The diagnosis of menopause is not always made at the exact moment when it occurs. In fact, most of the time it is confirmed after more than a year has passed ⁽¹⁾.  

Why? Because experts define menopause as the permanent cessation of menstruation. Therefore, to prove that there is a definitive amenorrhea, the physician must confirm that at least 12 months have passed since this event⁽²⁾. 

This is why they consider it a retrospective confirmation. Meaning looking back into the past. Except in cases of surgical menopause ^(1,2,3). 

Diagnosis of menopause by symptoms 

Many women can recognize different stages of menopause by the symptoms they experience. And while the only definite diagnostic sign is the lack of menstruation, the other signs are clues. ⁽⁴⁾. 

In general, in the years prior to the last menstrual period, irregular cycles begin. It is common to experience shorter or longer periods, heavy menstrual periods, or intermenstrual bleeding⁽⁵⁾. 

In fact, you may also notice any of the following symptoms ^(4,5):  

• Trouble sleeping. 

• Mood changes. 

• Changes in skin and hair, like dryness and brittleness. 

• Hot flashes and night sweats. These are sensations of sudden heat with reddening of the skin and excessive sweating. 

• Vaginal dryness. Due to the decrease in estrogen levels, which causes vaginal itching or pain during sexual intercourse. 

All of these symptoms tend to appear after the age of 40. On average, women go through menopause between the ages of 45 and 55 ⁽²⁾. 

In exceptional and less frequent cases, the last menstrual period may occur at a different time. If it occurs before the age of 45, it is called early menopause. On the other hand, it is late menopause when it occurs after the age of 55 years⁽⁶⁾. 

Diagnosis of menopause with laboratory tests 

Your doctor may order laboratory tests to confirm the diagnosis. Although they are not essential, they may be useful in women over 40 years of age with very irregular cycles. Also, if doctors suspect more serious problems with the functions of the uterus or ovaries⁽⁷⁾. 

The most used laboratory tests for the diagnosis of menopause are ^(7,8): 

1. Follicle stimulating hormone or FSH. When estrogens are reduced, the production of this hormone increases in parallel. It is secreted from the pituitary gland. Its elevated concentration is indicative of menopause. 
2. Luteinizing hormone or LH. It is the same with FSH. 
3. Estradiol. Its levels tend to decrease progressively as the woman's years go by. Therefore, low concentration of estradiol in the blood indicates menopause. 

Other important tests to undergo

Beyond the blood tests for the diagnosis of menopause, there are other important medical tests. They are used to assess health issues that may come with this phase.(9). 

The health professional may ask you for the following ^(7,8,10): 

• Bone density scan. At menopause, bone density usually decreases, which increases the risk of osteoporosis and fractures. This test measures that density. 

• Blood cholesterol levels may increase during menopause, raising the risk of cardiovascular disease. It is important to monitor these levels through a laboratory test and take appropriate action. 

• Pap smear. Professionals recommend that you continue with gynecological exams and cervical cancer screening until age 65. 

• Mammography. The older you get, the greater the risk of breast cancer. That's why mammograms are critical for early detection. 

Why is it important to have a diagnosis of menopause ?  

Menopause marks the end of a woman's reproductive function. Confirming that you are in this stage will help you better understand and cope with the changes ⁽²⁾.  

Some associated symptoms are treatable. If your doctor confirms that you are in menopause, they may prescribe some therapies. There are lubricating gels for vaginal dryness and hormone replacement, for example ^(1,9,11). 

For all these reasons, an appointment with a health professional is key if you are experiencing symptoms that concern you. At the consultation, you will be able to confirm the diagnosis of menopause. In addition, you will be able to clear up doubts about what perimenopause is, what postmenopause is, what changes you should make and, above all, how you can receive support. 

Referencias bibliográficas 

1. NHS. Overview menopause [Internet]. National Health System; 2022 [cited 2024 May 10]. Available from: https://www.nhs.uk/conditions/menopause/

2. NHS Cambridge University Hospitals. Menopause: a healthy lifestyle guide [Internet]. NHS Foundation Trust; 2021 [cited 2024 May 10]. Available from: https://www.cuh.nhs.uk/patient-information/menopause-a-healthy-lifestyle-guide/

3. Secoșan C, Balint O, Pirtea L, Grigoraș D, Bălulescu L, Ilina R. Surgically induced menopause—A practical review of literature. Medicina (Kaunas) [Internet]. 2019 [cited 2024 May 10];55(8):482. Available from: https://www.mdpi.com/1648-9144/55/8/482

4. NHS. Symptoms menopause [Internet]. National Health System; 2022 [cited 2024 May 10]. Available from: https://www.nhs.uk/conditions/menopause/symptoms/

5. Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: Signs, symptoms, and management options. J Clin Endocrinol Metab [Internet]. 2021 [cited 2024 May 10];106(1):1–15. Available from: https://academic.oup.com/jcem/article-abstract/106/1/1/5937009

6. Vatankhah H, Khalili P, Vatanparast M, Ayoobi F, Esmaeili-Nadimi A, Jamali Z. Prevalence of early and late menopause and its determinants in Rafsanjan cohort study. Sci Rep [Internet]. 2023 [cited 2024 May 10];13(1):1–8. Available from: https://www.nature.com/articles/s41598-023-28526-y

7. Mayo Clinic. Menopause. Diagnosis and treatment [Internet]. Mayo Clinic; 2023 [cited 2024 May 10]. Available from: https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

8. Eunice Kennedy Shriver National Institute of Child Health and Human Development. How do healthcare providers diagnose menopause? [Internet]. National Institutes of Health; 2021 [cited 2024 May 10]. Available from: https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/diagnosed

9. British Menopause Society. NICE: Menopause, Diagnosis and Management – from Guideline to Practice [Internet]. Women´s Health Concern and British Menopause Society 2022 [cited 2024 May 10]. Available from: https://thebms.org.uk/wp-content/uploads/2022/12/09-BMS-TfC-NICE-Menopause-Diagnosis-and-Management-from-Guideline-to-Practice-Guideline-Summary-NOV2022-A.pdf

10. Peacock K, Carlson K, Ketvertis KM. Menopause [Internet]. StatPearls Publishing; 2023 [cited 2024 May 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507826/

11. NHS. Treatment menopause [Internet]. National Health System; 2022 [cited 2024 May 10]. Available from: https://www.nhs.uk/conditions/menopause/treatment/