From the Research
The gold standard diagnosis for perimenopause is based on clinical symptoms combined with hormone level testing, particularly follicle-stimulating hormone (FSH) and estradiol, as well as menstrual history and age, without relying on laboratory test results alone, as suggested by the most recent study 1.
Diagnosis Criteria
The diagnosis of perimenopause is primarily based on:
- Clinical symptoms such as hot flashes, night sweats, sleep disturbances, and mood changes
- Menstrual history, including irregular menstrual cycles
- Age, as the prior probability of perimenopause is directly related to a woman's age
- Hormone level testing, including FSH and estradiol levels, although these can vary significantly during perimenopause
Importance of Clinical Assessment
A woman is considered perimenopausal when she experiences irregular menstrual cycles and symptoms, along with elevated FSH levels (typically >25 IU/L) and fluctuating estradiol levels. However, it's essential to note that hormone levels can vary significantly during perimenopause, making a single measurement unreliable.
Additional Testing
Additional testing may include:
- Antimüllerian hormone (AMH) levels, which decline as ovarian reserve diminishes
- Thyroid function tests to rule out thyroid disorders that can mimic perimenopausal symptoms
Confirmation of Diagnosis
The diagnosis is ultimately confirmed retrospectively after 12 consecutive months without menstruation, which marks the transition to menopause. Since perimenopause is a natural biological process rather than a disease state, the diagnosis is primarily made to guide symptom management and address health concerns related to hormonal changes, as discussed in 2 and 3.