Diagnosis of menopause

Diagnosis of menopause is usually clinical, based on the menstrual bleeding pattern, presence of menopausal symptoms and age. An algorithm to help establish menopausal status is available in A Practitioner’s Toolkit for the Management of the Menopause from the Australian Menopause Society website.

Assessment of hormone concentrations is not routinely required for diagnosis of menopause in individuals older than 45 years. Serum follicle stimulating hormone (FSH) and estradiol concentrations may be useful for the diagnosis of menopause if menstrual bleeding patterns cannot be interpreted (eg in individuals who have had a hysterectomy or endometrial ablation, or who have amenorrhoea induced by progestogen-only contraception). These tests also form part of the assessment of younger individuals with secondary amenorrhoea, which may be caused by premature ovarian insufficiency or early menopause.

Measurement of anti-Mullerian hormone (AMH) concentration is not currently recommended except by a specialist because of cost, and the variable sensitivity in diagnosing menopause.

Serum FSH and estradiol concentrations should not be measured if estrogen-containing hormone therapy (eg menopausal hormone therapy [MHT], combined hormonal contraception) has been taken in the preceding 4 weeks. Serum FSH and estradiol concentrations are not affected by progestogen-only contraception except for depot medroxyprogesterone.