment is crucial in diagnosing perimenopause. Healthcare providers should evaluate the patient's symptoms, including hot flashes, night sweats, sleep disturbances, mood changes, and vaginal dryness, as well as their age and medical history 1.
Tracking Menstrual Cycles
Tracking menstrual cycles for several months can provide valuable diagnostic information, noting changes in flow, frequency, and duration. This information can help healthcare providers diagnose perimenopause and develop an appropriate treatment plan. Remember that perimenopause is a natural transition rather than a medical condition requiring treatment, though symptom management options are available if needed.
From the Research
Diagnostic Criteria for Perimenopause
The diagnostic criteria for perimenopause are not strictly defined, but several studies provide guidance on the symptoms and signs that may indicate a woman is entering this transition period.
- Menstrual irregularity, defined by changes in the length of the menstrual cycle and/or changes in level of discomfort associated with menses 2
- Hormonal level fluctuations, which may precipitate vasomotor and other symptoms 2, 3
- Symptoms such as hot flashes, night sweats, vaginal dryness, and mood changes 4, 5
- Self-assessment of going through the transition, which can be a useful indicator of perimenopause 5
- High follicle-stimulating hormone levels and low inhibin B levels, which can also be indicative of perimenopause 5
Evaluation and Diagnosis
The evaluation and diagnosis of perimenopause should be based on a combination of factors, including:
- Menstrual history and age 5
- Symptoms and signs, such as those listed above 2, 4, 5
- Laboratory tests, such as follicle-stimulating hormone and inhibin B levels, although these should not be relied upon solely to diagnose perimenopause 5
- Clinical examination and medical history 6, 4
Importance of Individualized Approach
It is essential to take an individualized approach to diagnosing and managing perimenopause, as each woman's experience may vary 6, 3, 4.