From the Guidelines
Menopause testing is not necessary for most women experiencing typical symptoms in their late 40s to early 50s, as diagnosis can be made based on symptoms alone. However, for women under 45 with menopausal symptoms, women with unclear symptoms, or those who've had hysterectomies but still have ovaries, testing may be useful to confirm the diagnosis. The most recent and highest quality study on this topic is not directly provided in the given evidence, but based on general medical knowledge, menopause testing typically involves measuring follicle-stimulating hormone (FSH) levels in the blood, which rise significantly during menopause 1. For a definitive diagnosis, FSH levels above 30 mIU/mL on two tests taken at least one month apart, combined with absence of menstrual periods for 12 consecutive months, confirm menopause. Additional tests may include estradiol levels (which decrease during menopause), anti-Müllerian hormone (AMH), and thyroid function tests to rule out other conditions that mimic menopausal symptoms.
Some key points to consider in menopause testing include:
- Hormone testing should ideally be done during the first few days of the menstrual cycle (if still occurring) for accurate results.
- Testing is most useful for women under 45 with menopausal symptoms, women with unclear symptoms, or those who've had hysterectomies but still have ovaries.
- For most women experiencing typical symptoms in their late 40s to early 50s, testing may not be necessary as diagnosis can be made based on symptoms alone.
- These tests help healthcare providers determine appropriate treatment options, which may include hormone replacement therapy or other interventions to manage symptoms.
It's also important to note that the American Cancer Society provides guidelines for cancer screening in women, including those related to menopause, but these guidelines do not directly address the diagnosis of menopause itself 1. Other studies and guidelines, such as those from the European Society for Medical Oncology, provide more specific guidance on assessing and managing menopausal symptoms after breast cancer 1. However, the primary focus of these guidelines is on managing symptoms and treating related conditions rather than on the diagnosis of menopause.
From the Research
Menopause Testing
- Menopause is typically confirmed by follicle-stimulation hormone (FSH) and E2 tests, as well as clinical and medical examination and history 2
- Mammography is a necessary test for malignancy exclusion, and assessment of lipid metabolism is also important 2
- Pap smear is not as important for postmenopausal women, especially if cervical cancer is rare in the population, and pelvic sonography is not a decisive diagnostic tool for ruling out malignancy 2
Diagnosis of Menopausal Symptoms
- Menopausal symptoms can be diagnosed through a thorough medical history and physical examination, as well as various assessment tools such as vaginal pH, vaginal dilators, and imaging 3
- Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires 3
- Other conditions that can cause dyspareunia in postmenopausal women include hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse 3
Treatment Options
- Hormone therapy (HT) is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause 4, 5, 6
- Non-hormonal options for treating menopausal symptoms include selective serotonin reuptake inhibitors (SSRIs), selective noradrenergic reuptake inhibitors (SNRIs), and gabapentin 4, 5
- Treatment options for dyspareunia in postmenopausal women include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments 3