What are the diagnostic criteria for menopause?

Diagnosing Menopause According to NICE CKS Guidelines

Menopause is clinically diagnosed after 12 consecutive months of amenorrhea in women of appropriate age (typically 40-60 years), with supportive evidence from FSH levels >40 IU/L and estradiol levels <30 pg/mL, along with characteristic symptoms. 1

Diagnostic Criteria

The diagnosis of menopause relies primarily on clinical criteria rather than laboratory testing:

Primary Diagnostic Criteria

• Amenorrhea for ≥12 months (the gold standard definition) 1
• Age ≥60 years (presumptive diagnosis even without other criteria) 1

Supporting Laboratory Evidence

• FSH levels >40 IU/L (supportive but not diagnostic alone) 1
• Estradiol levels <30 pg/mL 1

Clinical Symptoms Supporting Diagnosis

• Vasomotor symptoms (hot flashes/night sweats) 2, 1
• Vaginal dryness 2, 1
• Sleep disturbances 1
• Mood changes 1
• Cognitive changes 1
• Sexual dysfunction 2
• Urinary complaints 2
• Arthralgias/myalgias 2
• Fatigue 2

Diagnostic Algorithm

1. Assess age and menstrual history

   • Women aged 45-60 with 12 months of amenorrhea: diagnose menopause without testing
   • Women aged 40-45 with menopausal symptoms and amenorrhea: consider FSH testing
   • Women <40 with symptoms: investigate for premature ovarian insufficiency

2. Laboratory testing (when indicated)

   • FSH testing is supportive evidence, not the sole diagnostic criterion 1
   • Consider thyroid function tests to rule out thyroid disease that may mimic menopausal symptoms 1
   • Complete blood count, liver and renal function tests to exclude other conditions 1

3. Symptom assessment

   • Hot flashes provide strong supporting evidence (positive likelihood ratio 2.15-4.06) 3
   • Night sweats (positive likelihood ratio 1.90) 3
   • Vaginal dryness (positive likelihood ratio 1.48-3.79) 3
   • Self-assessment of "going through the transition" has diagnostic value (positive likelihood ratio 1.53-2.13) 3

Important Considerations

Perimenopause vs. Menopause

• Perimenopause (menopausal transition) precedes final menstruation by several years 4
• Characterized by irregular periods and fluctuating hormone levels 5
• Women may experience menopausal symptoms during perimenopause 4
• No single symptom or test is accurate enough by itself to diagnose perimenopause 3

Common Pitfalls to Avoid

• Don't rely solely on FSH levels for diagnosis, as they can fluctuate significantly during perimenopause 1, 3
• Don't dismiss fertility potential during perimenopause - ovulatory cycles can still occur even after FSH levels reach postmenopausal range 1
• Don't overlook other conditions that may mimic menopausal symptoms (thyroid disease, diabetes) 1
• Don't assume all women experience the same symptoms - menopausal experience varies widely based on ethnic, psychological, and socio-cultural factors 6

Special Populations

• Women with premature menopause (before age 40) require additional evaluation 1
• Cancer survivors may experience treatment-induced menopause with similar symptoms 2
• Women with primary ovarian insufficiency may still have unpredictable ovarian function 1

Remember that the diagnosis of menopause is primarily clinical, based on the absence of menstruation for 12 consecutive months in women of appropriate age, with laboratory tests serving as supportive evidence rather than definitive diagnostic tools.